Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-3_04-cv-03019/USCOURTS-arwd-3_04-cv-03019-0/pdf.json

Nature of Suit Code: 110
Nature of Suit: Insurance
Cause of Action: 29:1002 E.R.I.S.A.: Employee Retirement

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IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

HARRISON DIVISION

MARY L. McBRIDE PLAINTIFF

v. Civil No. 04-3019

CENTURYTEL OF MOUNTAIN HOME, INC.;

THE PRUDENTIAL INSURANCE COMPANY

OF AMERICA; and METLIFE GROUP, INC. DEFENDANTS

O R D E R

Now on this 21st day of September, 2006, comes on for

consideration plaintiff’s Motion For Summary Judgment (document

#20), and from said motion, the responses thereto, and the

Administrative Record filed by the parties, the Court finds and

orders as follows:

1. Plaintiff Mary L. McBride (“McBride”) alleges that as an

employee of defendant CenturyTel of Mountain Home, Inc.

(“CenturyTel”) she was a participant in an employee benefit plan

(the “Plan”) insured by defendants The Prudential Insurance

Company of America (“Prudential”) and MetLife Group, Inc.

(“MetLife”). She alleges that her long term disability (“LTD”)

benefits under the Plan were wrongfully terminated. Her

administrative remedies have been fully exhausted.

CenturyTel and Prudential admit that Prudential insures the

Plan, and assert that CenturyTel, Inc., parent of CenturyTel, is

the administrator of the Plan. MetLife denies that it either

insures or administers the Plan.

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2. The parties have treated the matter now under

consideration as one for summary judgment, but the procedural

posture of this case is that of an administrative appeal. The

usual presumptions applicable to motions for summary judgment do

not apply. The facts are those contained in the Administrative

Record, and the standard for review is dictated by the terms of

the Plan. 

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. Metropolitan Life

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

The Plan in this case provides that Total Disability “exists

when Prudential determines that all of these conditions are met.

. . .” Such a provision gives Prudential discretionary authority

to determine eligibility for benefits. Ferrari v. Teachers Ins.

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

therefore, review Prudential’s decision to terminate McBride’s LTD

benefits for abuse of discretion. 

The abuse of discretion standard has been described as

follows:

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There is no dispute that McBride was past the initial period of Total Disability. 1

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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

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. The relevant Plan provisions, for purposes of this case,

are two. First, the Plan provides that Total Disability exists

when a participant, after the initial period of Total Disability ,

1

is “not able to perform for wage or profit the material and

substantial duties of any job for which you are reasonably fitted

by your education, training or experience.”

Second, the Plan limits benefits for Total Disability “if

your Disability, as determined by Prudential, is caused at least

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in part by a mental, psychoneurotic or personality disorder. In

that case, benefits are not payable for your Disability for more

than 24 months.” This limitation is referred to in the

Administrative Record as the “mental/nervous limitation,” and the

Court will so refer to it herein.

Prudential determined that McBride was disabled - although it

did not state the basis of that determination - effective May 26,

1996. LTD benefits were paid until February 1, 2002, when

Prudential terminated those benefits on the basis that the

mental/nervous limitation had expired. Prudential does not

dispute that McBride continues to be totally disabled, but takes

the position that her disability is because of mental problems,

and that if her mental problems could be taken out of the picture,

she would be able to perform sedentary or light work in spite of

her admitted physical problems. McBride now appeals this

conclusion.

4. The Court has examined the Administrative record, and

finds that it reflects the following chronology of relevant facts:

* McBride worked for over 18 years as a customer service

representative at CenturyTel in Mountain Home, Arkansas.

This work would be classified as sedentary according to

the Dictionary of Occupational Titles. 

* On May 17, 1994, McBride consulted Anne E. Winkler,

M.D., a Rheumatologist in Springfield, Missouri, with

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According to Stedman’s Medical Dictionary, 26th Edition, a trigger point is a 2

specific point or area where a painful response is elicited if stimulated by touch, pain

or pressure. All medical definitions in this Order are drawn from Stedman’s unless

otherwise indicated.

