Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-05-01063/USCOURTS-ca8-05-01063-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 

---

1

The Honorable Joan N. Ericksen, United States District Judge for the District

of Minnesota.

 United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 05-1063

___________

Susan J. Johnson, *

*

Appellant, *

* Appeal from the United States

v. * District Court for the

* District of Minnesota.

Metropolitan Life Insurance Company, *

*

Appellee. *

___________

Submitted: November 18, 2005

Filed: February 15, 2006

___________

Before WOLLMAN, LAY, and MELLOY, Circuit Judges.

___________

WOLLMAN, Circuit Judge.

Susan Johnson sued Metropolitan Life Insurance Co. (MetLife) for denying her

claim for long-term disability benefits. The district court1

 granted MetLife’s motion

for summary judgment, and we affirm.

Appellate Case: 05-1063 Page: 1 Date Filed: 02/15/2006 Entry ID: 2010125
-2-

I.

Johnson worked for Wells Fargo as an accounting clerk. Her job duties

required five to six hours of fine finger dexterity per day, sitting for five to six hours

per day, three to four hours of walking per day, occasionally lifting up to ten pounds,

continual interpersonal relationships, occasional stressful situations, and clerical duties

to reconcile internal bank accounts. Johnson asserts that her duties also included

performing substantial computer work, opening approximately a hundred pieces of

mail per day, handwriting information, and regularly lifting boxes in excess of twenty

pounds.

In 1995, Johnson began suffering from pain and stiffness in her hands and feet.

In October 2000, her treating physician, William D. Fox, M.D., diagnosed Johnson

with rheumatoid arthritis. For this, Johnson received intermittent short-term disability

benefits from October 30, 2000, through January 25, 2002, under her Employee

Retirement Income Security Act (ERISA) benefit plan. Thereafter, Johnson continued

to complain of pain and stiffness. Dr. Fox and another treating physician, Asim Khan,

M.D., a rheumatologist, diagnosed Johnson with rheumatoid arthritis even though she

had no active synovitis, a common symptom of rheumatoid arthritis. Dr. Fox stated

that Johnson was unable to work any type of schedule and recommended long-term

disability benefits. Dr. Khan stated that Johnson’s points of tenderness were also

consistent with fibromyalgia, but he further observed that there was no synovitis in

Johnson’s wrist joints and that she had good grip in her hands. Dr. Khan noted that

he was concerned that Johnson might be complaining of pain because she wanted

disability benefits. Dr. Fox did not share Dr. Khan’s concern, and on March 8, 2003,

he diagnosed Johnson as likely having fibromyalgia in addition to rheumatoid

arthritis. 

Johnson applied to MetLife, her plan administrator, for long-term disability

benefits. On March 21, 2002, MetLife sent Johnson’s file to Jefrey D. Lieberman,

Appellate Case: 05-1063 Page: 2 Date Filed: 02/15/2006 Entry ID: 2010125
-3-

M.D., board-certified in internal medicine and rheumatology, for an independent

review. Dr. Lieberman concluded that Johnson should be able to perform her job

functions because she had no active synovitis or joint abnormality or erosions to

indicate debilitating rheumatoid arthritis. Further, he determined that Johnson’s

complaints of tender spots “all over her body,” instead of in a defined region, were

inconsistent with a diagnosis of fibromyalgia. Admin. R. at 161. On March 27, 2002,

MetLife denied Johnson’s claim for long-term disability benefits, stating that her file

did not support a condition so significant or severe that it would preclude her from

performing her job.

On March 25, 2002, Dr. Khan concluded that Johnson had rheumatoid arthritis

and fibromyalgia. The following month, Dr. Fox reiterated that Johnson suffered from

both rheumatoid arthritis and fibromyalgia, noting that he observed some synovitis in

her wrist area. On May 8, Dr. Fox diagnosed Johnson as having rheumatoid arthritis,

polyarthritis, and fibromyalgia. Dr. Fox listed Johnson’s restrictions as an inability

to walk for any distance or stand for more than half an hour at a time without

significant pain. On June 25, Dr. Khan indicated that Johnson probably had

fibromyalgia, myofascial pain syndrome, and polyarthralgias. He did not find any

evidence of synovitis, however, and he noted that he would be reluctant to extend

Johnson’s disability benefits but would defer to Dr. Fox on the question of whether

Johnson was actually disabled. On July 1, Johnson’s bone scan came back normal.

