Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-5_04-cv-05305/USCOURTS-arwd-5_04-cv-05305-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1001 E.R.I.S.A.: Employee Retirement

---

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

FAYETTEVILLE DIVISION

DONALD HOLMAN PLAINTIFF

v. Civil No. 04-5305

HARTFORD LIFE AND ACCIDENT

INSURANCE COMPANY DEFENDANT

O R D E R

Now on this 6th day of November, 2006, the captioned matter

comes on for review, and from the Administrative Record, and the

briefs of the parties, the Court finds and orders as follows:

1. Plaintiff Donald Holman (“Holman”) is a participant in

a Voluntary Long Term Disability Plan (the “Plan”) provided by his

employer, Tyson Foods, Inc., and insured by Hartford Life and

Accident Insurance Company (“Hartford”). Holman was found

eligible for disability benefits under the Plan, but later

terminated, and now appeals the termination decision.

2. The parties agree that the Plan is governed by the

provisions of the Employee Retirement Income Security Act

(“ERISA”). Denial of ERISA benefits is “reviewed on a de novo

standard unless the benefit plan gives the administrator or

fiduciary discretionary authority to determine eligibility for

benefits or to construe the terms of the plan.” Firestone Tire &

Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). If the

administrator has discretionary authority, its eligibility

decisions are reviewed for abuse of that discretion. Groves v.

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Metropolitan Life Insurance Co., 438 F.3d 872 (8th Cir. 2006).

The Plan here provides that disability benefits become

payable when, among other things, the participant “submit[s] proof

of loss satisfactory to The Hartford.” It also provides that “The

Hartford reserves the right to determine if your proof of loss is

satisfactory.” These types of provisions have been held

sufficient to give the claims administrator discretionary

authority to determine eligibility, Ferrari v. Teachers Ins. and

Annuity Ass’n, 278 F.3d 801 (8th Cir. 2002), and the Court will,

therefore, review Hartford’s benefits decisions for abuse of

discretion. 

The abuse of discretion standard has been described as

follows:

In applying an abuse of discretion standard, we must

affirm if a reasonable person could have reached a

similar decision, given the evidence before him, not

that a reasonable person would have reached that

decision. A reasonable decision is fact based and

supported by substantial evidence. We may consider both

the quantity and quality of evidence before a plan

administrator. And we should be hesitant to interfere

with the administration of an ERISA plan.

Groves, 438 F.3d 872, 875 (internal citations and quotation marks

omitted).

“Substantial evidence” is “more than a scintilla but less

than a preponderance.” Leonard v. Southwestern Bell Corp.

Disability Income Plan, 341 F.3d 696, 701 (8th Cir. 2003).

Although abuse of discretion review puts a heavy burden on a

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participant whose benefits have been terminated, it does not

amount to “rubber-stamping the result.” A termination decision

must be reasonable, i.e., “supported by substantial evidence that

is assessed by its quantity and quality.” Torres v. UNUM Life

Insurance Co. of America, 405 F.3d 670, 680 (8th Cir. 2005). 

3. With the foregoing principles in mind, the Court has

examined the Administrative record, from which it has derived the

following relevant facts:

* Holman was employed for sixteen years by Tyson Foods,

Inc., as a maintenance technician, repairing plant

machinery. He is in his 60's and has a tenth grade

education.

* Holman was a participant in Tyson’s Voluntary Long Term

Disability Plan (the “Plan”), which was insured under

Hartford’s Group Insurance Policy GLT-43193 (the

“Policy”). Hartford is both the insurer and the claims

fiduciary for the Plan.

* Page 2 of the Plan Booklet-certificate states that

“[t]his plan which you have purchased is designed to

help you protect your greatest asset, your ability to

earn an income.” Page 4 states that “[t]his plan of Long

Term Disability Insurance provides you with income

protection if you become disabled.”

* The Plan pays disability benefits if a participant

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becomes “Totally Disabled” while insured; remains

Totally Disabled throughout and beyond the Elimination

Period; is under the “Regular Care of a Physician”; and

submits “proof of loss satisfactory to The Hartford.” 

* Benefits under the Plan accrue “as of the first day

after the Elimination Period,” and cease on the

occurrence of one of six defined events. The relevant

event, for our purposes, is “the date you are no longer

Disabled.”

