A ft erexami ni ng the br i efs and appe l l at e r ecor d, t hi s panel has det erm i ned * unani m ous l yt o gr antthe part i es ’ r eques tfora dec i s i on on the br i efs w i thoutor al a rg u m e n t. See F ed . R . A p p . P . 3 4 (f); 10 th C ir . R . 3 4 . 1 (G ). T h e c ase is th ere fo re or der ed s ubm i t t ed w i thoutor al ar gum ent . T hi s or derand j udgm enti s notbi ndi ng pr ece dent , exce ptunderthe doctr i nes of l aw of the ca s e, r es j udi cat a, and col l at er al es t oppel . I tm aybe ci t ed, how ever , fori t s per s uas i ve val ue cons i s t ent w ith F e d . R . A p p . P . 3 2 .1 a n d 1 0 th C ir . R . 3 2 .1 . 

## F I LED United States C ourt of Appeals Tenth Circuit 

### F e b r u ary9,2007 Elisab eth A. Shumaker C l erk of C ourt UNI TED S TATES CO URT O F AP PEALS F O R T H E T E N T H C IR C U IT BO NNI E M E RA OU, P lain tiff-A p p e llan t, v. T HE WI L L I AM S CO M P ANY L ONG T E R M D ISA B ILIT Y P L A N , S ued as: T he W i l l i ams C om pani es , I nc. L ong- T erm D i s abi l i tyPl an, D efe ndant - A ppel l ee. N o. 06- 5051 ( D. C. No . 0 4 - CV - 1 0 2 - E A) (N .D . O k la .)

ORDE R AND J UDGM EN T * B efor e KELLY , LU CE RO , and HA RTZ , C i rcui tJudg es.

B onni e M er aou appe al s the di s tr i ctcourt ’ s J anuary20, 2006, j udgm ent a ffi r mi n g th e d e c i s i o n b yth e Ad mi n i s tr a t i v e Co mmi t t e e o f Th e W i l l i a ms C om pany( “TW C ”) L ong- T erm D i s abi l i tyPl an ( the “Pl an”) t erm i nat i ngR efe r ence s t o s peci fi c pr ovi s i ons of the Pl an ar e t o the J anuary1, 2002, 1 ver s i on of the Pl an, and amendm ent s t her et o, cont ai ned i n the admi ni s tr at i ve r ecor d and pr ovi ded t o us as partof A ppel l ant ’ s Suppl ement al A ppendi x. T he di s tr i ctcourt , and both part i es i n thei rappel l at e br i efs , have c i t ed thi s ver s i on of the Pl an fori t s r el evantt erm s . T he 2002 ver s i on of the Pl an s peci fi cal l ypr ovi des that“[a ] nyi ndi vi dual w ho part i ci pat ed i n the Pr i orPl an on D ece m ber31, 2000, and w ho w as T ot al l yD i s abl ed on s uch dat e, s hal l cont i nue t o part i ci pat e under th is P la n ” in a c c o rd a n c e w ith its p ro v is io n s . A p lt. S u p p . A p p ., V o l. I I, a t 4 0 5 . T he Suppl ement al A ppendi x vol um es ar e pagi nat ed as fol l ow s : “B M / T W C . ####”, w her e “####” r epr es ent s the page num berw i thi n the appe ndi x. W e have abbr evi at ed the number i ng bydel et i ng the r efe r ence t o “B M / T W C . ”

- 2- M s . M e ra o u ’s lo n g -t e rm -d is a b ility (L T D ) b e n e fits u n d e r t h e P la n . W e exerci se ju ri s d ic tio n u n d e r 2 8 U .S .C . § 1 2 9 1 , a n d a ffir m . I . Backg r ound M s . M er aou w as hi r ed byT W C i n 1987 as a s y s t ems ana l y s t . D ur i ng her e mpl o yme n ta tTW C, s h e b e c a me a p a r t i c i p a n ti n t h e Pl a n , whi c h p r o v i d e s LTD benef i t s t o el i gi bl e part i ci pant s . I n 1992 s he bega n r ece i vi ng L T D benef i t s under 1 the Pl an, bas ed on di agnos es of fi br om y al gi a, os t eoarthr i t i s , cervi cal fac et at ropat hy , m i grai ne h eadac hes, and dep res si on . S he co nti nu ed to r ecei ve these benef i t s unt i l theyw er e t erm i nat ed i n A ugus t2002. O n Sept ember18, 1994, M s. M era o u w as a p p rov ed fo r soc ial sec u ri tyd isab il ityb en efit s, w h ich w ere a w a rd e d re tr o a c tiv e ly to J u ly 1 9 9 2 .

a. P rovi s i ons of

P l an T he P l an d efi nes “T otal D i sabi l i ty ” i n p ert i nen tpartas fol l ow s: “Tot al l yD i s abl ed” or“Tot al D i s abi l i ty ” means , [af t ert he] tw enty - four( 24) m onth [el i m i nat i on] per i od . . . t he i nabi l i tyof s uch- 3-

P a rticip a n t, ba se d u p o n c o n c lu siv e m e d ica l ev id e n c e , to e n g a g e in anygai nful occupa t i on forw hi ch he ors he i s r eas onabl yfi t t ed by educa t i on, tr ai ni ng orexper i ence , as det erm i ned bythe Pl an A d m inistrator. A p lt. S u p p . A p p ., V o l. II, a t 4 0 3 -0 4 . A to tallyd isa b led p a rticip a n t is e n tit led to p a ym e n t o f