An “inflammation of the fibrous and connective tissue, causing long-term but 3

variable levels of muscle and joint pain, stiffness, and fatigue.” Brosnahan v.

Barnhart, 336 F.3d 671, fn.1 (8th Cir. 2003), citing Jeffrey Larson, Fibromyalgia, 2 The

Gale Encyclopedia of Medicine, 1326-27.

A psychotherapeutic agent used to treat depression and anxiety. 4

A note in connection with the third level of administrative appeal of McBride’s 5

claim indicates that Dr. Wilson retired in June, 2003.

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complaints of arm pain, worsening over the past year,

“mainly located in hands, wrists, forearms as well as

upper arms, sometimes into her neck and shoulders” and

“tired feeling for at least a year.” She had eight

“trigger points.” In addition to her physical problems, 2

McBride reported “[p]roblems with depression, crying

spells, concentration, exhaustion, panic attacks,

nervousness and stress” to Dr. Winkler. Dr. Winkler

thought McBride’s physical problems were “most likely

fibromyalgia,” and started her on Doxepin . 

3 4

* McBride treated with Dr. Winkler from May, 1994, until

November, 1995, when her care was transferred to Jack

Wilson, M.D. Dr. Wilson provided medical care for

McBride from January 5, 1995, until at least December

18, 2002 , treating her fibromyalgia with a pharmacopeia 5

of substances and modalities, including repeated trigger

point injections.

* McBride’s last day to work at CenturyTel was February

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26, 1996. At that point, she found herself unable to

continue working, and applied for disability benefits

under the Plan because of her fibromyalgia.

* On May 28, 1996, Dr. Wilson completed an Attending

Physician’s Statement (“APS”) in which he indicated that

McBride had fibromyalgia and that her condition had

worsened since it was initially diagnosed. He indicated

that “pain, stiffness, fatigue, inability to use muscles

over any period to time” would prevent McBride from

working. Future changes, maximum recovery period, and

permanent limits on function were all designated as

“unpredictable.”

* On August 9, 1996, Prudential wrote to McBride,

reporting that it found her eligible for LTD benefits

effective May 26, 1996. The letter did not state the

basis upon which Prudential found McBride disabled, but

did point out the criteria and duration for Total

Disability “[d]ue to Sickness or accidental Injury.”

* On October 21, 1996, Dr. Wilson completed an APS,

stating that McBride was unable to work, and was not

expected to improve, as a result of fibromyalgia, due to

pain, stiffness, and fatigue. 

* On May 2, 1997, Douglas Stevens, Ph.D., a Clinical

Psychologist, diagnosed McBride as having, among other

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SOAP is an acronym for “subjective, objective, analysis, plan,” the four 6

categories considered in this type of claim documentation.

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conditions, major depression, chronic; generalized

anxiety disorder; psychological symptoms affecting

medical condition; and avoidant and schizoid personality

traits. It was his opinion that “[b]ased upon the

history, her present emotional condition (even with

heavy dosages of anti-depressant medication) and her

extreme fatigue, there is no way this lady is going to

be able to work.”

* On May 7, 1997, Dr. Wilson responded to several

questions posed to him in a letter from Prudential. He

stated that since McBride “has an incurable illness the

long-term treatment goals are management of and

lessening of the pain and morbidity of her condition.”

He stated as his opinion that McBride could not perform

sedentary work or work part-time.

* A Prudential SOAP Note of September 25, 1997, 6

summarized the report written by Dr. Stevens in May,

1997, indicating that Prudential had received it by that

date.

* On September 26, 1997, after reviewing the reports of

both Dr. Wilson and Dr. Stevens, Prudential concluded

that “[m]edical obtained supports a disability condition

and appears that although there may be a mental nervous

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An antidepressant. 7

An anti-anxiety agent. 8

An anti-psychotic agent. 9

An anti-depressant. 10

The Court believes this to be a misspelling of Ambien, a hypnotic used to treat 11

insomnia.

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compenent [sic] to condition, cannot separate physical

from mental.” 

* On March 10, 1998, a SOAP note indicated that “since

condition has not improved will approve any occ.” The

Court believes “any occ.” is a reference to the

provision in the Plan that after the initial period of

Total Disability, disability means a beneficiary is not

able to perform the material and substantial duties of

any job for which she is reasonably fitted.

