Summary
In Rhodes v. Panhandle Eastern Corporation, 1993 U.S.Dist. LEXIS 12212 (E.D. La. August 31, 1993), on defendant's motion for summary judgment this Court upheld the denial of plaintiff's extended disability benefits, holding that there was "substantial evidence" justifying the Plan's factual determination that the plaintiff was not permanently and totally disabled and explained: "Substantial evidence is such evidence that a reasonable mind might accept as adequate to support the conclusion reached by the [decision maker].
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CIVIL ACTION NO. 93-0429, SECTION "A".
August 31, 1993
ORDER AND REASONS
Before the Court is defendant Panhandle Eastern Corporation Long Term Disability Plan's (hereinafter "the Plan") motion for summary judgment pursuant to FRCP Rule 56. Plaintiff Donald J. Rhodes, Jr. ("Rhodes") has filed formal opposition to the Plan's motion for summary judgment stating that there exist material issues of fact regarding the primary issue — whether the defendant was arbitrary and capricious in denying disability benefits to plaintiff. The matter was set for oral hearing on Wednesday, August 4, 1993. However, the Court has determined that oral argument on the defendant's motion is not necessary and therefore, orders its submission on the briefs.
Plaintiff contends that the expedited time period in which his application for longterm disability benefits was reviewed and acted upon and the absence of any records or reports of one of his psychiatrists Dr. Richard Richoux raises issues of fact as to whether the defendant's conduct was arbitrary and capricious. Essentially, plaintiff argues that the PTD Plan has an obligation to obtain all of his medical records and develop a case in support of his claim for benefits. However, plaintiff has cited no authorities which would support imposing any such obligation on the plan administrator.
I. UNDISPUTED FACTS:
On July 20, 1990, while on his job as a "station tender" with Trunkline Gas Company, Rhodes received a back injury in a helicopter accident. Panhandle Eastern Corporation provides disability benefits coverage to eligible employees. (Webb Affidavit, para. 2) It is not disputed that at the time of his injury on July 20, 1990, Rhodes was a covered participant of the PTD Plan. (Webb Affidavit, para. 7)
Trunkline Gas Company is a subsidiary of Panhandle Eastern Pipe Line Company, which is a subsidiary of Panhandle Eastern Corporation. Affidavit of Cathey A. Webb, at para 6.
Here, the Court notes, that Rhodes' case against Petroleum Helicopters, Inc. and Allied Signal, Inc. for damages arising from the July 20th, 1990 helicopter accident was reverse bifurcated and was the subject of a bench trial on the issue of damages on December 19, 1991. "Karen F. Rhodes and Donald J. Rhodes, Jr. versus Petroleum Helicopters, Inc., et al", C.A. No. 90-4010 "A" (E.D.La.). This Court issued orders and reasons on April 6, 1992 with regard to the damage phase of the trial. Rhodes' case as to liability was never tried as the parties amicably settled plaintiff's claims against them.
Effective January 1, 1991, the Panhandle Eastern Corporation Permanent and Total Disability Plan was replaced by a successor plan known as the Panhandle Eastern Long Term Disability Plan.
By letter dated October 22, 1991, Rhodes requested that he be considered for disability benefits. The Plan formally responded to the aforesaid request by sending Rhodes an "Initial Long Term Disability Claim Form," accompanied by a letter referring to the pertinent provisions. Rhodes submitted the completed initial claim form dated January 13, 1992 to the Benefits Department.
Correspondence of Donald J. Rhodes, dated October 22, 1991 (Plan Exhibit "2").
Correspondence from Cathey A. Webb, Supervisor Welfare Plans, dated December 4, 1991, with attachment. (Plan Exhibit "3")
Initial Long Term Disability Benefits Form of Donald J. Rhodes, Jr., dated January 13, 1993 with attached Attending Physician's Statement of Disability completed by Kenneth N. Adatto, M.D. (Plan Exhibit "4").
On April 13, 1992, Plaintiff was notified by the Benefits Department that his claim for Disability Benefits was denied on the grounds that, plaintiff did not meet the Plan definition of permanent and total disability. The April 13, 1992 letter explained:
Based upon medical documentation that you provided, it is Dr. Beeks' opinion that you do not meet the Plan's definition of permanent and total disability. Therefore your claim for permanent disability has been denied.