m o n th lyd isa b ili tyb e n e fits, b u t su c h d isa b ili tyb e n e fits m a yter m in a te i f the Par t i ci pantcea s es t o be t ot al l ydi s abl ed. T heym ayal s o t erm i nat e i f the Par t i ci pantfai l s t o pr ovi de evi dence thats he r emai ns undera phy s i ci an’ s car e, or i f s he fa i l s t o pr ovi de curr entm edi cal i nform at i on r egar di ng t he condi t i on of her health. S pecifi cal l y , paragraph 3 . 10 . 2 o f t he P l an p rovi des: T he Pl an A dm i ni s tr at ors hal l fr om t i m e t o t i m e and i n anyeventat l eas teverytw o ( 2) y ear s r equi r e anyPar t i ci pantw ho s hal l be r ece i vi ng M onthl yD i s abi l i tyPaym ent s t o pr ovi de t o the Pl an A dm i ni s tr at orcurr entm edi cal i nform at i on fr om hi s phy s i ci an, or phy s i ci ans the Pl an A dm i ni s tr at ors el ect s , r egar di ng t he condi t i on of hi s heal th, i ncl udi ng evi dence of s uch Part i ci pant ’ s cont i nued Tot al Di s a b i l i ty . Un l e s s a P a r t i c i p a n twi th i n a r e a s o n a b l e p e r i o d o f t i me compl i es w i th a r eques tof the Pl an A dm i ni s tr at ort o be pr ovi ded w i th s uch i nform at i on, the Pl an A dm i ni s tr at orm ayt erm i nat e the P a rt ic ip a n t’ s M o n th ly D is a b ility P a ym e n ts . Id. at41 7. P aragr aph 3. 10 . 4 fu rther provides: W h ile re c e iv in g M o n th lyD isa b ili tyP a ym e n ts, a P a rticip a n t sh a ll r emai n underthe r egul arand appr opr i at e ca r e and tr eatm entof a q u a lifie d P h y sic ian a n d , u p o n re q u e st o f th e P lan A d m in istra to r, sh a ll pr ovi de evi dence t her eof s at i s fac t oryt o the Pl an A dm i ni s tr at or . I f a Par t i ci pantfai l s ei thert o r emai n unders uch ca r e ort o pr ovi de s uch ev iden ce , the P lan A d m inistrator m ayterm inate su ch P arti cipa n t’ s M on thlyD i sabi l i tyP aym ents . Id. at418.K emperi s now know n as “B r oads pi r e. ” B utbeca us e i tw as know n as 2 K emperdur i ng the t i m e per i od i n ques t i on, w e cont i nue t o r efe rt o i tas “K emper . ”

- 4-

b. P roce dural H i s t ory 1. I ni t i al D eni al O n February27, 2002, the cl ai m s admi ni s tr at orfort he Pl an, K emper N a tio n a l S e rv ice s o f

K e m p e r In su ra n c e C o m p a n ies (K e m p e r), re q u e ste d c e rta in 2 updat ed medi cal i nform at i on fr om M s . M er aou. A ccor di ng t o a J ul y3, 2002, l ett ert o M s . M er aou fr om K emper , t hi s r eques tas ked hert o s uppl y“an A t t endi ng P h ys i c i a n S t a t e m e n ta l o n g w i th s i x m o n th [ s ] o f C u rr e n to ffi c e , s u r g e ry, t h e r a p y, tr eatm entand/ orchartnot es , al ong w i th m edi cal document at i on fr om y our tr eat i ng phy s i ci ans , i . e. , l abs , bl ood w or k, phy s i cal exam, M R I / x- r ayr es ul t s and an yo ther d iagn o sti c test resu lt s p ertaining to the co n d it ion fo r w h ich y o u are c u rr e n tly tre a te d fo r f ro m D r. W e ld o n a n d D r. T o m [ e c e k ].” Id. , V o l. I , a t 6 7 -6 8 . I n r es pons e M s . M er aou s uppl i ed an a t t endi ng phy s i ci an’ s s t at ementfr om D r . W el don. T he s t at ement , how ever , w as notacc om pani ed byt he r eques t ed p ro g re s s n o te s . O n A pr i l 24, 2002, K emperr eques t ed thatM s . M er aou make an ap p o intm en t w ith D r. T o m ec ek , as T W C h ad p rep aid fo r an att en d ing p h y sici an ’s s t at ementand s i x m onths of curr entpr ogr es s not es fr om hi m . O n M ay16, 2002, M s. M era o u ad v ised K em p er tha t a ne w p h y sici an , D r. A n tho n y , w as treating h er,- 5-

and thats he w oul d have hi m s end s i x m onths of pr ogr es s not es . A s of J ul y3, 2002, how ever , s he had nots uppl i ed the att endi ng phy s i ci an’ s s t at ement s and pr ogr es s not es fr om D r s . T om ece k and A nthony , orthe pr ogr es s not es fr om D r . W el don. K emperw arned herthati f s he fa i l ed t o s uppl ythi s i nform at i on by J ul y30, 2002, herdi s abi l i tybenef i t s w oul d be t erm i nat ed effec t i ve A ugus t5, 2002. W hen the document s w er e notr ece i ved byA ugus t6, 2002, K emper uns ucce s s ful l yatt empt ed t o r eac h M s . M er aou byt el ephone. B yl et t erdat ed A ugus t7, 2002, K empernot i fi ed M s . M er aou thatherL T D benef i t s had bee n t erm i nat ed effec t i ve A ugus t1, 2002, beca us e of he rfai l ur e t o s uppl ythe re q u e s te d in fo rm a tio n .

2. F i rs t - l evelA ppeal K emperr ece i ved M s . M er aou’ s fi r s t - l evel admi ni s tr at i ve appe al on A ugus t29, 2002. O n Sept ember17, 2002, M s . M er aou fa xed t o K empert hr ee m edi cal r ecor ds t o be cons i der ed i n connec t i on w i th herappea l : an i ni t i al - offi cevi s i t - and- eval uat i on r eportfr om D r . T om ece k dat ed J anuary22, 2001; an oper at i ve r eportfr om D r . T om ece k dat ed February9, 2001; and a l et t erfr om D r . W el den t o K emper ’ s A ppeal s D i vi s i on dat ed A ugus t22, 2002, conce rni ng M s . M er aou’ s di agnos es and tr eatm ent . I n addi t i on, on A ugus t16, 2002, D r . W el den t el ephoned i n a r eportt o the A ppeal s D i vi s i on, w hi ch r eac hed them b e fo re th e a p p e a l h a d a c tu a llyb e e n filed . O n S e p tem b e r 2 3 , 2 0 0 2 , K e m p e r w ro te- 6-

