Opinion ID: 152240
Heading Depth: 3
Heading Rank: 5

Heading: Cognitive Impairments

Text: MetLife also acted arbitrarily and capriciously in discounting evidence of Holmstrom's cognitive impairments resulting from her heavy pain medication. In its 2006 denial, MetLife stated that Holmstrom could substantiate her claim of cognitive impairments with a battery to assess her neurocognitive status. Without more specific direction from MetLife, Holmstrom submitted a Schubert General Ability Battery performed by Dr. Noel, a Ph.D. with significant experience in evaluating cognition for the purposes of workplace function. The battery of tests replicates tests that Holmstrom had done in 1991 under controlled conditions, allowing comparisons of her current abilities. Dr. Noel shared the numerical results of the battery and expressed extreme doubt that Holmstrom could resume employment: If considered for a return to the workforce, it would be at the most menial level using her physical skills, if these were suitable. MetLife's reviewing doctor, Dr. Walker, opined that Dr. Noel was not the proper professional to conduct cognitive testing because he was not a neuropsychologist, but a clinical psychologist. Dr. Walker rejected the battery itself because it did not have appropriate measures of symptom validity. Although Dr. Noel responded with a detailed defense of his credentials and the battery, MetLife still rejected Holmstrom's cognitive impairments as insufficiently substantiated. MetLife never explained specifically what it meant by battery of neurocognitive testing or symptom validity or why a neuropsychologist was necessary while it deemed Dr. Noel's qualifications and training insufficient, other than the need for the proper level of experience, which Dr. Noel attested (without refutation) that he possessed. (Dr. Noel was obviously frustrated by what he saw as Dr. Walker's wrong assumptions about his qualifications and training.) ERISA requires plan administrators to provide claimants a reasonable opportunity for a full and fair review of the denial decision. 29 U.S.C. § 1133(2). Given the nature of the exchange and the data provided, we find MetLife's rejection of the cognitive evidence to be arbitrary and capricious, failing to provide a full and fair review. MetLife acted within its rights by asking for tests showing Holmstrom's cognition, but its request was general. MetLife provided no guidance as to what testing she should provide, much less how or by whom it should be done. The phrase neurocognitive testing did not give Holmstrom fair notice of the additional criteria that MetLife later insisted would need to be met before it would give weight to the results. When an administrator asks for additional information in broad terms, it is too easy to find later a reason to deem what it was given to be insufficient. If the administrator believes that a procedure must have certain characteristics, or that it must be performed by a certain kind of professional, it must provide at least some level of guidance, unless the test sought is so well-known that a claimant or her attorney or other representative can reasonably be expected to know what the administrator expects. MetLife provided no such guidance here. Also, of course, if a plan administrator requires a test and has detailed expectations for the way it is to be conducted, it may arrange for the testing itself. Holmstrom's policy, like most such policies, requires her to appear for testing that the administrator arranges. MetLife was free to make such a demand, but it did not. Having passed on that opportunity and having provided only a broad request for neurocognitive testing, MetLife's after-the-fact reasons for rejecting Dr. Noel's results reflect arbitrary and capricious decision-making that suffers from an absence of reasoning in the record to support it. See Hackett, 315 F.3d at 774-75.