Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-5_04-cv-05058/USCOURTS-arwd-5_04-cv-05058-0/pdf.json

Parties Involved:
CNA Group Life Assurance Company
Defendant
Continental Casualty Company
Defendant
Chryl Hardin
Plaintiff
Chryl Stinchcomb
Plaintiff

Document Text:

1

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

FAYETTEVILLE DIVISION

CHRYL HARDIN

formerly Chryl Stinchcomb PLAINTIFF

v. Case No. 04-5058

CONTINENTAL CASUALTY COMPANY

and CNA GROUP LIFE ASSURANCE COMPANY DEFENDANTS

MEMORANDUM OPINION

Plaintiff brings this action pursuant to the provisions of the

Employee Retirement Income Security Act of 1974 (“ERISA”), 29

U.S.C. § 1001 et seq., challenging defendants’ decision to deny her

application for long-term disability benefits. Defendants have

submitted the administrative record (the “AR”) that was before the

claims administrator (Doc. 7) and plaintiff has submitted a

“supplemental administrative record” (Doc. 8), which she argues

should be considered by the Court. The parties have submitted

briefs (Docs. 9, 12) on the issues before the Court and the matter

is now ripe for consideration. For the reasons stated below, the

Court finds that defendants’ decision was not supported by

substantial evidence and a separate judgment will be entered in

favor of plaintiff.

Background

1. Plaintiff worked for J.B. Hunt Transport Services (“J. B.

Hunt”) as a driver recruiter. According to J.B. Hunt’s written

job profile and demands analysis of plaintiff’s position,

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plaintiff’s primary responsibility was to make 100 phone calls a

day for a total of 500 phone calls a week “selling J.B. Hunt to

[p]rofessional drivers.” Plaintiff was required to schedule at

least ten drivers per week for orientation and to recruit two hires

per week. (AR 203 - 204.) Plaintiff’s other responsibilities

included:

* Always represent the Company with behavior representing

a Sales Professional.

* Be an active proponent of all operating groups, including

Van, DCS and the Independent Contractor program.

* Keep an eye on the competitions’ successes and failures

and communicate these to management.

* Keep up to date with industry news and events,

communicating relevant information back to a manager.

* Develop your own database supplied by J.B. Hunt . . .

entering all leads for optimum production and follow up.

* Always meet and[/]or exceed minimum production goals. 

The qualifications for plaintiff’s position included:

* Excellent communication skills, both oral and written.

* Ability to positively respond and interact with all

professional drivers.

* Must possess good reasoning, decision-making and

organizational skills.

* Abilit[y] to work effectively unsupervised, under

pressure with deadlines.

* Must be a willing and effective team participant. 

(AR 203.)

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2. Plaintiff participated in an employee benefits plan

sponsored by J.B. Hunt and issued and administered by defendants.

On May 21, 2002, J.B. Hunt’s benefits department submitted an

application for long-term disability benefits on plaintiff’s behalf

to defendants. (AR 200.) The forms completed by J.B. Hunt in

connection with plaintiff’s application reflected that plaintiff

had taken three leaves-of-absence for “depression” from February

to November 2001, and that her last day of work was January 7,

2001. (AR 201 - 202.) 

3. Under the terms of the plan, plaintiff was eligible for

long-term disability benefits “for each month of Total Disability

which continue[d] after the Elimination Period,” which ended July

6, 2002. (AR 3, 8, 11-12.) During the elimination period and

first 24 months the monthly benefit is payable, an employee is

considered to have a “Total Disability” if she is continuously

unable to perform the substantial and material duties of her

regular occupation. (AR 12.) Benefits are not payable beyond 24

months after the elimination period if the disability “is due to

mental or emotional disorders....” (AR 13.) 

4. The documentation submitted in support of plaintiff’s

claim for disability benefits reflects the following:

* Plaintiff has a history of major depression and she began

seeking treatment from her primary-care physician, Dr. Cynthia

Wilson, in June 2001. Plaintiff saw Dr. Wilson on a consistent

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basis from June 2001 through May 2002, for complaints of depression

and anxiety and also for complaints of back pain and headaches

following a motor-vehicle accident in February 2002. Dr. Wilson

prescribed plaintiff Prozac, Xanax, Flexeril, and Neurontin. (AR

65 - 94.)