t o M s . M er aou, r eques t i ng a 30- dayext ens i on t o s uppl yherw i th a w r i t t en d e c is io n , in o rd e r t o p e rm it K e m p e r t o re v ie w a ll th e in fo rm a tio n in h e r file . A tt hi s poi nti n the appe al s pr oces s , the emphas i s s eems t o have e xpanded fr om the pr ocedur al i s s ue of M s . M er aou’ s fai l ur e t o s uppl ythe r eques t ed medi cal r ecor ds t o i ncl ude the addi t i onal , s ubs t ant i ve ques t i on of w hethers he r emai ned di s abl ed. T hus , on Sept ember23, 2002, K emperr efe rr ed the ca s e t o a cons ul t i ng p h y sici an sp ec ial izi n g in intern al m ed ici n e a n d en d o crino log y , D r. T am ara B ow m an, t o pr epar e a pe er - t o- peerr evi ew des i gned t o ans w erthe fol l ow i ng q u e s t i o n : “ Doe s t h e me d i c a l e v i d e n c e s u b mi t t e d s u p p o r ta d i s a b i l i tyf r o m 8/ 1 / 0 2 ? I f does nots uppor t , pl eas e i ndi cat e det ai l ed r eas ons w hyand w hatcan be s enton appea l thatw oul d s uppor ta func t i onal i m pai r m ent . ” A pl t . Supp. A pp. , V ol . I , at 234. A ft erexami ni ng s t at ement s fr om M s . M er aou, m edi cal r ecor ds fr om D r . W el den and D r . R oy al , an ana es thes i ol ogi s t , and cl i ni cal r ecor ds fr om the W elfitM ed ical C li n ic an d the P ain E v alua ti o n an d T rea tm en t C en ter, D r . B ow m an det erm i ned thatt he evi dence “[f] ai l [ed] t o s uppor t[di s abl i ng] funct i onal i m pai r m ent ( s ) , ” i d. She s ugges t ed that“[i ] f addi t i onal document at i on w er e t o be s ubm i t t ed on appe al , then a f unct i onal capa ci tyeval uat i on and r ece nt compre hens i ve muscul os kel et al , j oi nt , and neur ol ogi c exa m i nat i ons w oul d be m os tr el evant . ” Id. a t 2 3 7 . O n O c to b e r 2 8 , 2 0 0 2 , K e m p e r re q u e ste d a n a d d iti o n a l 3 0 -d a ye x ten sio n to r evi ew i t s fi l e, pr om i s i ng a dec i s i on byN ovember22, 2002. K emperthen- 7-

obt ai ned an e m pl oy abi l i ty - as s es s m entr eportand a l abor - m arkets ur vey , w hi ch i ndi cat ed thatM s . M er aou coul d do s edent arys ki l l ed and s emi - s ki l l ed w or k, and thatw i thi n 50 m i l es of herhom e ther e w er e j obs avai l abl e of the type thats he had p re v io u slyp e rfo rm e d . O n D e c e m b e r 6 , 2 0 0 2 , K e m p e r n o tifie d M s. M e ra o u th a t it h a d c o mpl e t e d i t s r e v i e w of h e ra p p e a l . I tu p h e l d th e d e c i s i o n t o d e n yh e rLTD b e n e fits, b e c a u se o f

“ a lac k o f

m e d ica l ev id e n c e to su p p o rt [ h e r] in a b ili tyto per form s edent aryw or k. ” Id. a t 2 5 6 .

3. Second- l evelA ppeal M s . M er aou obt ai ned the s ervi ces of couns el , w ho s ubm i t t ed a s econd- l evel appea l ( m ot i on forr econs i der at i on) on J anuary22, 2003. M s . M er aou r eques t ed an ext ens i on of 30 day s t o s ubm i taddi t i onal evi dence and ar gum ent s i n s uppor tof h e r a p p e a l. S h e th e re a f ter re q u e ste d , an d K e m p e r g ra n ted , fu rth e r e x ten sio n s to p e rm it h e r to su b m it ad d iti o n a l ev id e n c e . K e m p e r g ra n ted a fin a l ex ten sio n to J u ly 7 , 2 0 0 3 , s ta tin g th a t n o f u rt h e r e x te n s io n s w o u ld b e g ra n te d . O n M ay29, 2003, M s . M er aou s entK emperhervi deot aped s t at ement to g e th e r w ith a tr a n s c ri p t, a n d o n J u ly 3 s h e s e n t r e c o rd s f ro m D r. C ra s s , a p s y c h o l o g i s t . Du r i n g J u l y2 0 0 3 Ke mp e ro b t a i n e d a d d i t i o n a l p e e rr e v i e ws , f r o m a doct orof i nt ernal m edi ci ne, D r . R us s el l Super fi ne; a rheumat ol ogi s t , D r . Shel don Z ane; an orthopedi c s ur geon, D r . I r a Pos ner ; and a ps y chol ogi s t , D r . E l ana M en d elsso h n . E ac h o f th ese d o ctors o p ined , b ase d o n a re v iew o f M s. M era o u ’s m edi cal r ecor ds , thats he w as notdi s abl ed. A ddi t i onal l y , byA ugus t4, 2003,- 8-

D r . B ow m an had c onduct ed a s uppl ement al peerr evi ew , bas ed on addi t i onal r ecor ds fr om D r s . A nthony , W el don, and R oy al , and addi t i onal hos pi t al i zat i on and off i ce- vi s i tnot es , t hatr eac hed the s ame concl us i on as herpr evi ous peer re v ie w : M s . M e ra o u w a s n o t f u n c tio n a lly im p a ir e d . O n A ugus t13, 2003, M s . M er aou r eques t ed an a ddi t i onal del ayof K e m p e r’s d e c isio n fo r 3 5 d a y s, in o rd e r to o b tain a th re e -d a yf u n c tio n a l ca p a c ity exami nat i on. She al s o r eques t ed thatK emperpayforthe exa m i nat i on. K emper rejec ted th e re q u e st fo r p a ym e n t b u t g ra n ted th e p o stp o n e m e n t. O n S e p tem b e r 5 , 2 0 0 3 , M s. M e ra o u re q u e ste d th a t K e m p e r f u rth e r d e lay i ts deci s i on on hercl ai m unt i l i t s O ct ober2003 m eet i ng. C ouns el expl ai ned that M s. M e ra o u h a d a rra n g e d fo r n e u ro p sy c h o lo g ica l tes tin g b u t w o u ld b e fin a n c ially unabl e t o have a funct i onal - capa ci tyt es tper form ed. O n O ct ober7, 2003, M s . M er aou not i fi ed K emperthats he had pos tponed the neur ops y chol ogi cal exam u n til O c to b e r 2 8 , 2 0 0 3 , an d re q u e ste d a d e lay of th e re v iew o f

h e r c laim u n til D e c e m b e r 1 1 , 2 0 0 3 . O n O ct ober28, 2003, M s . M er aou w as s een byD r . Sher m an, w ho co n d u cted a n eu rop sy ch o log ical ex am ination . B yN o v em b er 1 4 , 2 0 0 3 , h o w ev er, K e m p e r h a d n o t re c e iv e d th e re c o rd o f th is e x a m in a tio n , an d o n th a t d a te it advi s ed M s . M er aou thats he s houl d s ubm i tthe r ecor d of the exa m i nat i on by N ovember26, 2003, t o be ava i l abl e forcons i der at i on atthe D ece m ber11, 2003, m eet i ng. K empers t at ed thati f the r ecor d w er e s ubm i t t ed af t erN ovember26,- 9-