* A Claim Summary prepared on February 12, 2001, noted

that McBride had “depression, and crying spells,” that

she was “manic-depressive,” and that she was seeing “Dr.

Zubrowski (psych) meds - Effexor , Librium , Risperdal ,

7 8 9

Trazadone , and Abien .” 10 11

* On March 5, 2001, Dr. Wilson completed a Physical

Capacities Evaluation (“PCE”), in which he indicated

that McBride had reached maximum medical improvement.

He considered her capable of sitting, standing, and

walking for only one-half hour; of lifting only ten

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This PCE, like others completed in this case, includes additional findings and 12

restrictions. The Court has chosen to focus on those which appear relevant to McBride’s

ability to do sedentary or light work.

The myofascia is the fascia surrounding and separating muscle tissue, and thus 13

myofascial pain appears to refer to fibromyalgia.

Fibromyalgia syndrome. 14

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pounds; and of occasional handling/grasping, fingering

kneeling, and crouching. She was never to do any

pushing/pulling, climbing, stooping, crawling, or

reaching above her shoulders .

12

* On September 11, 2001, a Prudential consultant, Robert

Bonner, M.D., found that McBride had “a significant

history of myofascial pain , psychiatric disease and 13

sleep disturbance.” It was his opinion that McBride’s

“psychiatric condition appears to influence her other

complaints” and that “[h]er functional status with

regard to her FMS is not clear.” 14

* On September 20, 2001, a SOAP Note stated that

Prudential had “[r]eceived medical consultants review.

It is believed additional clarification is needed

regarding her psychiatric impairments. Therefore the

file will be referred to our psychologist for review.”

* On September 26, 2001, a second Prudential consultant,

Daniel LoPreto, Ph.D., a Clinical Psychologist, reviewed

McBride’s medical records, and concluded that she “is

demonstrating symptoms indicative of Pain Disorder

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Process by which psychological needs are expressed in physical symptoms. 15

The Court believes this to be a reference to the mental/nervous limitation. 16

This date is clearly wrong, based on all the other information in the 17

Administrative Record. It should be May, 1998.

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Associated With Both Psychological factors and a General

Medical Condition, along with Major Depression,

Chronic.” He stated as his opinion that her

“somatization has a fairly long history and has become 15

ingrained to the point of her becoming significantly

physically de-conditioned,” thus predicting “a poor

prognosis for successful resolution of her chronic pain

condition and hence re-integration into gainful

employment.” He considered McBride “permanently and

totally disabled by virtue of her mental condition.”

* On September 28, 2001, a SOAP Note stated “[r]eceived

psych review of the file. The medical evidence does

support the diagnosis of a mental condition that is

disabling. However we do not have objective evidence to

substantiate her physical level of impairment. The MN

limit on the claim ran out in 5/99 so we need to now 16 17

determine her physical impairment level.” 

* A SOAP Note on October 3, 2001, states “reviewed the

claim records and note that the claimant’s M/N limit has

expired subsequently, we must substantiate that she

remains disabled primarily due to a physical condition.

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The Court believes this to be an abbreviation for “attending physician.” 18

This date is estimated on the basis of a fax date on the document; the 19

handwritten date is illegible.

The Court is unsure of the professional speciality of Marmer. He appears to be 20

associated with the company which conducted the FCE.

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Her AP reports that due to pain she is decondition 18

[sic] and is unable to perform work activity.”

* On November 6, 2001, McBride underwent a Functional

Capacities Exam (“FCE”) at the request of Prudential.

The examiner found that she could sit, stand, and walk

for up to two hours; that she could occasionally lift 16

pounds from floor to waist, and frequently lift 8 pounds

in that range; that she could utilize fine motor skills

occasionally and gross motor skills frequently; that she

could do no lifting from waist to overhead; that she

could push, pull and carry frequently in the range of

12-17 pounds; and that she could do occasional

squatting, climbing, and overhead work. The examiner

rated McBride’s effort as “sub-consistent,” which was

defined by the test as “less than consistent, but within

acceptable limits of the stated diagnosis.” The stated

diagnosis was fibromyalgia.

