Opinion ID: 2668799
Heading Depth: 1
Heading Rank: 3

Heading: Abuse of Discretion Review.

Text: The remaining question is whether Prudential abused its discretion in denying Prezioso LTD benefits. Under this standard, “the plan administrator’s decision will be upheld if it was reasonable, that is, if it was supported by substantial evidence.” McGarrah, 234 F.3d at 1031. We must affirm “if a reasonable person could have reached a similar decision, given the evidence before him, not that a reasonable person would have reached that decision.” Ferrari, 278 F.3d at 807 (quotation omitted; emphasis in original). -11- The record demonstrates that Prudential provided Prezioso the required “full and fair review” before denying his first appeal from the initial denial of LTD benefits. It considered all comments, medical records, and other information submitted by Prezioso; did not afford deference to the initial decision; referred the appeal to a different decisionmaker; consulted a neutral health care professional with appropriate training and experience in lower back disabilities; and obtained advice from a qualified vocational expert regarding the demands of Prezioso’s “regular occupation.” See 29 C.F.R. § 2560.503-1(h)(2) and (3). Contrary to Prezioso’s assertions, Prudential did not abuse its discretion by according more weight to the opinions of its own experts -- Dr. Brenman and Irene Morris -- than to the opinions of his treating physicians and other experts. See Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003); Dillard’s Inc v. Liberty Life Assurance Co. of Bos., 456 F.3d 894, 899-900 (8th Cir. 2006). The key question presented to Prudential -- whether Prezioso was able to perform the material and substantial duties of his regular occupation -- was not meaningfully addressed by his medical records or by the opinions of Drs. Dowdle and Sinicropi, who submitted conclusory workability forms covering the 180-day elimination period and the succeeding months prior to Prezioso’s lumbar surgery, a period when he did not have a job and there is no evidence he was looking for work. By contrast, Prudential’s experts analyzed Prezioso’s medical records and job responsibilities, concluded that he “experienced a level of functional impairment” that did not meet the definition of “continuously disabled” in the LTD plan, and further concluded that his subjective complaints of continuously disabling pain were not supported by the objective medical evidence. Based on this record, Prudential did not abuse its discretion in denying Prezioso’s first appeal from the adverse initial decision. Turning to the abbreviated record of Prezioso’s voluntary second appeal, the district court noted that he submitted a large volume of documents, but “the majority of these documents provided little or no new information for Prudential to consider.” -12- Prezioso’s criticism of Dr. Brenman’s lack of expertise in neurology prompted Prudential to request an independent neurological review by Dr. Topper, who concluded that Prezioso’s claim was not supported “from a neurological point of view.” The Social Security decision was new, but “an ERISA plan administrator or fiduciary generally is not bound by an SSA determination that a plan participant is disabled.” Farfalla v. Mutual of Omaha Ins. Co., 324 F.3d 971, 975 (8th Cir.) (quotation omitted), cert. denied, 540 U.S. 875 (2003). Drs. Brenman and Topper explained to Prudential why they disagreed with the Social Security decision. The lumbar surgery was a newly-completed event. Prudential asked Dr. Brenman to reconsider his earlier conclusions in light of the new evidence. After reviewing records of the surgery and Prezioso’s subsequent recovery, Dr. Brenman concluded that Prezioso would have been unable to work for 30 days after the surgery, would have been limited to sedentary work for the next three months, and then would have again been able to work with the restrictions noted in Dr. Brenman’s initial report. We agree with the district court that the subsequent medical evidence submitted with Prezioso’s voluntary second appeal did not render Prudential’s denial of his mandatory first appeal an abuse of discretion. Particularly in a case like this involving a claim of total disability based primarily on the claimant’s subjective complaints of pain, “[w]here there is a conflict of opinion, the plan administrator does not abuse his discretion in finding that the employee is not disabled.” Clapp, 262 F.3d at 829 (quotation omitted). For the foregoing reasons, the judgment of the district court is affirmed. We deny Prezioso’s motion to strike Prudential’s separate appendix and Prudential’s motion for leave to file a Sur-Reply Brief. ______________________________ -13-