2003, herappea l w oul d be cons i der ed atthe J anuary2004 m eet i ng; and i f the recor d w as not s ub m i t t ed b yD ecem ber 18, 2003 , her app eal w ou l d n evertheles s be dec i ded att he J anuarym eet i ng w i thoutcons i der at i on of the addi t i onal in fo rm a tio n . M s . M e ra o u fo rw a rd e d th e re c o rd o n N o v e m b e r 2 1 , 2 0 0 3 . O n D ece m ber11, 2003, t he Pl an’ s A dm i ni s tr at i ve C om m i t t ee metand cons i der ed M s . M er aou’ s appea l . A ft erthor oughl yr evi ew i ng and di s cus s i ng t he m edi cal and otherevi dence pr ovi ded, the C om m i t t ee una ni m ous l yvot ed t o deny the appe al . I n a l ett ert o M s . M er aou’ s att orney , the C om m i t t ee e xpl ai ned that bas ed upon i t s r evi ew of the medi cal i nform at i on and document at i on pr ovi ded, “the C om m i t t ee ha s concl uded thatM s . M er aou i s capa bl e of e ngagi ng i n a gai nful occupa t i on as defi ned i n the Pl an, and ther efor e i s not‘ t ot al l ydi s abl ed’ u n d e r t h e P la n ’s d e fin itio n , a s a p p lic a b le to M s . M e ra o u .” A p lt. S u p p . A p p ., V o l. I I, a t 3 9 7 . 4. D i s t ri ct - court R evi ew T h e E mp l o yme n tRe t i r e me n tI n c o me S e c u r i tyAc to f 1 9 7 4 ( E RI S A) pr ovi des t hata pl an part i ci pantm aybr i ng a ci vi l act i on “t o r ecove rbenef i t s due t o hi m underthe t erm s of hi s pl an, t o enfor ce hi s r i ght s undert he t erm s of the pl an, ort o cl ar i fyhi s r i ght s t o futur e bene fi t s undert he t erm s of the pl an. ” 2 9 U .S .C . § 1 1 3 2 (a )(1 )(B ). A c tin g u n d e r th is p ro v isio n , M s. M e ra o u filed in d is tr ic t c o u rt a c o m p la in t fo r r e v ie w o f th e te rm in a tio n o f

h e r L T D b e n e fits . A f ter a n a ly z in g th e e v id e n c e th e c o u rt d e ter m in e d th a t T W C ’s d e c isio n to- 10-

t erm i nat e M s . M er aou’ s L T D benef i t s w as s uppor t ed bys ubs t ant i al evi dence and w as notarbi tr aryand capr i ci ous . I tther efor e uphel d the dec i s i on t erm i nat i ng b e n e fits . II . A n a ly sis a. St andard of R evi ew T her e i s no di s put e thatthe Pl an expr es s l ygi ves t he A dm i ni s tr at i ve C o m m itt e e “ so le a n d a b so lu te d isc re tio n ” to d e ter m in e “ w h e th e r to g ra n t o r to d e n ya n yc la im fo r b e n e fits u n d e r t h is P la n .” A p lt. S u p p . A p p ., V o l. I I, a t 4 2 4 . “Ther efor e, w e appl yan arbi tr aryand capr i ci ous s t andar d t o [the Pl an] admi ni s tr at or ’ s act i ons . ” A l l is o n v . UN UM L i f e In s . Co . o

f A m. , 381 F. 3d 1015, 1021 ( 10th C i r . 2004) ( br acke t s and i nt ernal quot at i on m arks om i t t ed) . “The d istric t co u rt’s d e ter m in a tio n o f w h e th e r a p lan a d m in istra to r’s d e c isio n is arbi tr aryand ca pr i ci ous i s a l egal concl us i on s ubj ectt o de novo r evi ew . ” R eks tad v. U. S. B an corp , 4 5 1 F .3 d 1 1 1 4 , 1 1 1 9 (1 0 th C ir . 2 0 0 6 ).

“ In d e ter m in in g w h e th e r [ th e A d m in istra tiv e C o m m itt e e ’s] d e c isio n is arbi tr aryand ca pr i ci ous , w e cons i deronl yt he ar gum ent s and evi dence befor e the admi ni s tr at oratthe t i m e i tm ade thatdeci s i on and dec i de: ( 1) w hethers ubs t ant i al ev iden ce su p p o rt ed [th e a d m inistrator’s] de cisi o n ; ( 2 ) w h ethe r [the ad m inistrator] b ase d it s d ec isi o n o n a m ist ak e o f law ; and (3) w h ethe r [the ad m inistrator] conduct ed i t s r evi ew i n bad fa i th orundera conf l i ctof i nt er es t . ” F i nl ey v . Hew l et t - P ackard C o. E mpl oyee B enef i ts O rg. Incom e Prot . P lan , 379 F. 3d 1168,- 11-

1 1 7 6 (10 th C ir . 2 0 0 4 ) (i n terna l qu o tat ion m ark s o m itted). “T h e A d m inistrator’s deci s i on need notbe the onl yl ogi cal one noreven the bes tone. I tneed onl ybe s uffi ci ent l ys uppor t ed byfac t s w i thi n hi s know l edge t o count era cl ai m thati tw as arbi tr aryorcapr i ci ous . T he dec i s i on w i l l be uphel d unl es s i ti s notgr ounded on anyr eas onabl e bas i s . ” Id. (i n terna l qu o tat ion m ark s o m itted).