* The “Elimination Period” is described as “the period of

time you must be Totally Disabled before benefits become

payable. It is the first 3 consecutive months of any

one period of Total Disability.”

* Insofar as relevant to Holman’s case, the Plan defines

“Totally Disabled” to mean that during the Elimination

Period and for the next twelve months, the participant

is “prevented by . . . sickness . . . from performing

the essential duties of your occupation” (the “own

occupation” test). After that, a participant is Totally

Disabled if he is “prevented from performing the

essential duties of any occupation for which you are

qualified by education, training, or experience” (the

“any occupation” test).

* In April, 2000, Holman began to notice headaches and

Case 5:04-cv-05305-JLH Document 9 Filed 11/06/06 Page 4 of 28 PageID #: <pageID>
Stedman’s Medical Dictionary, 26th edition (the source of all medical definitions 1

in this opinion) defines Arnold-Chiari malformation as “malformed posterior fossa

structures resulting from caudad traction and displacement of the rhombencephalon caused

by tethering of the spinal cord.” The rhombencephalon is a part of the brain.

A medical explanation of the condition from Robert I. Grossman & David M. Yousem,

Neuroradiology: The Requisites 436 (2003) is cited in Lawson v. U.S., --- F.Supp. ---

2006 WL 2819833 (D.Md. 2006), to-wit: “This congenital abnormality is characterized by

the underdevelopment of the bone at the base of the skull (posterior cranial fossa) and

overcrowding of the normally developed hindbrain. As a result of the underdevelopment

of the posterior cranial fossa and overcrowding of the hindbrain, individuals with this

abnormality have a larger than normal opening at the base of the skull (foramen magnum),

which permits the hindbrain/cerebellar tonsils to protrude, or herniate, into the spinal

canal. The herniation of the hindbrain happens at birth or shortly thereafter. In its

pure form, a Chiari I malformation shows the cerebellar tonsils down to the C1-C2

region, with normal brain stem location.”

The cerebellar tonsils are portions of the undersurface of the cerebellum. 2

The opening at the base of the skull through which “the spinal cord becomes 3

continuous with the medulla oblongata.”

This letter was dictated by Robert Strang, M.D., but it is clear that Dr. Strang 4

was reporting the findings of Dr. Al-Mefty.

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blurred vision. He consulted Vincent Runnels, M.D., a

neurosurgeon, on April 24, 2000.

* On May 1, 2000, Holman underwent a cranial MRI, as a

result of which he was diagnosed with a “Chiari

malformation , with 1 cm of cerebellum tonsil 1 2

herniation through the foramen magnum .” 3

* Dr. Runnels referred Holman to Ossama Al-Mefty, M.D., a

neurosurgeon with special expertise in treating ArnoldChiari malformations. On August 28, 2000, Dr. Al-Mefty4

wrote Dr. Runnels, reporting that an MRI of Holman’s

head “reveals evidence of a Chairi I malformation with

tonsils herniated down to the C1 arch.” Dr. Al-Mefty

wanted Holman to obtain an MRI of his cervical spine.

The letter reported that Holman “feels that he is

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Rhythmical oscillation of the eyeballs. 5

A type of nystagmus occurring with lesions of the lower part of the brainstem or 6

cerebellum.

While the significance of this finding is unclear, Hartford associated it (in a 7

file review dated 1/27/03) with the Arnold-Chiari malformation.

Atrophy refers to a wasting of tissues or organs. 8

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relatively asymptomatic at this point. His biggest

problem right now is the headaches.” The letter noted

“nystagmus with left lateral gaze and 1-2 beats of down 5

beat nystagmus ,” and “mild unsteadiness with tandem 6

gait .” Dr. Al-Mefty discussed the surgical procedure, 7

“Chiari decompression,” with Holman, who “wishes to

think about this before he makes a decision regarding

surgery.”

* On May 14, 2001, Holman underwent a cervical spine MRI.

It was reported as showing “a Type I Arnold Chiari

malformation” with “mild cortical atrophy .” 8

* On May 15, 2001, Dr. Runnels wrote a “To Whom It May

Concern” letter stating that Holman “is under my

professional care and should remain off work until

further notice. I am sending him to Little Rock to see

Dr. Al-Mefty for possible brain and cervical surgery.”

* May 16, 2001, was Holman’s last day to work at Tyson.