Dr. Beeks recognizes that you are unable to perform the duties of your former job with Panhandle Eastern Pipeline Company. However, the Plan also requires that in order to be "permanently and totally disabled," you must not be able to engage in any other gainful occupation for which you are reasonably fitted by training, experience or education. No evidence has been provided to indicate that this second requirement has been met.
Letter from Rebecca Shepard, dated April 13, 1992 (AR-21) (Plan Exhibit "1").
The denial of benefits was based upon a review of all medical documentation submitted by Rhodes to the Plan as of that date. As set forth herein above, the Plan's consulting physician Dr. John Beeks found no evidence from the medical documentation submitted by Rhodes in support of his claim that he was not able to performany job for which he was suited by training, experience or education. In that regard, Dr. Beeks' correspondence of April 6, 1992 reads in pertinent part:
I have reviewed the records furnished. This appears to be a rather interesting case in as much as this rather young man (age 30) has been complaining of a myriad of complaints regarding most parts of his body since being involved in a helicopter accident. Some of his complaints appear to be rather bizarre in nature and do not suggest a physiologic basis. Of particular interest is the almost total absence of any objective findings with the exception of degenerative disc disease at one level in his cervical spine and a spondylolisthesis in his lumbar spine.
Both of these objective findings are not terribly uncommon in the general population and certainly do not by and of themselves lead to permanent and in particular total disability.
Because of the above and because of this employees relative youth I am unable to say with conviction based upon the information furnished, that he is "Permanently unable to perform any job for which he is suited by education, training and experience."
Letter from Dr. John Beeks, dated April 6, 1992 (AR-20) (Plan Exhibit "1").
The plaintiff, having been notified of the procedures for appealing the decision, followed the administrative procedures provided for in the Plan and appealed the decision denying disability benefits. By letter dated May 5, 1992, Rhodes informed the Plan Administrator that he had become eligible to receive Social Security disability payments and requested a review of the Plan's denial of benefits in his case.
Correspondence of Rhodes, dated May 5, 1992, with attached eligibility letter from the Social Security Administration. (Plan Exhibit "5")
The administrative record (Plan Exhibit "1") was disseminated to all members of the PTD Plan Claims Committee ("the Committee") on July 24, 1992. (AR 1-2) Included in the record was physician information submitted to the Social Security Administration which identified a psychological component to Rhode's condition, which had not been previously considered. (AR 30-32).
Prior to the Committee's meeting on August 4, 1992, the administrative record was distributed to all Committee members, along with the following advice:
Social Security's criterion for disability is that the applicant must not be expected to engage in any substantial gainful employment for one year or more or is expected to die. Because Mr. Rhodes received a Social Security award and because it is unusual for an employee to qualify for Social Security and not qualify for our benefits, we asked Dr. Beeks to examine the documentation which led Social Security to its conclusion. Dr. Beeks continues to feel that Mr. Rhodes does not qualify for Panhandle's benefits.
Administrative Record, at pp. 1-2. (Panhandle Exhibit "1")
The minutes of the August 4, 1992 Committee meeting reflect that the Committee members discussed/reviewed the medical documentation in the record and concluded that there was no consistent evidence to the effect that Rhodes was permanently and totally disabled within the meaning of the Plan. The Plan Committee's Minutes of August 4, 1992 reflect in pertinent part as follows:
At Benefit's request, Mr. Rhodes provided copies of documentation used by Social Security in reaching its determination. Dr. Beeks reviewed this information and continues to feel that the evidence does not lead to a conclusion that Mr. Rhodes is totally and permanently disabled.
The Committee reviewed the medical documentation and concluded that there was no consistent evidence that Mr. Rhodes had orthopaedic or neurological conditions which rendered him totally and permanently disabled. However, in particular regard to the report of Dr. Edward D. Lewis [sic Levy], a psychiatrist, there appeared to be a possibility that Mr. Rhodes could be disabled by a Post-Traumatic Stress Disorder.
The Committee agreed to offer Mr. Rhodes the opportunity [to] be examined by a psychiatrist selected by the Committee who would give a second opinion as to whether Mr. Rhodes was totally and permanently disabled due to Post Traumatic Stress Disorder.
Minutes of a Meeting of the Claims Committee August 4, 1992 (Plan Exhibit "6"). See also, Webb affidavit, para. 15.
