In Eberle v. Am. Elec. Power Sys. Long-Term Disability Plan, No. 21-4224, 2022 WL 5434559 (6th Cir. Oct. 7, 2022), Plaintiff Diane Eberle filed an appeal challenging the district court’s order finding that the defendant American Electric Power System Long-Term Disability Plan (“the Plan”), as administered by Prudential Insurance Company of America, did not abuse its discretion in denying Eberle long-term disability benefits under the Plan’s “any occupation” definition of disability based on her lower-back pain. In an unpublished opinion, the Sixth Circuit affirmed the district court’s grant of judgment to the Plan.
The court explained that “the Plan required Eberle to provide ‘objective medical information’ establishing that she was unable to perform ‘the duties of any occupation’ she was ‘reasonably qualified’ for.” Though Eberle had a significant history of back and leg pain, the court noted that it was based mostly on subjective pain complaints. Her treating doctors did not cite to objective medical evidence such as medical tests to support their opinion that Eberle was at least partially disabled. The claims record did contain Eberle’s electromyography test results and her MRI and CT scans, which the court found did not reveal any “acute” findings. This is despite that one record noted that Eberle had “severe facet degenerative changes” in her L5-S1 vertebrae. Prudential had Eberle’s record reviewed by two doctors, Drs. Todd Graham and Phillippe Chemaly, who both concluded that the objective evidence did not show that Eberle was disabled from full-time work. The court rejected Eberle’s argument that the reviewers made improper credibility determinations by discounting her complaints of pain. Instead, the court explained the reviewers focused on the objective evidence, as required by the Plan. The court found that the medical reviews constituted substantial evidence supporting Prudential’s claim decision.
Lastly, the court found that Prudential did engage in a deliberate principled reasoning process despite not having Eberle evaluated in person. While the failure to conduct a physical exam may raise questions about the thoroughness and accuracy of the benefits determination, reliance on a file review alone does not lead to the conclusion that the claims administrator acted improperly. The court concluded that Prudential’s process for reviewing Eberle’s LTD claim was not arbitrary and capricious.
*Please note that this blog is a summary of a reported legal decision and does not constitute legal advice. This blog has not been updated to note any subsequent change in status, including whether a decision is reconsidered or vacated. The case above was handled by other law firms, but if you have questions about how the developing law impacts your ERISA benefit claim, the attorneys at Roberts Disability Law, P.C. may be able to advise you so please contact us.
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