* Following a consultation with Holman on May 17, 2001,

Dr. Runnels completed an Attending Physician’s Statement

(“APS”), noting that Holman’s primary diagnosis was

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The Court agrees with the Hartford claims examiner who stated, in a May 29, 2003, 9

entry in the Summary Detail Report, that Dr. Runnels “apparently . . is only trying to

communicate that he considers Mr. Holman disabled from his Arnold-Chiari rather than

that he has psychiatric problem [sic], which are not otherwise noted.”

The Court believes this is a reference to Kyle Hardy, M.D., who did the pulmonary 10

work-up to determine if Holman was a candidate for surgery.

Headaches in the back of the head. 11

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Arnold-Chiari malformation, referencing “my dictated

summary,” and stating that Holman was “disabled,

possibly permanently!” In the section of the form

asking for patient ability to perform such functions as

walking, sitting, lifting, etc., Dr. Runnels noted “the

patient would need to have a functional capacity

evaluation to determine these answers.” In the area of

the form dealing with psychiatric impairment, Dr.

Runnels checked the box beside the statement “Major

impairment in several areas - work, family relations.

Avoidant behavior, neglects family, is unable to work.”9

* On May 18, 2001, Dr. Runnels wrote Dr. Al-Mefty, noting

that he had been following Holman for his Arnold-Chiari

malformation, and that Holman had “seen Dr. Kyle who 10

did not want to operate at this time.” Dr. Runnels

stated that as of May 8, 2001, Holman “was still

complaining of occipital headache, which radiates to 11

his forehead. He has numbness in his thumb and next two

fingers. He notes spells of decreased vision although

I could not detect anything on my examination.” Dr.

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Runnels suggested obtaining cranial and cervical MRIs to

refine the diagnosis.

* On May 21, 2001, Dr. Runnels wrote Dr. Al-Mefty, stating

that Holman had returned to see him on May 15, and was

“still having the cough headaches as well as some neck

pain.” He had sent Holman for cervical spine x-rays,

and considered that Holman might need neck surgery as

well as surgery for the Arnold Chiari malformation. He

stated that he thought Holman “will be unable to work

for at least one year and should be granted short-term

disability. At the end of one year, though, we can

reevaluate him.” The letter stated that Dr. Runnels

would like to get Dr. Al-Mefty’s “opinion about the knee

[need] for a posterior fossa decompression.”

* On May 29, 2001, Dr. Runnels wrote Dr. Al-Mefty, noting

that he was sending Holman “down to see you for

evaluation of his Arnold-Chiari malformation with

symptoms of cough headache.” He also stated that Holman

“would like to quit smoking” and that he had been

referred to a pulmonologist.

* On August 20, 2001, Dr. Al-Mefty wrote Dr. Runnels,

stating that Holman “is still having episodes of

headaches after coughing associated with blurry vision

for about 45 seconds.” He noted that Holman was trying

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to stop smoking in preparation for surgery to correct

the Arnold-Chiari malformation. At some point after

August 20, 2001, Dr. Al-Mefty completed an undated APS,

indicating a diagnosis of Chiari I malformation, and an

MRI showing herniated tonsils down to the C1 arch. He

noted physical examination findings of nystagmus with

left lateral gaze, and mild unsteadiness with tandem

gait. He crossed out the section of the form inquiring

about physical impairments and wrote “N/A” over it. 

* On November 27, 2001, Dr. Runnels wrote Dr. Al-Mefty,

noting that Holman had been “cleared for surgery,” and

was hopeful to have it performed before the year was

out, while he still had insurance.

* On December 13, 2001, Hartford notified Holman that his

benefits were being terminated because “the medical

evidence does not render you Totally Disabled throughout

and beyond the Elimination Period.” The letter pointed

out that under the Plan, benefits were payable if

Holman’s disability prevented him “from performing the

essential job duties of your occupation as a Maintenance

employee throughout and beyond the Elimination Period,”

and noted that the Elimination Period ran from May 17,

2001 through August 15, 2001. The letter stated that

“there is no medical information or specific

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The Court believes this abbreviation refers to “disease,” given the context of 12

the quoted material, although “dx” is a common abbreviation for “diagnosis.”

A Valsalva maneuver is “any forced expiratory effort (“strain”) against a closed 13

airway, whether at the nose and mouth or at the glottis.” The glottis is part of the

vocal apparatus of the larynx.

