Opinion ID: 3064083
Heading Depth: 3
Heading Rank: 2

Heading: Creel’s Benefits Claim

Text: Creel is a fifty-six-year-old former employee of Wachovia. She worked there until 15 July 2002, when she was hospitalized for an attack in which she complained of chest pain and partial paralysis of the left side of her body. Creel subsequently applied for short-term disability (“STD”) benefits under Wachovia’s STD plan. As part of her application, Creel submitted two attending physician statements (“APS”) to Liberty Mutual. One APS, from her primary care physician, Dr. Nancy Sokany, made a primary diagnosis of major depression and a secondary diagnosis of anxiety and migraine headaches. The other APS was from her psychiatrist, Dr. Brian Harrelson, who rendered a primary diagnosis of anxiety and panic disorder. Liberty Mutual approved her application, and she received STD benefits for twenty-six weeks, the maximum period permitted under Wachovia’s STD plan. Creel also submitted a claim for LTD benefits under the Plan, which Liberty Mutual approved in January 2003. Over the ensuing months, Liberty Mutual requested medical records from Creel’s then-current physicians to monitor whether she still had a disability under the Plan. The responses it received largely reiterated 4 the diagnoses from the initial APSs. For example, her primary care physician in late 2003, Dr. Jorge Gadea, rendered a primary diagnosis of depression and a secondary diagnosis of migraine headaches. In January 2005, Liberty Mutual sent a letter to Creel informing her that it was commencing a review process to determine if she met the Plan’s post-twentyfour-month definition of disability. The letter noted that Liberty Mutual would terminate her LTD benefits unless it found that she was unable to perform any occupation, rather than just her own.3 As part of Liberty Mutual’s inquiry, it requested that Creel obtain various medical documents from her treating psychiatrist, Dr. Walter Afield, and her treating neurologist, Dr. Denise Griffin. Liberty Mutual also asked Creel to keep a headache diary, a blank copy of which it attached to the letter.4 Creel completed the headache diary, in which she described experiencing incapacitating migraine headaches on at least eight occasions between 19 January 2005 and 26 February 2005.5 She submitted the diary to Liberty Mutual along with the other requested documents. Shortly thereafter, Liberty 3 The letter noted that she would continue to receive benefits pending the outcome of the review, even after the twenty-four-month deadline had elapsed. 4 The diary asks the claimant to document her actions prior to the onset of the headache and to list the amount of time she was “incapacitated” due to each headache. WAC1140. 5 Some of these migraines lasted more than one day, so she experienced migraines on eleven days during that period. 5 Mutual sent her entire file to an independent physician consultant (“IPC”), the board-certified neurologist Dr. Patrick Parcells, for review. Dr. Parcells examined whether Creel’s file supported her assertion that her headaches constituted a physical, rather than mental, limitation. He concluded that her medical record supported the conclusion that her headaches were secondary to depression and anxiety and that she was not suffering from migraines. Liberty Mutual specifically asked Dr. Parcells to consider Creel’s headache diary, which it characterized as reporting headaches on nine out of thirty days.6 He found this evidence to be of limited value because of the lack of detail regarding each headache, though he noted that the headaches appeared to result from fluctuations in the weather. Additionally, he could find no information in her file showing that her headaches were incapacitating. According to Dr. Parcells, her file overall indicated that she “ha[d] subjective complaints of frequent headaches that subjectively are incapacitating;” however, there was no “objective information available on laboratory testing or by history that these headaches [were] an organic process.” WAC1135. Accordingly, he found that the record supported the 6 It is unclear how Liberty Mutual reached this total, since there were eight entries and eleven separate incidents over the thirty-nine days covered in the diary, from 19 January 2005 to 26 February 2005, and no particular thirty-day stretch had nine days of headaches. Creel’s initial entry, on 19 January 2005, spanned two columns in the diary, so Liberty Mutual possibly thought that this represented two distinct incidents. Dr. Parcells’s report describes the correct length and number of reported incidents. 6 conclusion that Creel’s headaches were “not physically incapacitating” and should not “be considered the main cause for any inability to work.” Id. After receiving Dr. Parcells’s report, Liberty Mutual sent a letter to Creel notifying her that her benefits were terminated effective 26 April 2005. In taking this action, Liberty Mutual primarily relied on Dr. Parcells’s conclusions about the non-physical cause of Creel’s problems and her apparent ability to work. It also noted that Creel herself, in her last visit with Dr. Griffin, indicated that her headaches might have been weather-related. Since “the medical information currently on file [did] not support the presence of a physical condition that would prevent [Creel] from performing any occupation” for which she was qualified, Liberty Mutual found her eligible to receive benefits only for the twenty-four months allotted for mental illnesses. WAC1125. Creel appealed this termination in October 2005. In support of her appeal, she submitted additional medical records from Dr. Afield and Dr. Gadea, which