* On December 5, 2001 , Keith Marmer completed a PCE. 19 20

He opined that McBride could sit for up to two hours at

a time, and for eight hours in a work day with breaks;

that she could only lift ten pounds; that she was

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capable of frequent handling/grasping and feeling, and

occasional fingering and pushing/pulling; and that she

could occasionally climb, stoop, and crouch. Marmer

appended a “Remark” to his PCE, as follows: “With

respect to section B, please note that Ms. McBride may

tolerate up to 8 hours of work activity, given regular

breaks with each activity and the ability to properly

recover from that activity. Additionally, Ms. McBride

demonstrated an occasional ability for pulling and

reaching. Given her subconsistent effort, it is

possible that her actual ability may be greater.”

* On January 22, 2002, Dr. Bonner revised his opinion,

based on the FCE. He based his revised opinion on

McBride’s “inconsistent effort on several tasks” and his

belief that McBride “greatly underestimate[d] her

physical abilities” (he noted that she “restricted

forward flexion on direct testing however fully flexed

her low back with her knees locked when she bent forward

to pick up a box”). His revised opinion was that

“[a]bsent her psychiatric illness, she could return to

at least, sedentary work similar to her pre-injury

occupation.” Dr. Bonner completed a PCE in which he

found McBride able to sit without restriction during a

work day; able to stand and walk for 3-4 hours during

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a work day; able to lift 20 pounds and to frequently

carry up to 10 pounds; able to do frequent

handling/grasping, fingering, and pushing/pulling; able

to occasionally climb, stoop, kneel, and crouch, but

never to crawl. He included a “Remark” to the effect

that he had “estimated” McBride’s physical abilities

“absent psychiatric illness issues.”

* A SOAP Note dated January 23, 2002, states that “[a]fter

completing a medical and vocational review of this file,

we find that the claimant does not meet the policy

definition of disability.” The Note reported that

McBride “has a significant history of myofascial pain,

psychiatric disease, and sleep disturbance,” and that

her “psychiatric condition is permanently and totally

disabling,” but that “the mental nervous limitation on

this claim expired May 26, 1998.” It concluded that

“[b]ased upon the relevant medical and vocational

documentation contained in the file, it appears

reasonable to determine that the claimant retains the

functional capacity and ability to perform gainful

employment within the sedentary to light exertion

level.”

* On January 31, 2002, Prudential notified McBride that it

was terminating her LTD benefits effective February 1,

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2002. This letter outlined the mental/nervous

limitation, and stated that “[d]espite your significant

psychiatric condition, physically you would be capable

of performing sedentary to light work including your

customer service representative occupation.” On that

basis, Prudential terminated McBride’s LTD benefits.

* On February 4, 2002, McBride appealed Prudential’s

termination decision. 

* On February 11, 2002, Dr. Wilson wrote “To Whom It May

Concern,” stating his surprise over Prudential’s

termination: “Ms. McBride is disabled on account of

fibromyalgia. The biggest problem with fibromyalgia is

pain, fatigue and tenderness of her torso. The letter

from Prudential denying her disability status is

incredulous because it asserts because of the fact that

an examiner they sent to her house could not demonstrate

limitation of motion that she was not disabled.

Limitation of motion is not the issue. The patient’s

fibromyalgia has gradually deteriorated over the years

that I have cared for her. That is the reason she is

receiving the medication that she is on and does

periodically receive injections.”

* On April 18, 2002, a Prudential consultant, Andrew

Porges, M.D., Rheumatologist, stated, based on his

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review of the records, that McBride’s medical

documentation “does confirm the diagnosis of

fibromyalgia,” but that it “reveals subjective but not

objective evidence of physical inability to work,” only

“[s]elf reported complaints of pain and weakness, as

well as fatigue.” Dr. Porges had reviewed a videotape

of the FCE, and agreed that it “does reveal an obese

female who moves in a manner typical of a fibromyalgia

patient,” but opined that “in terms of her fibromyalgia,

there is nothing limiting Ms. McBride’s ability to

perform regular employment, as long as this would

include sedentary or light physical activities.” Dr.

