Opinion ID: 1359690
Heading Depth: 3
Heading Rank: 1

Heading: August 2004 Termination of LTD Benefits After Recovery from Colitis-Related Surgery

Text: First, we conclude that MetLife's termination of Hobson's LTD benefits after she underwent surgery to address her colitis was not arbitrary and capricious. The report prepared in 2004 by Dr. Nesta, the independent physician consulted by MetLife, concluded that Hobson's alleged impairments did not preclude her from working. Specifically, Dr. Nesta determined that Hobson's surgery should have cured her ulcerative colitis, the MRI and her neurologist's progress notes indicated that she did not have significant radiculopathy, and her neurologist's decision to not take Hobson out of work indicated that he could not find any neurologic basis for [Hobson's] seizures and migraines. As for Hobson's asthma, fungal infection, and fibromyalgia, Dr. Nesta determined that these conditions were not disabling. Hobson's own infectious disease specialist agreed that her fungal infection did not prevent her from working. Although her treating internist d[id] not agree that most of her ailments do not preclude her from working because he was concerned about her yeast infection, he did not submit additional information to support Hobson's claim for benefits. In fact, he conceded that there was insufficient data to determine her ability to work. Hobson specifically challenges on appeal MetLife's reliance on Dr. Nesta's 2004 report because Metlife failed to consider fibromyalgia in his review. Upon evaluating Hobson's final diagnosis of fibromyalgia, Dr. Nesta's report again concluded that fibromyalgia does not usually preclude an individual from working. Two years earlier, however, Dr. Nesta explained why he concluded that Hobson was not disabled due to her fibromyalgia: Hobson had no documented trigger point tenderness which is normally part of a fibromyalgia diagnosis, no hard evidence ... substantiate[d] her disability from a rheumatologic viewpoint, and her neurological examinations were normal. Moreover, Dr. Lieberman, another independent consultant who evaluated Hobson's record in 2001, opined that there wasn't any substantial global or objective evidence to support the opinion that Hobson was unable to perform any occupation because of her fibromyalgia; instead, Dr. Lieberman stated that [t]here certainly are a wide range of treatments available for patients with fibromyalgia to allow them to be more productive, gainfully employed, and have a better quality of life. As the Supreme Court has explained, courts have no warrant to require administrators automatically to accord special weight to the opinions of a claimant's physician; nor may courts impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician's evaluation. Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003). Thus, MetLife acted within its discretion in relying upon the conclusions of its independent consultants' three reports. Because the three reports provided detailed, substantive analysis of Hobson's fibromyalgia, we cannot find that MetLife unreasonably failed to consider Hobson's fibromyalgia. As Hobson's own treating physician conceded, it is far from clear that Hobson's medical records demonstrated that she was disabled; rather, we find ample evidence in Hobson's file to support MetLife's determination that she failed to make this showing.