covered the period from February 2004 to September 2005. Creel contended that these records demonstrated that her migraines were of a disabling nature and resulted from a physical, rather than mental, impairment, thereby making the mental illness limitation inapplicable to her claim.7 She also unsuccessfully sought 7 Though these notes contain multiple references to psychological problems, such as depression, they also repeatedly mention disabling headaches and dementia, both of which were 7 to depose Dr. Parcells as an expert witness. After the district court denied Creel’s Petition Pursuant to Federal Rule of Civil Procedure 27 in April 2006, Liberty Mutual gave her until 10 June 2006 to submit all documents she wanted it to consider in the review of her appeal.8 Prior to this deadline, Creel provided additional medical records, including various documents from Dr. Afield and a 25 May 2006 report from Dr. Robert Martinez, a neurologist. Dr. Afield’s office notes indicated that Creel might be experiencing the early stages of dementia and that she had reported suffering from severe headaches approximately ten days out of every month. He also noted that she was “totally disabled,” which was due solely to the rapidly-worsening, purely physical, brain impairment that was causing her dementia. WAC0871, 0873–74. Dr. Afield also examined a number of prior medical reports regarding Creel, which he thought supported his conclusion that she suffered from “some rather substantive cerebral dysfunction.” WAC0867. He also found the conclusions in attributable to physical causes. 8 Rule 27 permits any “person who desires to perpetuate testimony regarding any matter that may be cognizable in any court of the United States [to] file a verified petition in the United States district court in the district of the residence of any expected adverse party.” Fed. R. Civ. P. 27(a)(1). Such a motion will be granted “[i]f the court is satisfied that the perpetuation of the testimony may prevent a failure or delay of justice.” Fed. R. Civ. P. 27(a)(3). 8 Dr. Parcells’s report to be “totally incorrect” and “wrong” because Dr. Parcells failed to recognize that Creel’s impairments had a physical cause.9 WAC0868–70. Dr. Martinez’s 25 May 2006 report evaluated Creel’s claims regarding migraine headaches. He agreed with the diagnosis of atypical migraine syndrome — a determination he found to be supported by Creel’s medical records, including the results from a battery of lab tests, her responses to various medications, and her own statements.10 As a result, he found that Creel’s headaches caused her to be incapacitated, and thus unable to work, for ten days a month. Since there was no discernable pattern for the onset of the migraines, he noted that it was impossible to predict when they would occur. Liberty Mutual submitted Creel’s entire file, including these new opinions, to a second IPC, Dr. Leslie Kurt. According to Dr. Kurt, the evidence in her record reflected “excellent comprehension and other cognitive functioning” and indicated that any cognitive problems Creel experienced were episodic and minimal. WAC0853. Dr. Kurt noted that no doctors appear to have observed Creel experiencing a migraine, despite their alleged frequency. Though Creel had “a 9 As Wachovia notes, Dr. Afield’s analysis may contain some factual errors, including the apparent assertion that Dr. Parcells relied on office notes that he likely was not shown. 10 The tests included an echocardiogram, magnetic resonance angiography (MRA), and magnetic resonance imaging (MRI). Dr. Martinez also indicated that doctors tried at least ten different medications to alleviate Creel’s problems. 9 documented history of hypertension, hypothyroidism and asthma,” Dr. Kurt believed that the records showed that these problems had been stabilized and thus were not contributing to her cognitive difficulties. Id. Accordingly, she characterized Creel’s cognitive problems as “most likely secondary to depression and anxiety” and deemed them to be “of insufficient severity” to necessitate any work-related restrictions. Id. In reaching this conclusion, she discounted Dr. Afield’s diagnosis of dementia because no other doctors had made such a diagnosis and Dr. Afield had performed no memory tests to confirm his suspicions.11 Dr. Kurt did find that the record supported a diagnosis of recurrent headaches connected to various muscle spasms. As a psychiatrist, though, she felt unqualified to determine whether Creel was experiencing migraines and thus suggested that the file be reviewed by a neurologist to determine if the claim of medical impairment due to migraines had adequate support. Based on Dr. Kurt’s recommendation, Liberty Mutual had a third IPC, Dr. Choon Rim, examine Creel’s file. Dr. Rim, a neurologist, reviewed all of the documents in her record and spoke with Dr. Martinez over the telephone about 11 She also noted that Dr. Afield expressed the opinion that Creel had fibromyalgia and chronic fatigue syndrome. Since there was no way to medically verify either condition, she expressed no opinion on those diagnoses. 