* Dr. Wilson referred plaintiff to a neurologist, Dr.

Michael Morse, for her complaints of pain. Dr. Morse’s findings

were as follows:

She has a significant amount of pain behavior. I

don’t find any abnormality on neurological

examination. The abnormalities on her MR are

minimal and should not limit her. I recommended

that she be more aggressive in her physical therapy

and get back to work. She needs her depression

treated in a more aggressive way and apparently is

seeing someone about that. (AR 107.)

* On May 9, 2002, Dr. Wilson completed an “Attending

Physician’s Certification of Health Condition” form submitted to

her by J.B. Hunt’s benefits department. Dr. Wilson diagnosed

plaintiff with depression and anxiety and with back pain and

headaches resulting from the motor-vehicle accident. Dr. Wilson

concluded that plaintiff was unable to perform work of any kind and

that a return to work date was unknown, as the duration of her

conditions was indefinite. (AR 210 - 212.)

* On May 20, 2002, Dr. Wilson completed a “Functional

Assessment Tool” submitted to her by defendants. Dr. Wilson opined

that plaintiff was “very depressed [and] having panic attacks” and

that she was “mentally unable to return to work.” (AR 113.)

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* Beginning in December 2001 and continuing through June

2002, plaintiff saw Dr. Stanley Rest approximately twice a month

for psychotherapy. During her sessions with Dr. Rest, plaintiff

consistently reported feeling depressed, anxious, and overwhelmed

and revealed to Dr. Rest that she had been raped by her father,

that she had a medical malpractice lawsuit pending against her

former therapist and psychiatrist, that she was having marital

problems, that her son had been arrested for manufacturing

methamphetamine, and that she had been in a motor vehicle accident.

Dr. Rest identified plaintiff’s “issues/problems” as:

Reaction To Trauma

Relational Difficulty

Grief or Loss

Family Problems

Legal Conflict

Dr. Rest diagnosed plaintiff as suffering from post-traumatic

stress disorder, borderline personality disorder, anxiety and

depression. (AR 140 - 175.) 

* Dr. Rest referred plaintiff to a psychiatrist, Dr. Aubrey

Pat Chambers, for “medication treatment.” The medical

documentation submitted to defendants contains records of only two

appointments with Dr. Chambers, one on February 11, 2002, and the

other on March 29, 2002, but there are references to other

appointments. Dr. Chambers’ notes from plaintiff’s February 11,

2002 appointment state, “The patient was last seen by me in July.

She carries a diagnosis of PTSD, a previous diagnosis of Multiple

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Personality Disorder, and Borderline Syndrome....” Dr. Chambers’

assessment was “Affective syndrome: R/O PTSD with Adjustment

Disorder .... I doubt Major Depression.” Dr. Chambers suggested

increasing plaintiff’s Xanax. (AR 162.) Dr. Chambers’ assessment

at plaintiff’s March 29, 2002 appointment was “increased Major

Depression, and Posttraumatic Stress Disorder.” (AR 154.) 

* On May 9, 2002, Dr. Rest completed an “Attending

Physician’s Certification of Health Condition” form and a

“Physician’s Statement” form submitted to him by J.B. Hunt’s

benefits department. Dr. Rest opined that plaintiff was mentally

incapacitated indefinitely. (AR 206 - 207, 214 - 216.) 

5. On July 8, 2002, defendants denied plaintiff’s claim for

long-term disability benefits, explaining:

[Y]ou are employed with J.B. Hunt as a[n] Inside

Recruiter. The job information received from your

employer indicates this position mostly requires

sitting and the use of telephone and computer. The

primary function of this position is to call people

off a call sheet and speak with them regarding

employment with J.B. Hunt and scheduling drivers to

attend orientation. 