b. Sub s t ant i al E vi dence M s . M er aou cont ends thatthe A dm i ni s tr at i ve C om m i t t ee’ s deci s i on l acke d s ubs t ant i al evi dence , “[p] art i cul ar l yi n l i ghtof the overw hel m i ng evi dence of di s abi l i ty . ” A pl t . O peni ng B r . at26. A s w e have not ed, t he A dm i ni s tr at i ve C om m i t t ee obt ai ned opi ni ons fr om fi ve cons ul t i ng phy s i ci ans w ho opi ned that M s. M e ra o u h a d fa iled to e sta b lish a d isa b ili tyu n d e r th e d e fin iti o n c o n tain e d in the Pl an. A ddi t i onal l y , D r . Sher m an, t he neur ops y chol ogi s tw ho conduct ed an i ndepende ntexami nat i on on behal f of M s . M er aou, di d notexpr es s l yfi nd her di s abl ed fr om al l w or k. A l though he s ai d that“the combi nat i on of herongoi ng phy s i cal and emot i onal s ym pt om s l i kel yr enderherunabl e t o r etur n t o her pr evi ous w or k as a s y s t ems ana l y s t , ” A pl t . Supp. A pp. , V ol . I , at11, he adde d thatfur thertr eatm ents houl d “ena bl e s om e degr ee of vocat i onal funct i oni ng” and th a t “r e fe rra l fo r c o m p re h e n siv e v o c a tio n a l ev a lu a tio n fo llo w in g a p p ro p ria te ps y chother apeut i c tr eatm entw i l l be hel pful i n fac i l i t at i ng s om e type of ga i nful empl oym ent , ” i d.- 12-

T he fa ctthatM s . M er aou’ s per s onal phy s i ci an, D r . W el den, r eac hed an oppos i ng concl us i on conce r ni ng di s abi l i tyi s not , i n and of i t s el f, a bas i s for re v e rs a l. S e e , e .g ., Jo h n s o n v . Me tr o . L ife In s . C o ., 4 3 7 F . 3 d 8 0 9 , 8 1 4 (8th C ir . 2006) ( “W hen ther e i s a conf l i ctof opi ni on betw een a cl ai m ant ’ s tr eat i ng phy s i ci ans and the pl an admi ni s tr at or ’ s r evi ew i ng phy s i ci ans , the pl an ad m inistrator h as d iscreti o n to d en yb en efit s u n less the re co rd d o es n o t sup p o rt d en ial . ”); E l l i ot tv. Sar a Lee C or p. , 190 F. 3d 601, 606 ( 4th C i r . 1999) ( pl an fid u ciarym ayd en yd isab il ityb en efit s w h en co n fli cti n g m ed ical op inion s are p re se n ted ); s ee als o Sandovalv. A etna Li f e & C as . Ins . C o. , 967 F. 2d 377, 382 ( 10th C i r . 1992) ( pl an admi ni s tr at orcoul d r el yon phy s i ci an’ s r eportconcl udi ng cl ai m antw as notdi s abl ed w hen i tdet erm i ned thatthe r eport“w as m or e det ai l ed, thati tcont ai ned more obj ect i ve medi cal fi ndi ngs , and thathi s concl us i ons m ade m or e s ens e bas ed on the medi cal evi dence ” than a c om pet i ng r eportconcl udi ng cl ai m antw as di s abl ed) . I n E R I SA cas es no s peci al defe r ence i s due the opi ni on o f th e c la im a n t’ s tr e a tin g p h y s ic ia n . See B lack & D ecker D isabil i t y P lan v. Nord , 5 3 8 U .S . 8 2 2 , 8 2 5 (2 0 0 3 ). A lth o u g h M s. M e ra o u su g g e sts th a t co n su ltan ts empl oy ed bythe Pl an mayhave f i nanci al i ncent i ves t o m ake a fi ndi ng of “not di s abl ed, ” A pl t . O peni ng B r . at26, t he Supr eme C our thas r ecogni zed that c o n tr a ry in c e n tiv e s m a ya ls o m o tiv a te a c la im a n t’ s tr e a tin g p h y s ic ia n . See Bl ack & D ecker , 5 3 8 U . S . at 83 2 (“[ A ] trea ti n g p h y sici an , in a c lose ca se, m ayfa v o r a fin d ing o f ‘d isab led.’”).- 13-

M s. M era o u ch all en g es th e v ali d ityo f th e c o n su lt an ts’ o p inion s, h o w ev er, o n se v e ra l sp e c ific g ro u n d s. F irst, sh e a ss e rts th a t th e c o n su ltan ts im p ro p e rly re lied o n a lac k o f

o bjec tiv e e v id e n c e to su p p o rt th e e x iste n c e o f h e r a lleg e d ly di s abl i ng condi t i ons . Second, s he cl ai m s thatthe cons ul t ant s fai l ed t o cons i der the combi ned effec tof heri m pai r m ent s on herabi l i tyt o w or k. T hi r d, s he chall eng es D r. B ow m an’s eval uati on of h er fi brom y al gia. W e turn no w t o those s p e c ific c h a lle n g e s .

1 . O b jec ti v e E v ide n ce o f D isab il it y M s . M er aou ar gues thatthe cons ul t ant s ’ opi ni ons w er e fl aw ed bec aus e they di d notdenythats he has the var i ous condi t i ons t hats he cl ai m s t o be di s abl i ng, butneverthel es s r equi r ed “r ece ntobj ect i ve t es t i ng t o i ndi cat e thes e condi t i ons exi s t . ” A pl t . O peni ng B r . at25. She cont ends t hati n l i ghtof the di agnos es re c e iv e d f

ro m h e r o w n d o c to rs o v e r th e y e a rs, it sh o u ld h a v e b e e n u n n e c e ss a ryto p ro v id e o bje c tiv e fin d in g s to s u b s ta n tia te th e e x is te n c e o f h e r c o n d itio n s . M s . M er aou’ s ar gum entr es t s i n l ar ge parton a mi s under s t andi ng of the cons ul t ant s ’ opi ni ons . Forthe mostpartt he cons ul t ant s di d nots t at e that M s . M er aou nee ded obj ect i ve evi dence t o documentt he exis t ence of herm edi cal c o n d iti o n s, a lre a d yd iag n o se d b yh e r d o c to rs. O bjec tiv e e v id e n c e , in th e ir opi ni on, w as nece s s arypr i m ar i l yt o confi r m t he dis abl i ng se v e rity of these c o n d itio n s .- 14-