MetLife continued to deny Johnson long-term disability benefits.

On September 16, 2002, Tracey Schmidt, M.D., board-certified in internal

medicine and rheumatology, reviewed Johnson’s updated file at MetLife’s request.

Agreeing with Dr. Lieberman, Dr. Schmidt concluded that Johnson’s file lacked

objective evidence of a “physical functional capacity impairment” past January of

2002, when her short-term disability benefits were terminated. Admin. R. at 206.

Based on this, MetLife sent its final denial letter to Johnson on September 17, 2002,

stating that “[s]elf-reported, subjective complaints, without supporting objective

Appellate Case: 05-1063 Page: 3 Date Filed: 02/15/2006 Entry ID: 2010125
-4-

medical findings of documented functional impairment, are insufficient to provide

proof of disability.” Admin. R. at 209. 

Johnson sued MetLife for denying her claim for long-term disability benefits.

The district court granted MetLife’s motion for summary judgment and dismissed

Johnson’s case with prejudice.

II.

We review de novo the district court’s grant of summary judgment. Aviation

Charter, Inc. v. Aviation Research Group/US, 416 F.3d 864, 868 (8th Cir. 2005).

Summary judgment is proper if there are no disputed issues of material fact and the

moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(c);

Aviation Charter, Inc., 416 F.3d at 868. We view the evidence and inferences that

may reasonably be drawn from the evidence in the light most favorable to the

nonmoving party. Aviation Charter, Inc., 416 F.3d at 868. 

Johnson argues that MetLife erred in requiring objective medical evidence of

her disability before it would grant her claim for long-term disability benefits.

Johnson contends that this constituted a procedural irregularity, compelling the

application of a standard of review less deferential than the ordinary abuse of

discretion standard utilized in ERISA claims. See Woo v. Deluxe Corp., 144 F.3d

1157, 1160-61 (8th Cir. 1998). Johnson also argues that, even if the abuse of

discretion standard of review applies, the lack of objective evidence was an arbitrary

and capricious ground for denying her claim for benefits. Cf. Schatz v. Mut. of

Omaha Ins. Co., 220 F.3d 944, 946 n.4 (8th Cir. 2000) (equating abuse of discretion

review with arbitrary and capricious review). We disagree.

In determining whether a plan administrator committed a procedural

irregularity, we examine whether the administrator labored under a conflict of interest,

Appellate Case: 05-1063 Page: 4 Date Filed: 02/15/2006 Entry ID: 2010125
-5-

whether the administrator acted dishonestly or from an improper motive, or whether

the administrator’s benefit decision “was made without reflection or judgment, such

that it was ‘the product of an arbitrary decision or the plan administrator’s whim.’”

Pralutsky v. Metro. Life Ins. Co., No. 04-2409, slip op. at 8, 2006 WL 130935 at *5

(8th Cir. Jan. 19, 2006) (quoting Buttram v. Cent. States, Southeast & Southwest

Areas Health & Welfare Fund, 76 F.3d 896, 900 (8th Cir. 1996)). This is not a case

where conflict of interest, dishonesty, or improper motive contributed to the

administrator’s decision. Nor is it a case where the plan administrator failed to inquire

into the relevant circumstances at issue. This is instead a case similar to Pralutsky v.

Metropolitan Life Insurance Co., in which the dispute concerns whether the

administrator reasonably interpreted the plan to require objective medical evidence to

prove the claimant’s disability. Id. at 8-9, *5. Therefore, ordinary abuse of discretion

review is appropriate here. See id.

The evidence a plan administrator may require to prove disability benefit claims

depends on the terms of the plan and the circumstances of the case. See id. at 9-10,

*5; House v. Paul Revere Life Ins. Co., 241 F.3d 1045, 1048 (8th Cir. 2001).

Generally, “[i]t is not unreasonable for a plan administrator to deny benefits based

upon a lack of objective evidence.” McGee v. Reliance Standard Life Ins. Co., 360

F.3d 921, 925 (8th Cir. 2004); accord Hunt v. Metro. Life Ins. Co., 425 F.3d 489, 491

(8th Cir. 2005) (per curiam). Johnson’s benefit plan requires that she “provide

documented proof” of her disability, which includes, but is not limited to, the date,

cause, and prognosis of her disability. Admin. R. at 034. This language resembles the

terms of the plan at issue in Pralutsky, in which we held that it was reasonable for the

administrator to interpret the plan to require objective evidence as part of the proof

and documentation that a claimant was required to submit. Slip op. at 10, 2006 WL

130935 at *5. The terms of Johnson’s plan may similarly be reasonably construed to

require objective evidence of her disability to support her claim for long-term

disability benefits. Cf. House, 241 F.3d at 1048 (determining that the terms of the

Appellate Case: 05-1063 Page: 5 Date Filed: 02/15/2006 Entry ID: 2010125
-6-

plan in question did not support the administrator’s demand for objective medical

evidence). 