Porges completed a PCE finding that McBride was capable

of sitting for 8 hours during a workday; of standing

for three hours; of walking for one hour; of lifting 20

pounds and frequently lifting up to 10 pounds; of

unlimited handling/grasping, fingering, pushing/pulling;

of occasional climbing, stooping, and kneeling; but not

capable of crouching or crawling.

* A SOAP Note dated April 29, 2002, noted that “Dr. Wilson

said that the problems arising from Ms. McBride’s

condition are pain, fatigue, and tenderness of her torso

not limitation of motion. Dr. Wilson also said that Ms.

McBride’s condition has gradually deteriorated over the

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years.” The Note went on to report that “medical

records supported that she had multiple trigger points

typical of the fibromyalgia; however, her physical

exams revealed no significant musculoskeletal disease.”

* On May 17, 2002, Prudential affirmed its decision to

terminate McBride’s LTD benefits. The termination

letter stated that while McBride’s “medical records

supported that you had multiple trigger points typical

of the fibromyalgia,” her “physical exams revealed no

significant musculoskeletal disease.”

* On September 18, 2002, McBride again appealed to

Prudential to reverse its decision.

* On November 8, 2002, a SOAP Note reflected that “Dr.

Wilson states the claimant’s pain, fatigue, and

tenderness of her torso is directly related to FMS. He

goes on to say that limitation of motion is not the

issue. And that Ms. McBride’s condition has

deteriorated over the years.” On the other hand, the

Note reports that Prudential’s consultant “noted that

the records indicate diffuse musculoskeletal pain,

insomnia, and fatigue with multiple trigger points

typical of FMS. However physical exams revealed no

significant musculoskeletal disease.”

* On November 26, 2002, another Prudential consultant,

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Katherine Duvall, M.D., Occupational Medicine, completed

a PCE, finding that McBride could sit without

restriction during the work day; that she could stand

for 3 hours and walk for 2; that she could lift only 10

pounds; that she was capable of continuous

handling/grasping; and pushing/pulling, and of frequent

fingering; and capable of occasional climbing, stooping,

kneeling, crouching, and crawling.

* On December 5, 2002, Dr. Duvall opined that “the primary

diagnosis affecting Ms. McBride’s ability to work is

fibromyalgia.” She appeared confused about the medical

facts, however, stating “that this diagnosis is

basically supported by subjective complaints only,” but

later noting that “physical exam of trigger-points does

support the diagnosis of fibromyalgia.” She thought

that the fibromyalgia had “plateaued,” stating that Dr.

Wilson had last mentioned fibromyalgia on February 16,

2001. Apparently she had not seen Dr. Wilson’s letter

of February 11, 2002. Dr. Duvall was of the opinion

that “Ms. McBride may need to be limited from heavy

lifting, continuous keyboarding, and prolonged sitting,

standing, and walking,” but that “[t]here is no

objective evidence to support that she has an inability

to do sedentary work” based on her fibromyalgia. 

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* On December 18, 2002, Dr. Wilson completed a

Fibromyalgia Residual Functional Questionnaire. In it

he indicated that McBride had daily pain in the

shoulders, arms, hands/fingers, legs, and

knees/ankles/feet, precipitated by changing weather,

fatigue, movement/overuse, and humidity, and frequently

severe enough to interfere with attention and

concentration. He placed significant limitations on

reaching, handling, and fingering, and indicated that

McBride could not do any repetitive activities with her

fingers or arms. He indicated that McBride would need

to lie down at unpredictable intervals during a work

shift. He stated that she could occasionally lift 10

pounds, but never lift more than that. He stated that

McBride could not work an 8-hour day and “cannot work in

a competitive work site.” He stated that McBride was

not a malingerer, and that emotional factors do not

contribute to the severity of her limitations.

* On December 23, 2002, another Prudential consultant,

Daniel Cohen, M.D., Rheumatologist, reviewed additional

information along with Dr. Porges’ report, and concluded

that “no change is warranted in Dr. Porges’ 04/18/02

opinion.” Dr. Cohen appeared to misread Dr. Porges’

report as stating that McBride “suffered from

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exclusively subjective complaints.” In addition, it

does not appear that Dr. Cohen was furnished with a copy

of Dr. Wilson’s letter of February 11, 2002.