D r. B o w m a n , fo r e x a m p le, a c k n o w led g e d th a t M s. M e ra o u “ h a s m u lti p le m e d ica l co n d iti o n s, in c lu d in g a se izu re d iso rd e r, h isto ryo f p o sitiv e rh e u m a to id fac t or , l um barand ce r vi cal di s c di s eas e, fi br om y al gi a, and mi gr ai ne hea dache s . ” A pl t . Supp. A pp. , V ol . I , at237. She not ed, how ever , the l ack of evi dence reg ard ing the c u rren tl yd isab li n g sev erityo f th ese co n d it ion s. S p ec ifi ca ll y , there w as no document at i on conce r ni ng M s . M er aou’ s r es pons e t o r ece ntm edi cal pr ocedur es per form ed t o al l evi at e pai n, the func t i onal defi ci t s r es ul t i ng fr om her a lleg e d d isc d ise a se , an yse izu re a c tiv ityw ith in th e p a st y e a r, o r a n ya c tiv e ly di s abl i ng arthr i t i s s ym pt om s . D r . B ow m an conc l uded thatthe ava i l abl e obj ect i ve e v id e n c e d id n o t e s ta b lis h th e d is a b lin g n a tu re o f h e r m e d ic a l c o n d itio n s . D r . Posne rnot ed M s . M er aou’ s “pos i t i ve di s cogr am atL 4- 5, ” her compl ai nt s of pai n, and the r el i ef s he obt ai ned fr om s pi nal bl ocks and abl at i on th e ra p ie s . Id. , V ol . I I , at323. B uthe conc l uded that“ther e i s no obj ect i ve document ed phy s i cal fi ndi ngs i n the medi cal r ecor ds w hi ch w oul d, fr om an o rth o p e d ic p o in t o f

v iew , ind ica te th a t th is c laim a n t is f u n c tio n a llyto tally di s abl ed fr om per form i ng anyoccupa t i on. ” Id. D r. P o sn e r c o n c lu d e d th a t, beca us e of the l ack of obj ect i ve evi dence , he coul d notquant i fythe effec tof M s . M er aou’ s s pi nal i m pai r m ent s on herabi l i tyt o w or k. D r . M endel s s ohn acknow l edged thatM s . M er aou had a hi s t oryof depr es s i on and coul d be expe r i enci ng emot i onal and cogni t i ve di ffi cul t i es . She not ed, how ever , that“the mostr ece ntdocument at i on does notpr ovi de obj ect i ve- 15-

fi ndi ngs orbehavi or al obs ervat i ons s ubs t ant i at i ng how the cl ai m ant ’ s di ffi cul t i es ar e i m pact i ng herfunct i oni ng and pr event i ng herfr om per form i ng us eful w or k. ” Id. at327. A l though D r . Z ane a cknow l edged M s . M er aou’ s “s l i ght l ypos i t i ve R A /A N A ” (a p p a re n tly re fe rr in g to ra g o c yte a n d a n tin u c le a r a n tib o d y , s ee McMan us v. B arnh art , N o. 5: 04- C V - 67- O C - G R J , 2004 W L 3316303, at*4 nn. 37, 38 ( M . D . Fl a. D ec. 14, 2004) ) , he “c oul d notfi nd anycl i ni cal evi dence of o bj e c t i v e j o i n tfi n d i n g s , r a s h e s , a n d h e p a t o - r e n a l i n v o l v e me n tt o c o n fi r m a connec t i ve t i s s ue di s or ders uch as R heumat oi d A r thr i t i s orSy s t emi c Lupus. ” A p lt. S u p p . A p p ., V o l. I I, a t 3 2 0 . D r. S u p e rfin e a g re e d th a t M s. M e ra o u su ffe rs f ro m “ fa tig u e , a p o ss ib le connec t i ve t i s s ue di s or der , heada ches , s ei zur e di s or der , i rr i t abl e [bow el ] and pos t - m enopaus al s yndr om es . ” Id. at 31 7 . B u t he c o n clud ed that there w ere

“ in su fficie n t p h y sic a l an d d iag n o stic fin d in g s to su p p o rt a f u n c tio n a l im p a irm e n t” o f d is a b lin g s e v e ri ty. Id. T he cons ul t ant s di d concl ude, i n s om e i ns t ance s , thatthe di agnos es of part i cul arai l m ent s w er e unr el i abl e bec aus e theyw er e bas ed on s ubj ect i ve re p o rt in g o r w e re u n s u p p o rt e d b ya v a ila b le o bje c tiv e te s tin g o r o th e r d a ta . See, e. g. , i d. at326 ( “[I ] tdoes notappea rthatanybehavi or al obs ervat i ons orobj ect i ve d a ta [ c o n c e rn in g d e p re ss io n ] w e re d o c u m e n ted . R a th e r, th is n o te p rim a rily p rov ides self rep o rt ed sym p tom s. ”). E v en a re li an ce o n this reaso n ing , h o w ev er,- 16-

w oul d nothave be en arbi tr aryand capr i ci ous . T he Pl an pr ovi des that“‘ T ot al D i s abi l i ty ’ m eans the i nabi l i tyof [the] Par t i ci pant , bas ed upon conclus i ve m edi cal evi dence , to e n g a g e in a n yg a in f u l o c c u p a tio n fo r w h ich h e o r sh e is re a so n a b ly fi t t ed byeduca t i on, t r ai ni ng orexper i ence , as det erm i ned bythe Pl an A dm i ni s tr at or . ” Id. a t 4 0 4 (e m p h a sis a d d e d ). M s. M e ra o u fa ils to sh o w th a t it w a s u n re a so n a b le fo r th e C o m m itt e e to in terp re t th is d e fin iti o n to re q u ire re c e n t, obj ect i ve evi dence of the exi s t ence of a c ondi t i on, part i cul ar l yw hen the cons ul t i ng phy s i ci ans s t at ed thats uch evi dence s houl d have be en pr ovi ded but w as not . “G ener al l y , i ti s notunr eas onabl e fora pl an admi ni s tr at ort o deny benef i t s bas ed upon a l ack of obj ect i ve evi dence . ” Johns on , 437 F. 3d at813 (b ra c k e ts a n d in ter n a l q u o tatio n m a rk s o m itt e d ); s ee als o, e. g. , K i m berv. Thi okol C or p. , 1 9 6 F .3 d 1 0 9 2 , 1 0 9 9 (1 0 th C ir. 1 9 9 9 ) (“ A ra tio n a l p lan a d m in istra to r c o u ld fin d [ a lette r a n d tw o re p o rts b ya p h y sic ian ] in su fficie n t [ to e sta b lish d isa b ili ty bas ed on di abet es ] beca us e theydo notcont ai n s uppor t i ng dat a forthe c o n c lu s io n s re a c h e d .” ).

