Opinion ID: 1359690
Heading Depth: 3
Heading Rank: 2

Heading: Requirement of Objective Medical Evidence

Text: Hobson alleges that MetLife failed to afford her full and fair review of her LTD benefits claim by requiring objective support for her medical conditions, because MetLife's own policy does not require such proof, and because this court has clarified that subjective complaints alone may constitute sufficient evidence of disability. See Connors v. Conn. Gen. Life Ins. Co., 272 F.3d 127, 136 (2d Cir.2001) (It has long been the law of this Circuit that the subjective element of pain is an important factor to be considered in determining disability.) (internal quotation marks omitted). This court has never directly addressed whether it is reasonable for a plan administrator, who retains the discretionary authority to interpret the terms of its plan, to require the plaintiff to produce objective medical evidence, where such a requirement is not expressly set out in the plan. However, several courts in this district have found that it is not unreasonable or arbitrary for a plan administrator to require the plaintiff to produce objective medical evidence of total disability in a claim for disability benefits. Fitzpatrick v. Bayer Corp., No. 04 Civ. 5134, 2008 WL 169318, at  (S.D.N.Y. Jan. 17, 2008); see also Suren v. Metro. Life Ins. Co., No. 07-CV-4439, 2008 WL 4104461, at  (E.D.N.Y. Aug. 29, 2008) (collecting cases and concluding that MetLife did not abuse its discretion when it based its opinion on objective tests and examinations, despite Suren's subjective complaints of fatigue and weakness). We conclude that it is not unreasonable for ERISA plan administrators to accord weight to objective evidence that a claimant's medical ailments are debilitating in order to guard against fraudulent or unsupported claims of disability. As the Eighth Circuit has explained, even in a claim involving fibromyalgia, trigger-point findings ... constitute objective evidence of the disease, and it is not unreasonable for a plan administrator to require such evidence so long as the claimant was so notified. Johnson v. Metro. Life Ins. Co., 437 F.3d 809, 813-14 (8th Cir.2006). When MetLife denied Hobson's initial appeal in March 2002, it informed her that there has been no documentation ... that substantiates documented trigger point tenderness that falls within the major criteria for the diagnosis of fibromyalgia. In light of this notification, MetLife acted within its discretion in requiring some objective evidence that Hobson was disabled from performing in a sedentary capacity. Such a requirement is not contradicted by any provision of MetLife's own policy, which provides that an employee's claim may be denied if she cannot obtain sufficient medical evidence to support her disability claim. By the terms of the Plan, MetLife retains the discretion to interpret what constitutes sufficient medical evidence, and MetLife's determination that such evidence requires objective support, rather than merely subjective reports of pain, is reasonable. In this case, MetLife's conclusion that Hobson's subjective pain did not rise to the level of rendering her unable to work was supported by Dr. Subrt, the very doctor who diagnosed Hobson with Dercum's, and who reached the same conclusion. Thus, we decline to hold that MetLife's decision to deny Hobson's claim for benefits, because she failed to provide objective evidence showing that she was disabled from sedentary work deprived her of full and fair review.