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restrictions and or limitations to support why you were

able to work full time 4/24/00 through 5/16/01 with the

current diagnosis you are now claiming disability why

you are now unable to work.”

* On December 18, 2001, Hartford contacted Dr. Runnels and

“posed [a] question” to him, apparently about how

Holman’s condition affected his ability to work. Dr.

Runnels “suggested to familiarize myself with Arnold

Chiarie’s [sic] malformation and that should answer any

of the questions that I have.”

* On December 19, 2001, the Summary Detail Report in the

record indicates that Hartford obtained input on

Holman’s case from a consultant, Dr. Lyon, who

“confirmed the seriousness of the dx and the 12

neurological symptoms and sequalae [sic] of potential

death. The MRI showed that the herniation had

increased, any lifting, pushing or pulling associated

w/valsalva would increase his symptoms ie: increase 13

intracranial pressure and therefore cause further

complications and potential death.” Later that same

day, “Dr. Lyon said he did some more research and that

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Abbreviation for “employee.” 14

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any valsalva maneuver such as lifting, pushing, pulling

etc, needed for his job would cause the insured to

become symptomatic and cause severe/critical

complications to the insured’s medical condition.”

Still later that day, “The insured is neurologically

symptomatic when he coughs (Valsalva) which is

consistent with the seriousness of his diagnosis. His

dx most likely could progress and lead to death if not

treated. Surgery is complicated and carries a high

death rate.”

* On December 20, 2001, the Summary Detail Report noted

that “Dr. Lyon confirmed the seriousness of the dx and

the neurological symptoms and sequalae [sic] of

potential death. The MRI showed that the herniation had

increased, any lifting, pushing or pulling associated

w/valsalva would increase his symptoms ie: increase

intracranial pressure and therefore cause further

complications and potential death . . . the EE’s14

essential job duties do require physical labor

crouching, crawling, standing and lfting [sic] up to 25

lbs and operating hand tools with the EE’s symptoms that

cause EE to become blurred vision and severe headaches

. . . .” Hartford notified Holman that day that his

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One may be forgiven for wondering how this decision squares with Hartford’s 15

December 13, 2001, letter notifying Holman that his benefits were being terminated

because “the medical evidence does not render you Totally Disabled throughout and beyond

the Elimination Period.” The Administrative Record sheds no light on this curious

circumstance.

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claim for long term disability benefits (“LTD”) had been

approved, effective August 15, 2001. The letter 15

pointed out that after August 15, 2002, in order to

qualify for benefits Holman would have to be prevented

from performing the essential duties of any occupation

for which he was qualified by education, training or

experience.

* On February 21, 2002, Hartford wrote Holman, notifying

him that, because he had become eligible for benefits on

August 15, 2001, “[e]ffective 8/15/02 you must be

considered totally disabled” according to the “any

occupation” test of the Policy. The letter went on to

advise Holman “that this office has initiated an

investigation to determine if you will qualify for

benefits on and after 8/15/02. When we have completed

our investigation, we will notify you regarding our

determination.”

* On March 1, 2002, Dr. Runnels completed an APS in which

he indicated that Holman “is awaiting surgery from Dr.

Al-Mefty” for Arnold-Chiari malformation and that the

date upon which he would be released to return to work

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was “undetermined.”

* On March 29, 2002, Holman completed a Claimant

Questionnaire, in which he indicated that he had

“unexpected severe headaches that prevent me from

working,” and that “I never know when the headache will

occur.” He indicated that there had been no change in

his condition for the past 18 months.

* On May 9, 2002, Hartford wrote Holman, pointing out that

it had not received various forms and medical

documentation it had requested for use in re-evaluating

his claim. On that basis, it had decided to terminate

Holman’s LTD benefits.

* Following an examination of Holman on May 30, 2002, Dr.

Runnels completed an undated APS showing a primary

diagnosis of Arnold-Chiari, for which the treatment was

“post fossa decompression.” Dr. Runnels again failed to

indicate what, if any, physical impairments Holman had,

and again checked the box under psychiatric impairments

for “Major impairment in several areas - work, family

relations. Avoidant behavior, neglects family, is

unable to work.” After this statement he wrote “needs

brain surgery for Arnold Chiari.”