* On January 21, 2003, Dr. Cohen reiterated his earlier

opinion, having been supplied with a copy of Dr.

Wilson’s Fibromyalgia Residual Functional Questionnaire

- but still not having seen Dr. Wilson’s February 11,

2002, letter.

* A “Definition Recommendation” prepared in January, 2003,

indicates that McBride’s LTD file “was reviewed

initially from a physical perspective (9/11/01). It was

believed that Ms. McBride’s psychiatric condition

significantly impacted her physical abilities. The file

was then reviewed on a psychological basis (9/26/01) and

the claimant was found to be significantly impaired by

virtue of her medical condition. An FCE was performed

(ll/6/01) indicating that the claimant had the physical

capacity to function in a sedentary level of activity.

The file including the FCE was forwarded to the medical

consultant for re-review (1/22/02).”

* On February 4, 2003, Prudential again affirmed its

decision to terminate McBride’s LTD. As summarized by

the author of the letter, “Ms. McBride’s history and

present condition do not support a disabling condition

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of such magnitude as to preclude a return to work in a

sedentary capacity.”

5. McBride contends that on the facts shown above, it was

an abuse of discretion for Prudential to terminate her benefits.

She relies primarily on McOsker v. Paul Revere Life Insurance Co.,

279 F.3d 586 (8th Cir. 2002), wherein the Court stated that

“unless information available to an insurer alters in some

significant way, the previous payment of benefits is a

circumstance that must weigh against the propriety of an insurer’s

decision to discontinue those payments.” 

The Court has examined the Administrative Record with the

teachings of McOsker in mind, as follows:

(a) What was the basis upon which benefits were initially

awarded?

The letter initially awarding McBride benefits does not state

the basis for the award, but the evidence suggests that it was

based on McBride’s physical condition, not her mental condition.

McBride applied for disability on the basis of fibromyalgia. The

letter informing her that she had been awarded benefits also

informed McBride of the criteria and duration for Total Disability

“[d]ue to Sickness or accidental Injury,” including the two-year

limitation for “own occupation” disability, but made no mention of

the Plan’s two-year mental/nervous limitation. 

The Court has considered, and rejected, the possibility that

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Prudential simply overlooked the potential applicability of the

mental/nervous limitation. The medical evidence available to

Prudential during the first two years McBride was receiving

benefits indicated that she was totally disabled on the basis of

two separate conditions: her fibromyalgia (according to Dr.

Wilson), and her mental problems (according to Dr. Stevens). In

September, 1997, a claim reviewer found that while there might be

a mental/nervous component to McBride’s disability, it could not

be separated from the physical component. 

Prudential paid McBride benefits for over five years (from

May 26, 1996, until February 1, 2002), when the mental/nervous

limitation, if applicable, would have capped its liability at two

years. The first indication that Prudential was actively focusing

on the potential to terminate McBride’s benefits on the basis of

the mental/nervous limitation appears in the SOAP Note of

September 28, 2001.

For these reasons, the Court concludes that Prudential found

McBride totally disabled in 1996 on the basis of her physical

condition alone, and continued to consider her totally disabled on

that basis for over five years.

(b) Did the information available change in any significant

way before Prudential decided to terminate McBride’s

benefits?

From the Administrative Record, it is clear that Prudential

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There is additional information about various conditions that did not contribute 21

to any disability, and there is additional information that might prove to be about a

disabling condition but which became available after exhaustion of the review process.

The Court has not considered any of this type of information.

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knew - at least from September 25, 1997, when it was in possession

of Dr. Stevens’ May 2, 1997, report - that McBride had mental

conditions that were disabling. This was not new information in

the Fall of 2001, when Prudential began to focus on it for

purposes of terminating her benefits. The only new items of

relevant information at that time were: 21

* the FCE conducted on November 6, 2001; 

* the opinions of Prudential’s consultants, who focused on

McBride’s mental health and the lack of limitation on range of

motion in the FCE; and 

* the opinion of Dr. Wilson that pain and fatigue - not

limitation on range of motion - were the aspects of fibromyalgia

that made McBride unable to work. 