Based on our review, the information received does

not support an impairment to functionality which

would preclude you from performing the material and

substantial duties of your regular occupation from

your date of loss of 1/8/02 through your

Elimination Period. (AR 100.)

Defendants summarized the evidence supporting their denial of

benefits as follows:

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* Office notes from plaintiff’s visit with Dr. Wilson on

May 7, 2002, indicated that plaintiff was less depressed and that

she would be “reviewed to be released” after her appointment with

the neurologist. Further, Dr. Wilson noted no functional

limitations or restrictions.

* Plaintiff’s neurological examination revealed no

abnormalities and the neurologist recommended that plaintiff return

to work.

* Dr. Chambers noted no functional limitations or

restrictions.

* Dr. Rest’s psychotherapy notes indicated that as of

January 8, 2002, plaintiff was “able to sustain substantial gainful

employment with support and prompting.... Remaining progress notes

indicate[d] focus on situations related to family and legal issues.

No functional limitations or restrictions were noted.” (AR 100.)

6. Plaintiff retained counsel and appealed the denial of

benefits. 

* On July 23, 2002, defendants advised plaintiff that she

had until January 3, 2003, to submit additional medical information

in support of her claim. (AR 95 - 96.) 

* On October 29, 2002, plaintiff’s counsel advised

defendants, “I should have collected medical and have that

forwarded to you in an index shortly.” (AR 63.) 

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* On December 11, 2002, defendants wrote plaintiff’s

counsel, stating that they had not received any additional medical

records and that they would grant him an additional thirty days,

until February 3, 2003, to submit any additional information he

wished to be considered in the re-evaluation of plaintiff’s claim.

(AR 62.) 

* On February 12, 2003, defendants wrote plaintiff’s

counsel stating that they had not received any additional medical

records and “[t]herefore, this claim has been submitted for a

formal appeal review with the information on file at this time.”

(AR 61.)

* On April 1, 2003, a registered nurse on defendants’

appeals committee wrote plaintiff’s counsel advising:

As you must know, claims of disability are not

alone paid on self-reported symptoms or selfreported limitations. Neither are disability

claims approved solely on the presence of a

diagnosis or prescribed treatment or[] alone based

on a physician’s statement indicating a “no work”

status. Instead, claims of disability are based on

the review of presenting medical evidence and

documentation and the effort to correlate that

information to self-reported symptoms, alleged

functional limitations, and the treating

physicians’ opinions with regard to occupational

restrictions and/or limitations....

After a full review of the Company’s original

determination and[] following an independent review

of the medical evidence and documentation made

available, Appeals finds reasonable the outcomes

and conclusions of the Company’s benefit

determination and concurs with the findings

therein....

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This concludes the Appeals Review Process. Please

be advised that with the completion of this

process, all of the available administrative

remedies (for further pursuing benefits in this

claim) have now been exhausted and the

administrative record in this matter (your client’s

claim file) has been closed. Also be advised that

the appellate decision rendered today, as of the

date of this letter, is to be considered in this

matter the company’s final decision. (AR 47-48.)

* On July 10, 2003, plaintiff’s current attorney wrote a

letter to the Appeals Committee advising that he had been retained

to represent plaintiff and that he had “additional information to

provide in regard to [plaintiff’s] disability benefits.” (AR 45.)

* In a letter dated July 11, 2003, the Appeals Committee

responded that an appellate decision upholding the denial of

benefits had been issued on April 1, 2003, and that this

constituted defendants’ final decision and plaintiff’s claim file

had been closed. (AR 42.)

Discussion

* Standard of Review

1. ERISA provides a plan beneficiary with the right to

judicial review of a benefits determination. See 29 U.S.C. §

1132(a)(1)(B). A denial of benefits by a plan administrator must

be reviewed de novo unless the benefit plan gives the administrator

discretionary authority to determine eligibility for benefits or to

construe the terms of the plan, in which case the administrator’s

decision is reviewed for an abuse of discretion. See Firestone

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Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). Under the

terms of plaintiff’s employee benefits plan, the “Administrator and

other Plan fiduciaries have discretionary authority to interpret

the terms of the Plan and to determine eligibility for and

entitlement to benefits in accordance with the Plan.” (AR 36.)