2. C om b i n ed E ffect of Im p airm en ts M s. M eraou co m plai ns t hat none of the con sul t ants w as asked to address D r. W e ld e n ’s c o n c lu sio n th a t itis th e c o m b in a tio n o f M s. M e ra o u ’s im p a irm e n ts thathas m ade he rdi s abl ed. She cont ends t hatbyas ki ng m anydi ffe r ent s peci al i s t s abouthervar i ous condi t i ons , t he C om m i t t ee e val uat ed ea ch of he r- 17-

di s abl i ng condi t i ons i n a “va cuum, ” an i ndi cat orof bad fai th. A pl t . O peni ng B r . at27. B utther e i s no r eas on t o doubtthatthe C om m i tt ee’ s deci s i on w as bas ed on cons i der at i on of a c om bi nat i on of M s . M er aou’ s condi t i ons . M or eover , gi ven the abs ence of s uffi ci entevi dence ( i n t he vi ew of the i ndi vi dual s peci al i s t s ) of f u n c tio n a l li m itatio n s re su lti n g f ro m a n yo f

h e r c o n d iti o n s, it w o u ld b e e m in e n tly re a so n a b le to in fe r th a t th e c o m b in a tio n o f h e r c o n d iti o n s w o u ld n o t re su lt i n d i s a b i l i ty. 3 . D r . B o w m a n ’s E v a lu a tio n o f F ib r o m y a lg ia M s . M er aou t akes i s s ue w i th D r . B ow m an’ s eval uat i on of herfi br om y al gi a. She ar gues thatthe evi dence thats he pr oduced c oncerni ng thi s condi t i on w as s uffi ci entt o es t abl i s h di s abi l i ty . She s peci fi cal l ycr i t i ci zes D r . B ow m an for r equi r i ng obj ect i ve evi dence of a c ondi t i on w hi ch, byi t s verynatur e, can be e s ta b lis h e d o n ly b yth e re p o rt o f a p a tie n t’ s s u bje c tiv e s ym p to m s . See Welch v. UN UM L i

f e In s . Co . o

f A m. , 3 8 2 F .3 d 1 0 7 8 , 1 0 8 7 (1 0 th C ir. 2 0 0 4 ) (fib ro m y a lg ia pr es ent s conundrum fori ns ur er s and court s beca us e no obj ect i ve t es texi s t s for p rov ing the d isease , it s ca u se o r ca u ses a re u n k n o w n , an d it s sym p tom s are e n tir e ly su bje c tiv e ). Fi br om y al gi a i s a di s or der“‘ char act er i zed byachypai n, t endernes s and s t i ffne s s of m us cl es , ar eas of t endon i ns er t i ons and adj ace nts oft - t i s s ue s tructur es . ’ ” G i l ber ts on v. A l l i ed Signal, Inc. , 3 2 8 F . 3 d 6 2 5 , 6 2 7 n . 1 (10 th C ir .- 18-

2003) ( quot i ng The Mer ck Manual481 ( 17th ed. 1999) ) . T he condi t i on can be di agnos ed more orl es s obj ect i vel ybyexami ni ng forpai n 18 tr i ggerpoi nt s on t he b o d y . See Haw ki ns v. F i rs tUni on C or p. Long- Ter m D is abi l i t y Pl an , 326 F. 3d 914, 919 ( 7th C i r . 2003) . D r . W el den’ s not es i ndi cat e thatM s . M er aou exper i ence d pai n at18 outof 18 of thes e tr i ggerpoi nt s . D r . B ow m an acknow l edged the di agnos i s of fi br om y al gi a, butr ej ect ed the as s er t i on thati tw as o f d isa b lin g se v e rity , sta tin g th a t M s. M e ra o u “ is n o ted to h a v e fa tig u e a n d p a in s econda ryt o fi br om y al gi a. T hes e ar e both s ubj ect i ve s ym pt om s . T he pr es ence of tr igg er p o ints [alo n e] w o u ld n o t con sti tute a d isab il ity . ” A p lt . S u p p . A p p . , V o l. I, at237. M s . M er aou ar gues thatD r . B ow m an’ s comm ent s do notpr ovi de a convi nci ng r at i onal e forconcl udi ng thatherfi br om y al gi a w as notdi s abl i ng. She cont ends t hatdi s abi l i tycannotbe r ej ect ed s i m pl ybeca us e fi br om y al gi a i nvol ves onl ys ubj ect i ve s ym pt om s . I f thi s w er e true, fi br om y al gi a coul d neverbe d is a b lin g , a p ro p o s itio n th a t c o u rt s h a v e reje c te d . See Haw ki ns , 3 2 6 F .3 d a t 9 1 9 . S he als o argue s that tri gg er poi nts are i nd i cat ors of the u nd erl y i ng dis ease process that are u sed as a d iagn o sti c too l, an d that D r. B o w m an ’s co m m en t th at th eir m ere e x iste n c e d o e s n o t co n stitu te a d isa b ili tyis th e re fo re irre lev a n t an d in c o rre c t. W e not e, how ever , t hatt he C om m i t t ee di d notexpr es s l yadopt D r. B o w m a n ’s r e a so n in g . It i n d ica ted in ste a d th a t itc o u ld n o t cr e d it M s . M er aou’ s al l egat i ons conce r ni ng fi br om y al gi a w i thoutm or e compr ehens i ve- 19-