In the Court’s view, this “new” information was not

significantly different from that available to Prudential before

it decided to terminate benefits. Indeed, the only difference -

other than focus - was the information that McBride did not suffer

a limitation in her range of motion and that such was not the

aspect of her condition which caused her to be disabled.

 (c) Does McOsker apply?

Given the Court’s conclusion that there was no significant

change in the information available to Prudential between the time

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it made the initial benefits decision and the time it terminated

McBride’s benefits, it follows that McOsker applies in this case.

The previous payment of benefits is, therefore, a circumstance to

be considered as weighing against the propriety of Prudential’s

decision to discontinue those payments.

6. Another factor which would suggest an abuse of

discretion in the benefits analysis is Prudential’s changing

emphasis with respect to the cause of McBride’s disability. After

it found McBride to be totally disabled on the basis of her

physical condition in repeated reviews from 1996 to 2001,

Prudential apparently chose to alter its focus in the Fall of 2001

so as to place primary emphasis on McBride’s mental condition. In

trying to discern the basis for such a shift in emphasis, the

Court notes:

* The diagnosis of fibromyalgia was made by a specialist

in rheumatology - the branch of medicine devoted to the study of

conditions of inflammation and pain in the musculoskeletal system.

It was based on criteria considered to be objective by case law in

the Eighth Circuit. Chronister v. Baptist Health, 442 F.3d 648

(8th Cir. 2006). This diagnosis has never been refuted by any

doctor who examined McBride, and, indeed, was accepted and

acknowledged by Prudential’s consultants.

* Prudential took the position that McBride’s “physical

exams revealed no significant musculoskeletal disease.” That

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position is untenable since Dr. Wilson’s trigger point findings

were based on physical exams and Dr. Bonner reported “a

significant history of myofascial pain.” Moreover, Prudential had

already concluded that there was evidence of significant

musculoskeletal disease, having previously found McBride’s

fibromyalgia significant enough to award her disability benefits

on that basis. 

* There is no evidence that McBride’s fibromyalgia ever

improved, and her treating physician was of the opinion that her

condition had deteriorated over time.

* McBride underwent only one exam at the request of

Prudential - the FCE of November, 2001. Prudential’s consultants

focused almost exclusively on that single exam - and on McBride’s

mental condition - in formulating their opinions. These

consultants:

# appeared to focus on the fact that McBride’s range of

motion was not particularly limited, even though Dr. Wilson noted

(in a letter the consultants appear not to have seen) that

limitation of motion was never the issue; 

# “estimated” her ability to function based on what

they thought she could do if she were giving the test full effort

(apparently believing that she had not done so) although

“subconsistent” effort was defined by the test instrument itself

as “less than consistent, but within acceptable limits of the

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stated diagnosis” of fibromyalgia; and 

# concluded that the results of the test were

influenced entirely by McBride’s mental condition, giving no

consideration to whether fibromyalgia pain affected McBride’s

effort on the test.

The foregoing are not, in the Court’s view, sufficient

justifications for the change in focus by Prudential with respect

to the basis for McBride’s disability. Taken together, the

foregoing facts show that, after initially relying on Dr. Winkler

and Dr. Wilson, Prudential disregarded the opinions of Dr. Wilson

from 2001 on. While Prudential is not required “automatically to

accord special weight to the opinions of a claimant’s physician,”

it "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 (2003). 

The Court notes that Dr. Wilson and McBride had a

doctor/patient relationship of long duration, characterized by

frequent visits which allowed Dr. Wilson ample opportunities to

observe his patient and evaluate her pain and fatigue. No reason

is suggested as to why Dr. Wilson’s opinions might have been

reliable initially but later were not. Indeed, neither Prudential

nor its reviewers ever suggested that his opinions were unreliable

or otherwise attempted to discredit them. 

In sum, therefore, the Court sees no sufficient basis for the

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change in Prudential’s focus as to the cause of McBride’s

disability. 