* On June 11, 2002, Dr. Runnels wrote Dr. Al-Mefty,

stating that he had seen Holman on May 31, 2002, and he

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A slipping backwards of the vertebrae. 16

Cerebrospinal fluid. 17

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“still has cough headaches, etc. He is also troubled

with some impotence. He has heard about Viagra and

wanted to try it.” Dr. Runnels prescribed the Viagra,

along with Holman’s regular medications, and counseled

Holman “to be sure to telephone [Dr. Al-Mefty] so that

he stays on track and gets set up for surgery.” He

noted that “I agree that he is disabled. . . . At this

time, he is unable to work until further notice.”

* On July 18, 2002, Dr. Runnels wrote a “To Whom It May

Concern” note, stating that Holman was disabled from

Arnold-Chiari malformation and that he had “referred him

to one of the world’s experts, Dr. Al-Mefty,” for

decompressive surgery. The note stated that Holman “is

disabled until he can get his decompressive surgery,”

and that he has “retrolisthesis at the two levels 16

above his previous [cervical] fusion” which “also

contributes to his disability.”

* On September 20, 2002, Holman appealed Hartford’s

decision to terminate his benefits. 

* On December 23, 2002, Dr. Al-Mefty wrote Dr. Runnels,

noting that Holman has “a known Chiari I malformation,”

“confirmed CSF dynamic disturbance” consistent with 17

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“A sensation of spinning or whirling motion. V. implies a definite sensation of 18

rotation of the subject or of objects about the subject in any plane.”

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his diagnosis, and episodes of vertigo .

18

* An entry in the Summary Detail Report on December 30,

2002, notes that “the claimant’s treating physician is

clearly supporting disability.” The Report references

a telephone call to Holman that date, in which the

claims examiner explained to Holman that “the definition

of disability changed in August” (from the “own

occupation test” to the “any occupation test”), and that

“it is possible the examiner will be able to make a

decision regarding the ‘own occupation’ period, but may

need additional investigation in order to make a

decision for ‘any occupation’.”

* In a file review on January 27, 2003, documented in the

Summary Detail Report, Hartford noted that the

“restrictions and treatment provided through the

11/27/01 office note would suggest and support a lack of

functionality. Per Dr. Runnels the claimant would lack

functionality until after surgery. . . .” The Summary

Detail Report went on to conclude, however, that

“[w]hile it appears that the claimant lacked

functionality through the 11/27/01 office note there are

no records to support a level of impairment that would

continue to suggest that the claimant lacked

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The Court has been unable to determine who these initials refer to, but there is 19

no evidence of an outside file review, or even a file review by a Hartford medical

director.

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functionality beyond 11/27/01.” The reviewer therefore

recommended that benefits continue to be terminated

effective May 30, 2002.

* On February 12, 2003, the Summary Detail Report fleshed

out the January 27, 2003, review, stating “[i]t is the

MCCM medical opinion, with reasonable medical 19

certainty, that the claimant’s medical work up was

appropriate through the 11/27/01 office note. After the

11/27/01 office note the claimant’s focus changed from

complaints associated with Arnold Chiari Malformation to

that of Impotence. The severity and necessity of

decompressive surgery is questioned based on the

following. 1. The claimant’s complaints suddenly

changed and his care ended. It is my experience, from

reviewing prior claims, that claimant’s suffering with

severe complications associated with Arnold Chiari

Malformation’s (ACM), so severe that it requires

surgical intervention, undergo medical management

recommendations. In the claimant’s situation he ceased

medical intervention. 2. The claimant’s complaints

changed from associated symptoms related to ACM to that

of impotence. It is unclear how the claimant would be

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able to physically participate in activities associated

with non impotence, if the severity of the ACM precluded

functionality to RTW [return to work]. Based on a lack

of ongoing medical treatment, and based on the change in

the claimant’s medical complaints, the records reviewed

would not support a lack of functionality beyond

11/27/01.”

* On February 13, 2003, Holman was notified by Hartford

that his benefits were being terminated effective May

30, 2002, because the medical information in his file

“does not support an inability to perform essential

duties of your own occupation.” This letter also

explained to Holman that after twelve months of

disability from his own occupation, the “any occupation

test” applied to his claim. The letter noted that on

his APS, Dr. Al-Mefty “did not indicate any restrictions

or limitations that would prevent you from performing

your occupation,” and that when called, someone in AlMefty’s office told the Hartford caller that “Dr. AlMefty does not complete this type of form.” It also

noted that Holman stated, during an office visit of

8/28/00, that he felt he was “asymptotic [sic] at this

point,” and wanted to think about it before having

surgery for his condition, then did not follow up until

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Stiffening or fixation of the vertebrae of the neck. 20

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8/20/01.