e v id e n c e c o n c e rn in g h e r re c e n t m e d ica l co n d iti o n , w h ich M s. M e ra o u fa iled to supp l y . A l tho ug h ack no w l edg i ng the d i agn osi s of fibr om y al gia, i tst at ed thatas a gener al m att er“ther e i s no document at i on w i thi n the l as ty earof compre hens i ve m us cul os kel et al , j oi nt , orneur ol ogi c exa m i nat i ons t o s uppor ta s i gni fi cant f u n c tio n a l im p a ir m e n t th a t w o u ld p re c lu d e y o u f ro m w o rk in g .” A p lt. S u p p . A p p ., V o l. I, a t 2 5 6 . In v iew o f th is d e ficie n c y , M s. M e ra o u w a s a d v ise d to su b m it m e d ic a l d a ta to s u p p o rt h e r a p p e a l, in c lu d in g , b u t n o t lim ite d to , a “C om pr ehens i ve R heumat ol ogyeval uat i on. ” Id. A s w e have not ed, s he s ubm i t t ed s om e addi t i onal i nform at i on, aft erm uch del ay , butnota compr ehens i ve exami nat i on bya rheumat ol ogi s t . D eni al of bene fi t s i s perm i s s i bl e w hen the all eg ed lyd isab li n g co n d it ion h as b ee n estab li sh ed o n lyb ythe c lai m an t’ s s ubj ect i ve compl ai nt s , and the cl ai m anthas fai l ed t o s uppl yr eques t ed i nform at i on thatw oul d al l ow t he admi ni s tr at ort o det erm i ne the ongoi ng effectof the c o n d itio n . See J

or dan v. Nor thr op G r um m an C or p. Wel f ar e Benef

i tP lan , 3 7 0 F .3 d 8 6 9 , 8 7 7 (9 th C ir . 2 0 0 4 ). I n the ca s e of a di s eas e s uch as fi br om y al gi a, the cl ai m ant ’ s s ubj ect i ve, u n co rrob o rated co m p lai n ts of p ain c o n sti tute the o n lyev iden ce o f th e a il m en t’ s s ever i ty . T he medi cal i nqui r yi s ther efor e i nt er tw i ned w i th ques t i ons of the c la im a n t’ s c re d ib ility, w h ic h a re th e p ro v in c e o f th e P la n a d m in is tr a to r. See i d. at 878 ( “W i t h a condi t i on s uch as fi br om y al gi a, w her e the appl i cant ’ s phy s i ci ans d ep en d en ti relyo n the p ati en t’ s p ain re p o rt s fo r th eir diag n o ses, th eir ip se d ixit- 20-

cannotbe uncha l l engea bl e. T hatw oul d s hi ftthe di s cr et i on fr om the admi ni s tr at or , as t he pl an r equi r es , t o the phy s i ci ans chos en bythe appl i cant , w ho d e p e n d fo r t h e ird ia g n o s e s o n th e a p p lic a n t’ s re p o rt s to th e m o f p a in .” ). M s. M e ra o u fa ils to sh o w th a t th e C o m m itt e e ’s d e c isio n , b a se d o n h e r fa ilu re to s ubm i tr ece nt , compre hens i ve medi cal evi dence s uffi ci entt o es t abl i s h the d isab li n g n ature o f h er fibro m y algia, w as a rbitraryan d ca p ri ciou s. W e the refo re reje c t h e r c h a lle n g e to th is a s p e c t o f th e C o m m itte e ’s d e c is io n . c. Soci al Securi t y D i s abi l i t y D et erm i nat i on T h e P lan re q u ire d M s. M e ra o u to a p p lyfo r S o c ial S e c u rityd isa b ili ty b e n e fits a s a c o n d iti o n o f re c e iv in g b e n e f

its u n d e r th e P lan . T h e S o c ial S e c u rity A dm i ni s tr at i on found hert ot al l ydi s abl ed, effect i ve J ul y1992, and has cont i nued t o payherbenef

i t s s i nce thatfi ndi ng w as m ade. M s . M er aou appe ar s t o ar gue th a t in lig h t o f

th e re d u c tio n in c o st to th e P lan o f h e r re c e ip t o f

S o c ial S e c u rity benef i t s overm anyy ear s , the Pl an s houl d now be es t opped fr om t erm i nat i ng her b e n e fits . T o adoptthi s pos i t i on, how ever , w oul d be t ant amount t o r equi r i ng the Pl an a d m in istra to r to c o n tin u e to p a yb e n e fits so lo n g a s S o c ial S e c u rityb e n e fits cont i nue. A s the di s tr i ctcourtnot ed, “The det erm i nat i on of di s abi l i tyundert he S o c ial S e c u rityre g im e c a n n o t b e e q u a ted w ith th e d e ter m in a tio n o f d isa b ili ty underthe ER I SA r egi m e. ” A pl t . A pp. at11 ( ci t i ng B lack & D ecker , 538 U . S. at 832) . W e r ej ectM s . M er aou’ s ar gum entt hatherpas tand cont i nued r ece i ptof- 21-

Soci al Secur i tydi s abi l i tybenef i t s r equi r ed TW C t o cont i nue t o paybenef i t s under the Pl an des pi t e i t s fi ndi ng thats he had fai l ed t o es t abl i s h herent i t l ementt o s uch c o n tin u e d b e n e fits u n d e r t h e P la n re q u ir e m e n ts .

d. E s t oppel B as ed on P ri or D i s abi l i t y D et erm i nat i on M s . M er aou ar gues thatbeca us e TW C found herdi s abl ed i n 1992 and her condi t i ons have onl yw or s ened s i nce then, i ts houl d be es t opped fr om t erm i nat i ng herbenef

i t s now . T he t erm s of the Pl an, how ever , r equi r ed hert o pr ove her cont i nued di s abi l i tybys uppl y i ng appr opr i at e medi cal r ecor ds . T he C om m i t t ee found thats he had fai l ed t o do s o. I f the t erm s of a Pl an “c ont empl at e[] t he o n g o in g re v iew o f

a ll d isa b ili tyc laim s,” th e in iti a l g ra n t o f d isa b ili tyb e n e fits “does notfor ecl os e s ubs equentpr i nci pl ed r evi ew . ” K i m ber , 1 9 6 F .3 d a t 1 0 9 8 .

e. D i s t ri ct - court R evi ew M s . M er aou ques t i ons w hethert he di s tr i ctcourtactual l ycons i der ed the r ecor d as a w hol e, part i cul ar l ys i nce i tfai l ed t o m ent i on the vi deot aped i nt ervi ew thats he s ubm i t t ed t o t he C om m i t t ee. B utbeca us e ourr evi ew of the di s tr i ct court ’ s deci s i on i s de novo, anys uch err orbyt he di s tr i ctcourtw oul d be im m a ter ial. T h e j u d g me n to f

th e d i s tr i c tc o u r ti s AF F I RMED . E n tered fo r th e C o u rt H a rris L H a rtz C i r cui tJ udge