7. Failure to credit the opinion of the claimant’s treating

physician assumes more than ordinary importance in a case such as

the one at bar. Where the symptoms of physical disability are

almost entirely subjective, their detection and evaluation yield

much more readily to a treating physician - who can examine and

observe the patient - than to an evaluating physician who merely

examines and observes the records. As noted by the Seventh

Circuit (in a case cited with approval by the Eighth Circuit),

fibromyalgia is

a common, but elusive and mysterious, disease, much like

chronic fatigue syndrome, with which it shares a number

of features. Its cause or causes are unknown, there is

no cure, and, of greatest importance to disability law,

its symptoms are entirely subjective. There are no

laboratory tests for the presence or severity of

fibromyalgia. The principal symptoms are ‘pain all

over,’ fatigue, disturbed sleep, stiffness, and - the

only symptom that discriminates between it and other

diseases of a rheumatic character - multiple tender

spots. . . .

Hawkins . First Union Corp. Long-Term Disability Plan, 326 F.3d

914, 916 (7th Cir. 2003), cited with approval in Chronister v.

Baptist Health, 442 F.3d 648 (8th Cir. 2006). 

While trigger point findings consistent with fibromyalgia

constitute objective evidence of the disease, completely objective

evidence of the level of pain and fatigue a person experiences is

impossible to come by. The Eighth Circuit has recognized that

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there may be “cases in which objective evidence simply cannot be

obtained, and it would be unreasonable for an administrator to

demand the impossible.” Pralutsky v. Metropolitan Life Insurance

Co., 435 F.3d 833, 839 (8th Cir. 2006). 

Here, in the Court’s view, to the extent that such evidence

can be produced, Dr. Wilson’s long-term relationship with McBride,

and his repeated prescription of medications and treatments

appropriate for severe fibromyalgia pain, objectifies his opinion

that her symptoms were real and significant. Accordingly,

Prudential’s failure to consider that opinion - without any

showing of unreliability - must be factored into the abuse of

discretion analysis.

8. When the Court considers the teachings of McOsker,

coupled with Prudential’s unwarranted disregard of the opinions of

McBride’s treating physician, it does not believe that a

reasonable person could have reached the conclusion that McBride

is not disabled on the basis of her physical condition. The

Court, therefore, finds that Prudential abused its discretion in

so concluding and in terminating McBride’s LTD under the Plan. 

It follows, therefore, that those benefits should be

reinstated, paid current with interest, and paid forward for so

long as McBride meets the criteria for LTD under the Plan.

9. McBride makes no showing of any conduct on the part of

either CenturyTel or MetLife that affected the termination of her

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LTD benefits, and the Court finds that McBride’s claims against

those defendants should be denied.

10. McBride prays, in her Complaint, for an award of

attorney’s fees. These are recoverable under 29 U.S.C.

§1132(g)(1), and the Court finds they are appropriate in this

case, provided a properly-supported motion therefor is filed

within fourteen (14) days of the date of this Order. Prudential

will have ten (10) days thereafter to lodge any objection to the

motion.

IT IS THEREFORE ORDERED that the decision of Prudential

Insurance Company of America to terminate the long-term disability

benefits of Mary L. McBride is hereby reversed, and Prudential is

directed to reinstate those benefits, pay back benefits with

interest current to the date of this Order, and continue to pay

such benefits in the future for so long as McBride continues to be

entitled to same under the terms of the employee benefit plan of

CenturyTel of Mountain Home, Inc.

IT IS FURTHER ORDERED that if the parties are unable to agree

on the amount of past-due benefits, they shall - within thirty

(30) days of this Order - file simultaneous written briefs with

supporting documentation so that the Court can determine the

correct amount.

IT IS FURTHER ORDERED that plaintiff’s claims against

CenturyTel of Mountain Home, Inc., and MetLife Group, Inc., are

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dismissed.

IT IS FURTHER ORDERED that plaintiff is entitled to an

attorney’s fee, provided a properly-supported motion therefor is

filed within fourteen (14) days of the date of this Order.

Prudential will have ten (10) days thereafter to lodge any

objection to the motion.

IT IS SO ORDERED.

 /s/ Jimm Larry Hendren 

JIMM LARRY HENDREN

UNITED STATES DISTRICT JUDGE

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