Dr. Charles Freed, Jr. was selected by the Committee to perform a psychiatric examination of the plaintiff, which he in fact performed. Dr. Freed's report reflects that the source of his information included a 60 minute interview with the plaintiff and a review of the medical records of Dr. Dennis M. Spiers, a psychiatrist in the Houma area. Dr. Freed's report further reflects that he was apprised that Rhodes had been treated by Dr. Richard Richoux at DePaul Hospital over an 18 month period, which treatment consisted of individual psychotherapy and medication management. Dr. Freed concluded that Rhodes was not disabled within the meaning of the Plan's definition, as follows:
It is apparent from the record that Rhodes did not furnish the Plan a copy of any medical record(s)/report(s) regarding Dr. Richard Richoux's treatment described above, but rather, merely supplied information that he had been under Dr. Richoux's care in the past.
The Panhandle Eastern Corporation Select-plan definition of permanent and total disability indicates that the individual is "permanently unable to perform any job for which he is suited by education, training, and experience." I do not feel, based on psychiatric reasons, that Mr. Rhodes is "permanently unable to perform any job for which he is suited by education, training and experience." While I do feel that Mr. Rhodes suffers from Post Traumatic Stress disorder for which he needs ongoing treatment, I am not of the opinion that this impairs his ability to find employment. Mr. Rhodes is also alleging ongoing physical disability which he claims, for example, interferes with his ability to sit in a classroom for any duration such that he would be able to complete college courses, etc. Based on his alleged physical disability he may meet the criteria of the plan for disability, but this is not a determination that I would be capable of making.
See, Report of Dr. Charles R. Freed, Jr., M.D., dated October 1, 1992 (Plan Exhibit "8").
By letter dated November 23, 1992 (Plan Exhibit "7"), the Committee confirmed the initial denial of Rhodes' claim for benefits, which in addition to all other medical information submitted by Rhodes, was further based upon the aforesaid opinion of Dr. Freed that Rhodes was not permanently and totally disabled within the meaning of the Plan.
Here the Court summarizes the some of pertinent undisputed facts relative to the plaintiff's contentions in opposition to the Plan's Motion for Summary Judgment that the Plan's consulting physician and the Committee did not review the reports of his psychiatrist, Dr. Richoux. Rhodes initial report/claim submitted to the Plan stated that his disability was caused by cervical neck and lower back injury. Attached to his claim form was only the Attending Physician Statement completed by Dr. Kenneth Adatto, an orthopaedic surgeon. The record reflects that plaintiff never submitted a Statement of Disability or any medical documentation from Dr. Richoux or any other psychiatrist, despite the fact that he had every opportunity to do so.
The Court further notes that it was only when his claim was reviewed by the Committee, and in so doing, the Committee obtained physician's information submitted to the Social Security Administration, that information was identified for the first time, regarding a psychological component to the plaintiff's condition. Upon discovery the psychological facet of the plaintiff's condition, the Committee proposed that plaintiff be examined by an independent psychiatrist, Dr. Charles R. Freed, who later upon examination found the plaintiff not permanently and totally disabled. Even at that juncture of the administrative process, plaintiff never submitted any records or reports of Dr. Richoux or ask the Plan Committee to obtain such records. The Committee confirmed the initial denial of plaintiff's claim for benefits.
See, Psychiatric Evaluation of Dr. Edward Levy, Jr. (AR 30-32).
Plaintiff commenced the instant action to obtain judicial review of the Plan's denial of benefits under Section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. Section 1132(a)(1)(B).
The single issue determined by the defendant Plan whether Rhodes, the plaintiff herein, was "totally disabled" within the meaning of the employee benefits plan at issue. The issue for this Court's review is whether the Plan's factual determination that the plaintiff was not totally and permanently disabled was arbitrary and capricious or tantamount to an abuse of discretion.
See Panhandle Eastern Corporation Permanent and Total Disability Plan (Plan Exhibit "9").
Plaintiff submits that material issues of fact inhere because of the Committee's failure to consider medical records of his psychiatrist Dr. Richard Richoux. However, plaintiff never provided the administrator with a copy of Dr. Richoux's records.Via supplemental memorandum, the Plan made it perfectly clear that at no time did Rhodes submit to or request that the Plan obtain any medical records from Dr. Richoux in connection with his claim for disability benefits. Moreover, Rhodes did not submit the "Attending Physician's Statement of Disability" completed by Dr. Richoux. As previously mentioned, the Committee not Rhodes identified a psychological component to his condition and suggested that Rhodes be examined by a psychiatrist Dr. Freed, who independently assessed Rhodes' psychiatric condition.
