Opinion ID: 204142
Heading Depth: 3
Heading Rank: 3

Heading: Paper consulting physicians

Text: Richards' final argument is targeted at both the specific opinion of Dr. Brachman and, more generally, at the use of non-examining physicians to review claimant files. As to the latter, Richards argues that the policy language giving Prudential the right to have a claimant undergo a physical examination somehow limits Prudential to the use of physical exams. [12] We do not share this strained reading of the policy language, for which Richards has provided no legal support. [13] Moreover, we have squarely held that an insurer is not required to physically examine a claimant, and that benefit determinations may be based on reviews of medical records. Orndorf, 404 F.3d at 526. Additionally, as in Orndorf, this is simply not a case where the only medical evidence ran in [claimant's] favor, thus casting into doubt a denial of benefits. Id. In fact, while the evidence may have supported the diagnoses of fibromyalgia or chronic fatigue immune dysfunction, every reviewing, board-certified doctor, with the exception of Dr. Hryniewich, found that Richards could perform a sedentary job for which he was reasonably fit by education, training or experience. [14] As to Dr. Brachman's opinion, Richards first takes issue with her medical qualifications. We are not persuaded. The record reflects that Dr. Brachman specializes in occupational medicine and rheumatology, and Richards offers no evidence to the contrary. Next, Richards argues that Brachman improperly ascribed a psychiatric conditiondepressionto him without any basis. He then asserts that Prudential used this finding to discontinue his benefits by relying on the Plan's twenty-four month maximum payment period for disabilities caused in whole or part by a mental health issue. Even assuming that Dr. Brachman's mental health conclusion is overstated, [15] Richards' argument nevertheless fails for two related reasons. First, while Dr. Brachman in her report discussed the medical record evidence of depression in Richards' history, she also addressed the lack of evidence of physical impairment, including synovitis, deformity, or decreased range of joint motion. She also noted the lack of any inflammatory vascular disease or neurocognitive impairment. Second, Prudential did not terminate Richards' benefits on the ground that he had exhausted them under the mental health provisions of the Plan. Instead, Prudential explicitly stated that it was evaluating whether his current physical condition prevented [him] from performing any occupation. In other words, regardless of Dr. Brachman's reference to Richards' mental health history, the requirement that he prove his then-current physical disability remained. Finally, to the extent that Richards argues that Dr. Brachman did not review the entirety of his medical history, we note that the denial letter need not detail every bit of information in the record; it must have enough information to render the decision to deny benefits susceptible to judicial review. Orndorf, 404 F.3d at 526. Dr. Brachman's report and Prudential's termination letter easily satisfy this standard. [16]