* On March 18, 2003, Dr. Runnels signed an APS in which he

indicated that Holman would be disabled “permanently” as

a result of Arnold-Chiari malformation and cervical

spondylosis . An entry dated May 29, 2003, in the 20

Summary Detail Report noted that this APS “is a

reiteration of [Dr. Runnels’] opinion that Mr. Holman

should be considered disabled; however, there is no

evidence to support why.”

* On April 21, 2003, Holman appealed the decision to

terminate his benefits. In this letter, he pointed out

that he had been declared totally disabled for purposes

of receiving Social Security benefits.

* On May 27, 2003, Hartford notified Holman that it had

completed review of his appeal, and was still denying

benefits because “you are not disabled as defined in the

Policy.” It stated that while “it is clear” that -

according to Dr. Runnels - Holman “should be considered

disabled,” there “is no evidence in his office notes,

forms or correspondence to support why.” This statement

was apparently related to another, that “[a]lthough Dr.

Runnels has consistently stated that he considers you

disabled pending your surgery, he has not provided

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specific information about why you should be considered

disabled, i.e., specifically how your activities are

limited.” The letter acknowledged that “[o]ur medical

investigation previously concluded that with the

presence of Arnold-Chiari, in general, activities

involving straining may increase your risk of medical

complications including death,” but went on to state

that “[i]t is unclear if there is a legitimate

restriction against any type of straining activities in

your particular case.” The letter stated that the risk

of death did not constitute a disability: “Because the

policy determines disability based on functional or

cognitive limitations preventing occupational

requirements, the potential risk of medical

complications associated with performing work does not

constitute a disability, particularly in light of the

lack of actual ongoing impairment.” In the letter,

Hartford took the position that Holman was “active”

because “when our Examiner called your house on 8/21/02

we were told you were performing maintenance on your

car.” The letter noted that “[n]ew reported symptoms,

such as vertigo in December 2002, are only pertinent to

your claim if there is proof of disability from June

2002 to the onset of the new symptoms,” and that

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Holman’s medical records “beyond 5/31/02 do not document

that you are having symptoms that are frequent or severe

enough to prevent you from working.”

4. The foregoing recitation of evidence from the

Administrative Record makes it clear that Dr. Runnels, a

neurosurgeon and thus a specialist in the field which treats

Arnold Chiari malformation, took the unequivocal position that

Holman was totally disabled. Dr. Lyon, the medical professional

consulted by Hartford, agreed. Holman’s condition is such that

the essential duties of his occupation would put him at risk for

further complications from his condition, up to and including

death. The only treatment for the condition is a surgical

procedure which itself has a high death rate. 

Set off against this evidence is the failure of Holman’s

physicians to specify what physical functions he was incapable of

performing, and the fact that Holman performed some maintenance on

his car and requested a prescription for Viagra.

The Court finds that Hartford’s decision to terminate

Holman’s benefits on this basis was an abuse of its discretion,

for the following reasons:

(a) To find that Holman was not disabled, Hartford had to

disregard - without adequate justification - the opinion of

Holman’s treating physician. While ERISA plan administrators need

not “automatically . . . accord special weight to the opinions of

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This procedural irregularity in Woo was found to justify less deferential review 21

of the plan administrator’s decision, for which Holman here contends as well. Because

the Court finds that even with fully deferential review, Hartford’s decision in this

case cannot stand, it has not undertaken the Woo analysis to determine whether or not

less deferential review is warranted.

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a claimant’s physician,” they “may not arbitrarily refuse to

credit a claimant’s reliable evidence, including the opinions of

a treating physician.” Black & Decker Disability Plan v. Nord,

538 U.S. 822, 834 (2003).

(b) Hartford’s decision was based on an almost total failure

to investigate Holman’s claim. Although confronted with objective

medical evidence of an uncommon condition, and the unequivocal

opinion of his treating physician that Holman was disabled,

Hartford did not have a neurologist review the claim. Such

conduct was held to be a serious procedural irregularity in Woo v.