Accordingly, defendants’ decision will be reviewed for an abuse of

discretion. 

2. Under the abuse-of-discretion standard, the Court must

determine whether a reasonable person could have reached the same

decision. See House v. Paul Revere Life Ins. Co., 241 F.3d 1045,

1048 (8th Cir. 2001). This inquiry focuses on the presence or

absence of substantial evidence supporting the administrator’s

decision. Id. While the administrator’s decision need not be

supported by a preponderance of the evidence, there must be “‘more

than a scintilla.’” Id. (citations omitted).

* Record on Review

3. Plaintiff urges the Court to consider not just the

administrative record that was before defendants when they issued

their decision, but a “supplemental administrative record”

consisting of the documentation plaintiff attempted to submit to

the Appeals Committee after it had already issued its decision and

closed plaintiff’s claim file. 

4. Plaintiff had approximately seven months (from July 23,

2003 to February 3, 2003) in which to submit any additional

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information she wished to be considered in the re-evaluation of her

claim by the Appeals Committee. Plaintiff offers no explanation as

to why she did not submit the documentation contained in the

proposed “supplemental administrative record” to the Appeals

Committee during this time frame. Even if plaintiff could

demonstrate good cause for failing to timely submit the

documentation to the Appeals Committee, “[w]hen reviewing a denial

of benefits by an administrator who has discretion under an ERISAregulated plan, a reviewing court ‘must focus on the evidence

available to the plan administrators at the time of their decision

and may not admit new evidence ....’” King v. Hartford Life and

Acc. Ins. Co., 414 F.3d 994, 999 (8 Cir. 2005) (citation omitted). th

Thus, the “supplemental administrative record” submitted by

plaintiff will not be considered by the Court.

* Defendants’ Denial of Benefits

5. In their initial decision denying plaintiff benefits,

defendants found that plaintiff’s impairments did not prevent her

from performing the duties of her position as a driver recruiter,

as the position:

mostly require[d] sitting and the use of telephone

and computer [and] [t]he primary function of this

position [was] to call people off a call sheet and

speak with them regarding employment with J.B. Hunt

and schedul[e] drivers to attend orientation. (AR

100.) 

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Defendants did not address the impact plaintiff’s mental

impairments had on her other job responsibilities, which, according

to J.B. Hunt’s written job profile and demands analysis, included:

being an active proponent of all operating groups; monitoring the

competitions’ successes and failures; keeping up to date with

industry news and events; developing a database on all leads; and

meeting or exceeding minimum production goals of making 100 phone

calls a day for a total of 500 phone calls a week, scheduling at

least ten drivers per week for orientation, and recruiting two

hires per week. (AR 203 - 204.) Defendants also did not address

the impact plaintiff’s mental impairments had on her qualifications

for the job, which included: excellent communication skills, both

oral and written; the ability to positively respond and interact

with drivers; good reasoning, decision-making and organizational

skills; and the ability to work effectively unsupervised, under

pressure with deadlines. (AR 203.)

6. Defendants based their initial denial of benefits, in

part, on the fact that Dr. Rest, plaintiff’s psychotherapist,

indicated that plaintiff was able to sustain employment with

support and prompting as of January 2002, the focus of plaintiff’s

subsequent sessions with Dr. Rest related to family and legal

issues, and Dr. Rest noted no functional limitations or

restrictions. However, as of May 2002, Dr. Rest had diagnosed

plaintiff as suffering from post-traumatic stress disorder,

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borderline personality disorder, anxiety and depression, and Dr.

Rest opined that plaintiff was mentally incapacitated indefinitely.

(AR 206 - 207, 214 - 216.) Dr. Rest’s diagnosis is corroborated by

plaintiff’s psychiatrist, Dr. Chambers, whose last assessment of

plaintiff’s condition was that she was experiencing “increased

Major Depression, and Posttraumatic Stress Disorder.” (AR 154.) 