See, Supplemental Memorandum in Support of Summary Judgment and attached Affidavit of Cathey A. Webb at paras. 3, 4, and 5.
II. ANALYSIS
Summary judgment is appropriate when "there is no genuine issue as to any material fact" and "the moving party is entitled to judgment as a matter of law." F.R.C.P. Rule 56(c). The purpose of summary judgment is to determine whether a trial will be necessary. "The mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment; the requirement is that there be no genuine issue of material fact." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986).
The appropriate standard of review under ERISA cases arising from a denial of benefits is de novo unless the benefit plan grants the administrator discretionary authority to determine eligibility for benefits. Firestone v. Bruch, 489 U.S. 101 (1989). The authority of the administrator under PTD's plan is granted to the committee serving as the plan administrator of the Retirement Income Plan as the plan administrator. Specifically, section 5.1 of the Plan (Plan Exhibit "9") provides in pertinent part:
Id. at para. 3.
The Plan Administrator shall have authority to control and manage the operation and administration of the Plan including all rights and powers necessary or convenient to the carrying out of its functions hereunder whether or not such rights and powers are specifically enumerated herein. Without limiting the generality of the foregoing, and in addition to the other powers set forth in the Plan, the Plan Administrator shall have the following express authorities:
(a) to construe and interpret the Plan, decide all questions of eligibility and determine the amount, manner and time of payment of any benefits hereunder in its discretion; . . .
Id. at p. 10.
Additionally, Section 5.4 of the Plan states:
[A]ll determinations, interpretations, rules, decisions of the Plan Administrator shall be conclusive and binding upon all persons having or claiming to have any interest or right under the Plan.
There appears to no dispute that the plan administrator in the case at bar has been vested with discretion sufficient to preclude de novo review of its determinations. The Plan language quoted extensively above supports application of the arbitrary and capricious standard of review with regard to interpretation of the terms of the plan.
However, where as here the issue involves a factual determination under an ERISA plan, as opposed to plan term interpretation, the more deferential "abuse of discretion" standard of review is applicable. Thus, this Court shall give "due deference to the administrators' factual conclusions that reflect reasonable and impartial judgment."
In Pierre v. Connecticut General Life Insurance Co., 932 F.2d 1552 (5th Cir. 1991), cert. denied, 112 S.Ct. 453 (1991), the Fifth Circuit drew a distinction between issues involving plan interpretation (i.e., the Firestone case) and issues involving factual determinations, such as a denial of benefits based upon eligibility provisions. Therein the Fifth Circuit noted that theFirestone case was expressly limited to instances in which the facts were not in dispute and recovery of benefits was dependent solely on interpretation of the plan terms.
Pierre, 932 F.2d at 1562.
In reviewing the instant denial of benefits under ERISA, the Court is limited and may only consider evidence available to the administrator at the time the final decision was made. The Sixth Circuit stated in Perry v. Simplicity Engineering, 900 F.2d 963, 967 (6th Cir. 1990):
Pierre, 932 F.2d at 1559.
A primary goal of ERISA was to provide a method for workers and beneficiaries to resolve disputes over benefits inexpensively and expeditiously. Permitting or requiring district courts to consider evidence from both parties that was not presented to the plan administrator would seriously impair the achievement of that goal. If district courts heard evidence not presented to plan administrators, employees and their beneficiaries would receive less protection than Congress intended. Id. (citation omitted).
As to plaintiff's contention that the plan administrator was arbitrary and capricious for failing to take into account the opinion of his treating psychiatrist Dr. Richoux, an administrator's decision is not arbitrary and capricious for failing to take into account evidence not before it. This Court's responsibility is to determine whether the administrator's actions constituted an abuse of discretion, and not in determining whether Rhodes was, in this Court's view, entitled to longterm disability benefits with the meaning of the Plan. Accordingly, the Court will evaluate the record as it was at the time of the decision in this case.