Deluxe Corp., 144 F.3d 1157 (8th Cir. 1998) . 

21

(c) To the limited extent that Hartford did investigate

Holman’s claim, what it learned was consistent with the opinion of

Holman’s treating physician and inconsistent with a decision to

terminate benefits: Dr. Lyons told the claims examiner that

Holman’s condition was serious and continuation at his job was

life-threatening.

(d) Hartford misinterpreted a relevant provision of its own

Policy. The Policy does not, as asserted in Hartford’s May 27,

2003, termination letter, “determine[] disability based on

functional or cognitive limitations preventing occupational

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requirements.” It defines “Totally Disabled” as a condition which

exists when a participant “is “prevented by . . . sickness . . .

from performing the essential duties of your occupation.”

Holman’s doctor - and Hartford’s own consultant - established that

Holman’s condition prevented him from performing his job. The

interpretation applied by Hartford is inconsistent with the stated

goal of the Plan (to “help you protect your greatest asset, your

ability to earn an income”) and would render the definition of

Totally Disabled meaningless in a case such as Holman’s, where

what prevents him from working is not an inability to perform the

actual functions, but the risk that performing them will kill him.

It is, therefore, an unreasonable interpretation.

(e) It was not necessary to a finding of disability for

Holman’s doctors to list particular physical functions that he

could not perform, in the fashion commonly seen on standardized

forms for evaluating functional capacity, where an evaluator

estimates the length or amount of time a patient can sit, stand,

walk, etc. Hartford’s own reviewer concluded, on January 27,

2003, that the restrictions imposed by Holman’s doctor as of

November 27, 2001, “would suggest and support a lack of

functionality.” There is no evidence that Holman’s condition

abated or improved after that date. 

(f) The fact that Holman performed some form of maintenance

on his vehicle, and the fact that he obtained a prescription for

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Viagra, are not probative. Neither simple auto maintenance nor

sexual activity is shown to necessarily involve exertions that

would put Holman at the same risk his job would entail. 

(g) The frequency or severity of symptoms in this particular

case is not dispositive. For Holman, it was not merely the fact

that he had headaches, blurry vision, and vertigo that impaired

his ability to work. The additional - and more important -

consideration was that these events were symptomatic of a

condition which placed Holman at risk of death when carrying out

his job duties. Disability may be posited upon the risk of

worsening a known condition. Herring v. Canada Life Assurance

Co., 207 F.3d 1026 (8th Cir. 2000).

As noted in paragraph 2, the reasonableness or

“unreasonableness of a plan administrator’s decision can be

determined by both the quantity and quality of the evidence

supporting it.” Torres, 405 F.3d at 680. Here, neither the

quantity nor the quality raises above the “scintilla” mark, and

the Court finds that no reasonable person would have reached the

same decision Hartford reached in this case. It was, therefore,

error for Hartford to terminate Holman’s benefits as of May 30,

2002, and he is entitled to benefits from that date until August

15, 2002.

5. Because Hartford’s decision was that Holman was not

disabled from performing his own occupation, the Court has

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considered whether it is appropriate to remand this matter for

further consideration of whether Holman could - after August 15,

2002 - perform the essential functions of any occupation for which

he is reasonably fitted by education, training or experience.

Ordinarily, it is for the plan administrator to make such a

decision in the first instance, as courts should avoid becoming

“substitute plan administrators,” DuMond v. Centex Corp., 172 F.3d

618 (8th Cir. 1999), but the Court finds that this case presents

a special situation in which such remand is not appropriate. 

Hartford’s administrative review of Holman’s claim took place

with full knowledge on Hartford’s part that the issue of Total

Disability was governed by the “any occupation” test. Hartford

repeatedly explained to Holman that this test, rather than the

“own occupation” test, applied after August 15, 2002. Indeed, a

determination of whether Holman met the “any occupation” test was

the very purpose of the investigation into Holman’s claim that was

commenced in February, 2002 (six months before the point at which

the new test would even become applicable). Notwithstanding this,

Hartford chose to base its decision on Holman’s ability to perform

the essential functions of his own occupation. 

