Opinion ID: 2976436
Heading Depth: 4
Heading Rank: 1

Heading: Objective Evidence of Disability

Text: We next consider Huffaker’s argument that MetLife’s denial of disability benefits was arbitrary and capricious. MetLife contends that its denial was based on Huffaker’s failure to prove her disabled status under the terms of the Plan, namely because she provided insufficient objective evidence of disability. We first address whether the terms of the Plan allow MetLife to require that Huffaker present objective evidence of her disabled status. We hold that it may. The Plan provides that a beneficiary will receive disability benefits once the beneficiary is disabled as defined by the Plan, after the completion of an elimination period. The Plan defines “disabled” as follows: Disabled or Disability: You are Disabled if, due to sickness or pregnancy or accidental injury for which you are receiving Appropriate Care and Treatment from a Doctor on a continuing basis: -9- During the first 24 months that benefits under this Plan are paid to you, you are unable to perform each of the material duties of your Occupation. After benefits under this Plan are paid to you for 24 months, you are unable to engage in any business or occupation or to perform any work for compensation, gain or profit for which you are reasonably fitted by your education, training, background, or experience. This Court has previously held that a disability benefits plan employing similar eligibility requirements could require a claimant to provide objective evidence of disability. In Cooper v. Life Ins. Co. of N. America, we held that “[r]equiring a claimant to provide objective medical evidence of disability is not irrational or unreasonable.” Cooper v. Life Ins. Co. of N. America, 486 F.3d 157, 166 (6th Cir. 2007) (citing Spangler v. Lockheed Martin Energy Sys., Inc., 313 F.3d 356, 361 (6th Cir. 2002)). The definition of “disability” at issue in Cooper required that the claimant prove inability to perform “all the material duties of his or her Regular Occupation,” id. at 159-60, and did not explicitly require the claimant to provide objective evidence of disability. We found the administrator’s objective-evidence-of-disability requirement reasonable, explaining that “[o]bjective medical documentation of [the claimant’s] functional capacity would have assisted [the administrator] in determining whether [the claimant] was capable of performing ‘all the material duties of her Regular Occupation,’ as required by the [long-term disability plan]’s definition of disability.” Id. at 166. Here, Huffaker must similarly prove she is “unable to perform each of the material duties of [her] Occupation” to satisfy the Plan’s definition of “disability.” As in Cooper, MetLife could reasonably interpret the Plan’s language to require objective evidence of disability. See also Michele v. NCR Corp., No. 94-3518, 1995 WL 296331, at  (6th Cir. May 15, 1995) (holding that the administrator did not act arbitrarily or capriciously in denying long-term disability benefits for -10- chronic fatigue syndrome where the plan requires proof of total disability from “a bodily injury or disease”; and the claimant failed to present sufficient objective medical evidence of total disability). A claimant could certainly find burdensome a requirement that she proffer objective evidence of fibromyalgia itself, the symptoms of which are largely subjective.2 But objective evidence of disability due to fibromyalgia can be furnished by a claimant without the same level of difficulty. See Boardman v. Prudential Ins. Co., 337 F.3d 9, 16-17 n.5 (1st Cir. 2003) (“While the diagnos[is] of . . . fibromyalgia may not lend [itself] to objective clinical findings, the physical limitations imposed by the symptoms of such illness[] do lend themselves to objective analysis.”). One method of objective proof of disability, for instance, is a functional capacity evaluation, a “reliable and objective method of gauging” the extent one can complete work-related tasks. Cooper, 486 F.3d at 176 (Sutton, J., concurring in part, dissenting in part). In Johnson v. Metropolitan Life Ins. Co., 437 F.3d 809 (8th Cir. 2006), the Eighth Circuit held that a “plan administrator [can] require objective evidence of a disability, even when the claimant’s alleged disability stem[s] from fibromyalgia, so long as the administrator notified the claimant that her file lacked the required objective evidence.” 2 The Seventh Circuit has aptly described the difficulties in diagnosing fibromyalgia: [F]ibromyalgia, also known as fibrositis[,] 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, more precisely 18 fixed locations on the body (and the rule of thumb is that the patient must have at least 11 of them to be diagnosed as having fibromyalgia) that when pressed firmly cause the patient to flinch. Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914, 916 (7th Cir. 2003) (internal quotation marks, alterations, and citations omitted). -11- Id. at 814 (citing Pralutsky v. Metropolitan Life Ins. Co., 435 F.3d 833, 838-40 (8th Cir. 2006)). Here, MetLife notified Huffaker that her file lacked the required objective evidence in its December 22, 2004 letter denying benefits, which stated as its reason for denial: “There is no medical evidence provided by the treating sources to suggest a significant functional impairment or support the severity of this medical condition to prevent you from performing your job.” Thus, MetLife did not act unreasonably in requiring objective evidence of disability.