7. Defendants also relied on an office note dated May 7,

2002, in which Dr. Wilson, plaintiff’s primary-care physician,

noted that plaintiff was less depressed and would be “reviewed to

be released” after a neurological examination; the neurological

examination revealed no abnormalities and the neurologist

recommended that plaintiff return to work. The neurologist clearly

only assessed plaintiff’s ability to return to work from a physical

standpoint and, in fact, noted that plaintiff needed “her

depression treated in a more aggressive way.” (AR 107.) 

Defendants focused on an isolated visit with Dr. Wilson when

plaintiff reported being less depressed. However, plaintiff saw

Dr. Wilson on a consistent basis for approximately one year and Dr.

Wilson, like Dr. Rest, diagnosed plaintiff with depression and

anxiety and prescribed her various medications for these

conditions. As of May 20, 2002, Dr. Wilson reported that plaintiff

was “very depressed [and] having panic attacks.” Further, Dr.

Wilson did in fact review the possibility of plaintiff returning to

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work and concluded that plaintiff was “mentally unable” to perform

work of any kind and that a return to work date was unknown. 

8. Defendants denied plaintiff’s appeal, explaining that

disability benefits are not awarded based on self-reported symptoms

or even a diagnosis or a physician’s “statement indicating a ‘no

work’ status.” (AR 47-48.) Defendants concluded that the medical

evidence did not correlate to plaintiff’s “self-reported symptoms,

alleged functional limitations, and the treating physician’s

opinions ...” (Id.) In reaching this conclusion, it appears that

defendants relied on the opinion of a registered nurse on the

Appeals Committee who reviewed plaintiff’s medical records.

However, the nurse’s opinion cannot be considered substantial

evidence supporting defendants’ decision, in light of the fact that

plaintiff’s primary care physician and psychotherapist both

concluded that plaintiff was mentally unable to return to work.

9. Under the terms of the benefits plan, defendants had the

right, at their own expense, to have a physician examine plaintiff.

(AR 15.) Had defendants required plaintiff to submit to an

independent medical examination or had they even had a psychologist

or psychiatrist, rather than a registered nurse, review plaintiff’s

medical records, they perhaps would have been justified in

discounting plaintiff’s treating physicians’ opinions in favor of

a contrary opinion produced by an independent exam or review. See

Donaho v. FMC Corp., 74 F.3d 894, 901 (8th Cir. 1996) (“where there

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is a conflict of opinion, the plan administrator does not abuse his

discretion in finding that the employee is not disabled”).

Defendants did not do so, however, and they did not possess even a

scintilla of evidence refuting the documentation supporting

plaintiff’s entitlement to benefits. See House, 241 F.3d at 1048

(administrator improperly denied employee’s claim for disability

benefits where it had no evidence refuting documentation from

plaintiff’s treating specialist that supported entitlement to

benefits; even if documentation could be dismissed as subjective,

plan’s terms did not support insurer’s demand for objective medical

evidence but only to require employee to submit to independent

medical examination, which administrator did not do).

Conclusion

10. Based on the foregoing, the Court concludes that

defendants abused their discretion in denying plaintiff disability

benefits. The medical evidence clearly indicates that plaintiff’s

disability was due to a “mental or emotional disorder.”

Accordingly, under the terms of the plan, plaintiff is only

entitled to an award of benefits for the 24 month period following

the elimination period – from July 7, 2002, through July 7, 2004.

11. The parties shall have ten days from entry of this order

in which to confer and submit a written stipulation calculating the

total award due plaintiff so that a judgment may be entered

accordingly. 

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12. Further, the Court will consider awarding a reasonable

attorney's fee and costs to plaintiff under 29 U.S.C. § 1132(g).

Plaintiff shall submit an application for fees and costs, including

an itemization and affidavit and a brief supporting her argument as

to why an award of fees and costs would be appropriate in this

case, within ten days as well. Defendants shall have ten days

thereafter in which to file a response.

IT IS SO ORDERED this 25th day of October 2005.

/S/JIMM LARRY HENDREN 

JIMM LARRY HENDREN

UNITED STATES DISTRICT JUDGE

 

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