The circumstances of this case also indicate that Metlife was reasonable in

requesting objective evidence of Johnson’s disability. Johnson argues that a claimant

cannot proffer objective evidence of fibromyalgia because it is an elusive disease. In

Brosnahan v. Barnhart, however, we noted that trigger-point findings consistent with

fibromyalgia constitute objective evidence of the disease. 336 F.3d 671, 678 (8th Cir.

2003); see also Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d

914, 919 (7th Cir. 2003) (explaining that fibromyalgia can be diagnosed “more or less

objectively” by the tender-points test). Therefore, this is not the type of case

contemplated in Pralutsky in which “objective evidence simply cannot be obtained,

and it would be unreasonable for an administrator to demand the impossible.” Slip

op. at 9, 2006 WL 130935 at *5. Moreover, Johnson’s file also lacks evidence that

any alleged ailments precluded Johnson from performing her job. In Pralutsky, we

determined that the plan administrator could require objective evidence of a disability,

even when the claimant’s alleged disability stemmed from fibromyalgia, so long as

the administrator notified the claimant that her file lacked the required objective

evidence. See id. at 10-12, 2006 WL 130935 at *6-*7. Here, when MetLife first

denied Johnson’s claim for long-term disability benefits, it informed her that the

evidence in her file did not support a condition that was so significant or severe that

it would preclude her from performing her job. Taking into account this notification,

MetLife was reasonable in requiring some objective evidence of Johnson’s disability.

Based upon the evidence in Johnson’s file, MetLife was also reasonable in

denying Johnson’s claim for long-term disability benefits. When there is a conflict

of opinion between a claimant’s treating physicians and the plan administrator’s

reviewing physicians, the plan administrator has discretion to deny benefits unless the

record does not support denial. Coker v. Metro. Life Ins. Co., 281 F.3d 793, 799 (8th

Cir. 2002). Here, both of the independent physicians reviewing Johnson’s file

Appellate Case: 05-1063 Page: 6 Date Filed: 02/15/2006 Entry ID: 2010125
-7-

concluded that she was not disabled so as to require long-term disability benefits.

This case is analogous to Hunt v. Metropolitan Life Insurance Co., in which we

affirmed the district court’s grant of summary judgment and held that the plan

administrator did not abuse its discretion in denying benefits. 425 F.3d at 490-91; see

also Coker, 281 F.3d at 799 (holding that providing only subjective medical opinions,

which were unsupported by objective medical evidence, did not suffice to prove a

claim for benefits). In Hunt, the claimant complained of fatigue, mental confusion,

loss of memory, anxiety attacks, and depression. 425 F.3d at 491. The claimant’s

treating physicians diagnosed her with Restless Legs Syndrome and stated that this

rendered her totally disabled. Id. The plan administrator’s reviewing physicians,

however, disagreed and stated that “until we have objective evidence of impairment

. . . we cannot consider the patient to be impaired on the basis of evidence in our file.”

Id. We held that the administrator was entitled to rely on the opinions of its two

reviewing physicians and affirmed the district court’s grant of summary judgment in

the administrator’s favor. Id. Here, Johnson’s subjective, uncorroborated complaints

of pain constituted the only evidence of her ailments. All of the objective medical

evidence in the record, including a bone scan, a grip test, and a tender-points test,

indicates that she did not suffer from rheumatoid arthritis or fibromyalgia to the extent

that they rendered her disabled. As noted above, even one of Johnson’s own treating

physicians, Dr. Khan, suspected that Johnson was exaggerating her symptoms in an

attempt to qualify for long-term disability benefits. Accordingly, substantial evidence

supported MetLife’s decision denying Johnson long-term disability benefits.

The judgment is affirmed.

_____________________________

Appellate Case: 05-1063 Page: 7 Date Filed: 02/15/2006 Entry ID: 2010125