This is not a case where subsequent to an administrative

decision a court finds that the administrator was mistaken about

the proper standard, corrects that mistake, and then sends the

matter back for the application of the proper standard. Here,

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Hartford chose to ignore the very standard it claimed to be

applicable. To send the matter back to Hartford at this point

would essentially give Hartford two bites at the apple, while

penalizing Holman - by subjecting him to yet another round of

administrative decision-making and review - because Hartford chose

not to base its review on what it recognized as the applicable

standard. “[T]he concepts of judicial economy, prompt adjudication

of claims, and fundamental fairness to claimants require that all

defenses or objections to pension claims be considered by the

pension plan trustee prior to federal court review. Multiple

reviews and remands are costly and lengthy, both for the claimants

and the courts.” Bruce v. K-Mart Corp., 568 F.Supp. 378, 384

(D.C. Ark. 1983). Holman would not be granted such leeway, had he

failed to present evidence at the administrative level. Davidson

v. Prudential Insurance Company of America, 953 F.2d 1093 (8th

Cir. 1992). Thus, fundamental fairness counsels against remand.

In spite of the foregoing, if the record were devoid of facts

upon which to base an “any occupation” decision, the matter would

have to be remanded. Based on the facts now before it, however,

the Court considers it unlikely that Hartford could reasonably

find Holman not disabled under the “any occupation” test. It

would have to show that Holman could, after August 15, 2002, have

performed the essential functions of some occupation for which he

was “qualified by education, training or experience.” In August,

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2002, Holman was 61 years of age. He had a tenth grade education,

and his relevant work experience was limited to his maintenance

technician job at Tyson. Thus the range of jobs for which he

might be found qualified was very small. He had a serious medical

condition which caused him blurred vision, vertigo, and

unsteadiness on his feet. He had a secondary, potentially

disabling condition, the retrolisthesis. His treating

neurosurgeon, and Hartford’s own consultant, had opined that he

was unable to work, and Hartford had already interpreted Dr.

Runnels’ opinions as meaning that Holman would “lack functionality

until after surgery.” It can thus be seen that Holman had very

significant impairments that would further limit the work that he

might be able to perform. Holman has been found disabled by the

Social Security Administration, which, while not determinative, is

further evidence that Holman is disabled from any occupation.

Riedl v. General American Life Ins. Co., 248 F.3d 753, fn. 4 (8th

Cir. 2001).

Under these circumstances, a remand would put both Holman and

Hartford to considerable, and probably needless, expense. The

evidence is so one-sided in favor of a finding of disability under

even the “any occupation” test that the Court deems it the proper

course of action to resolve the matter here, by finding that

Holman was disabled from both his own and any occupation for which

he was qualified, from August 15, 2002, through the end of the

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Based on Policy provisions not herein relevant, it appears that Holman’s 22

eligibility for benefits would have terminated under any circumstances no later than

August 15, 2006.

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maximum period of eligibility.22

6. In addition to his claim for unpaid benefits, Holman

prayed for an award of costs and attorney’s fees. The Court has

discretion to award reasonable attorney’s fees and costs to either

party in an ERISA action, under 29 U.S.C. §1132(g)(1). Such an

award in favor of Holman is merited in this case, conditioned upon

submission of an appropriate petition therefor within fourteen

(14) days of the date of this Order. Hartford will have eleven

(11) days thereafter to lodge any objections to the petition.

IT IS THEREFORE ORDERED that the decision of Hartford Life

and Accident Insurance Company, finding Donald Holman not disabled

for purposes of the Tyson Foods, Inc., Voluntary Long Term

Disability Plan, is reversed. 

IT IS FURTHER ORDERED that the parties confer and file,

within twenty (20) days of the date of this Order, either (a) an

agreed statement of the amount of past-due benefits owed to Holman

from May 30, 2002, until the last date benefits would have been

payable to him under the Maximum Duration Of Benefits Table

contained in the Booklet-certificate for Hartford Group Insurance

Policy GLT-43193, or (b), should they be unable to agree on this

amount, position papers setting forth their respective positions

on that issue.

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IT IS FURTHER ORDERED that Holman is entitled to a reasonable

attorney’s fee, conditioned upon presentation of an appropriate

petition for same within fourteen (14) days of the date of this

Order. Hartford will have eleven (11) days from such filing to

state any objections thereto.

IT IS SO ORDERED.

 /s/ Jimm Larry Hendren 

JIMM LARRY HENDREN

UNITED STATES DISTRICT JUDGE

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