10 Creel.12 He thought that her file contained no evidence of a neurological abnormality that could account for her headaches.13 He noted that Creel “ha[d] a history of depression, anxiety, panic attacks, and chronic fatigue syndrome” and that “her symptoms appear[ed] to be clinical manifestations being either psychogenic or psychiatric in nature.” WAC0846. Though migraine headaches normally would render a patient unable to work, he concluded that Creel did not fall within this group since there was no evidence in her file to support an inability to work. On 25 July 2006, Liberty Mutual sent Creel a letter notifying her that her appeal had been denied and that she could ask Wachovia’s Benefits Committee to review the decision. In the letter, Liberty Mutual quoted extensively from Dr. Kurt’s and Dr. Rim’s reviews, including their conclusions regarding a lack of any neurological impairment or physical cause for her cognitive problems. It then found that, “[b]ased on the totality of information contained in Ms. Creel’s file,” it 12 According to Dr. Rim, in this conversation, Dr. Martinez reiterated his belief that Creel had atypical migraine headaches but also agreed that anxiety, depression, and medication overuse could be contributing to the headaches. Dr. Rim attempted to speak with Dr. Afield as well, but was unsuccessful in contacting him by telephone. 13 Although Dr. Rim found no evidence that Creel had ever suffered a stroke or experienced partial seizures, he noted that the 15 July 2002 attack for which she was initially hospitalized might have been a transient ischemic attack (TIA), or mini-stroke. There appeared to have been no further occurrences of TIAs, however. Dr. Rim also discounted the possibility of a hemiplegic or complicated migraine since Creel had no family history for what is normally a very rare disorder. Hemiplegia involves paralysis on one side of the body. 11 had no support for concluding that she either had a physical impairment that prevented her from performing any occupation for which she was qualified or a “continued physical disability.” WAC0834. Since she already had received the maximum benefits permitted for mental illness-based disabilities under the Plan, she was ineligible to receive further LTD benefits. Creel timely appealed this decision to Wachovia’s Benefits Committee. As part of this appeal, she submitted a 7 September 2006 opinion from Dr. Martinez, which was based on his examination of Creel and her medical records.14 In this document, Dr. Martinez reiterated his earlier diagnosis of atypical complex migraine syndrome.15 He indicated that this condition would cause Creel to feel sharp pains on the right side of her head, to experience weakness on her left extremities, and to become partially paralyzed. The onset of these attacks would be unpredictable, and, when they occurred, she would be “totally incapacitated and in bed” for, on average, ten days a month, with each attack lasting anywhere from four hours to two days. WAC0814. This combination of problems, he asserted, made her “100% permanently, totally disabled, unable to work, function, or 14 It appears that Dr. Martinez conducted a new physical examination of Creel in making this report, but it is unclear if his report utilized any other information he did not have when he wrote his 25 May 2006 opinion. 15 His earlier opinion identified the condition as “atypical migraine syndrome,” but there appears to be no difference between the two terms. WAC0896. 12 compete in a competitive job environment.” WAC0817. Creel’s appeal letter referenced these conclusions and noted that they contradicted the IPCs’ findings regarding the lack of a neurological cause for her migraines and the unlikelihood of her experiencing hemiplegic migraines. Wachovia’s Benefits Committee sent Creel a letter notifying her that it was affirming the decision to deny further LTD benefits. The Committee referenced the Plan’s mental illness limitation and disability definition as well as Dr. Rim’s conclusion that there was no neurological basis for her impairment, though it did not address Dr. Martinez’s new opinion nor the appeal letter. According to the Committee, Creel had submitted “[n]o new medical documentation . . . which would controvert the previous decisions” to deny benefits.16 WAC0783. As a result, there was an “absence of documentation supporting a physical impairment that meets the definition of Disability or Disabled under the provisions of the plan,” which meant the Committee had no basis upon which to reverse the earlier decisions to deny benefits. Id. 16 Liberty Mutual apparently believed that the documents did not affect its earlier conclusion and that it was unnecessary to send them to an IPC for review. An appeals review consultant for Liberty Mutual noted in an email to Wachovia that Dr. Martinez’s report was not based on any new neurological or physical findings but rather on Creel’s self-reported complaints. Accordingly, the consultant thought that the information contained in that report was consistent with that already addressed in earlier IPC reviews. 13 In February 2007, Creel filed suit in the United States District Court for the Middle District of Florida seeking LTD benefits from Wachovia under the Plan. Wachovia moved for summary judgment, which the district court granted. See Creel v. Wachovia Corp., 543 F. Supp. 2d 1298 (M.D. Fla. 2008). The court evaluated Wachovia’s decision under the six-step standard of review for ERISA benefit denials set forth in Williams v. BellSouth Telecommunications, Inc., 373 F.3d 1132, 1137–38 (11th Cir. 2004). See id. at 1305–06. The court found that Wachovia’s decision to terminate benefits was not de novo wrong in light of the facts of the case and the language of the Plan. See id. at 1306. In particular, the court focused on the “proof” standard in the Plan, which it viewed as requiring Creel to submit evidence in whatever form Wachovia deemed satisfactory and permitting Wachovia to require objective medical evidence. See id. at 1306–07. Under Williams, this finding was sufficient to uphold the denial of benefits, and the court therefore granted Wachovia’s summary judgment motion.17 See id. at 1305–06, 1309. Creel now appeals the district court’s decision.