Cf. LeFebre v. Westinghouse Electric Corp., 747 F.2d 197, 208 (4th Cir. 1984) (holding that the trustees are not duty bound to seek out medical evidence contradicting the medical evidence before them and stating that "experience has shown that an `expert' can be found to support almost any position. . . .");Sandoval v. Aetna Life and Casualty Ins. Co., 967 F.2d 377, 381 (10th Cir. 1992) (holding that a participant cannot complain of the administrator's failure to consider evidence which the participant did not submit for review).
"In effect, a curtain falls when the fiduciary completes its review, and for purposes of determining if substantial evidence supporting the decision, the district court must evaluate the record as it was at the time of the decision." Sandoval v. Aetna Life and Casualty Ins. Co., 967 F.2d 377, 381 (10th Cir. 1992) (citing, Perry, 900 F.2d at 967).
ERISA provides that a plan must follow certain procedural steps when denying or terminating benefits to a plan participant. First, the plan must provide the participant with written notice of the denial which sets forth the specific reasons underlying the decision. 29 U.S.C. § 1133(1). Second, the plan must "afford a reasonable opportunity . . . for a full and fair review by the appropriate named fiduciary of the decision denying the claim."Id. at § 1133(2). Labor regulations specify that the review procedure must permit the claimant to "(i) [r]equest a review upon written application to the plan; (ii) [r]eview pertinent documents; and (iii) submit issues and comments in writing." 29 C.F.R. § 2560.503-1(g)(1). There is no contention in this case that these requirements were not met.
Here, as in Perry and Sandoval, supra, which cases both involved a district court's review of a plan administrator's determinations of questions of historical fact, this court limits its review of the historical facts underlying the claim to those presented to the plan administrator. A fair reading of the Fifth Circuit's precedents in Denton v. First National Bank of Waco, 765 F.2d 1295 (5th Cir. 1985), Lowry v. Bankers Life Casualty Retirement Plan, 871 F.2d 522 (5th Cir.), cert. denied, 493 U.S. 852, 110 S.Ct. 152, 107 L.Ed.2d 111 (1989), Pierre v. Connecticut General Life Insurance Co., 932 F.2d 1552 (5th Cir.), cert. denied, 112 S.Ct. 453 (1991), and Wildbur v. Arco Chemical Co., 974 F.2d 631, 639 (5th Cir. 1992), support this court's decision to limit its review of historical facts underlying plaintiff's claim in the case at bar to those facts presented to the plan administrator, since interpretation of the plan terms is not an issue in this case.
In Wildbur v. Arco Chemical Co., 974 F.2d 631, 641 (5th Cir. 1992), the court held that a district court is not confined to the administrative record in determining whether the plan administrator abused his discretion, where the plan administrator incorrectly interprets the plan terms. However, the court explained in no uncertain terms that:
This is not to say that a litigant dissatisfied with an administrator's benefit determination is free to disregard the evidence before the administrator and relitigate in court the historical facts surrounding a claim. We have long held that in conducting a review under an abuse of discretion standard, a district court should evaluate the administrator's fact findings regarding the eligibility of a claimant based on the evidence before the administrator, assuming that both parties were given an opportunity to present facts to the administrator. Id. at 639.
In this vein, the Wildbur court cited Masella v. Blue Cross Blue Shield of Connecticut, Inc., 936 F.2d 98, 104 (2nd Cir. 1991) for the proposition that "`evidence regarding the proper interpretation of plan terms . . . would be "treated differently from evidence intended to establish a particular historic fact regarding the claimant. . . .'" Id. at 641.
Unlike the facts of Wildbur, interpretation of the plan terms is not the issue in the instant case. The present case simply involves the plan administrator's factual determination i.e., that the plaintiff was not permanently and totally disabled. Reduced to its essence plaintiff's argument is twofold: (1) that the Committee should have considered the report(s) of the psychiatrist Dr. Richard Richoux, which medical evidence plaintiff apparently did not submit for review; and (2) that the determination was arbitrary and capricious or tantamount to an abuse of discretion considering that the Committee did not seek out and review Dr. Richoux's report(s) or other medical evidence which might have contradicted the evidence contained in the administrative record in the case of Rhodes.
Plaintiff's contentions to the effect that he did not receive a full and fair review are without merit. All of the medical documentation provided by the plaintiff including the reports of Dr. Adatto, and the medical opinions upon which the Social Security Administration relied for its determination were distributed to the Appeals Committee, including the reports of Drs. James T. Williams, and Edward D. Levy, Jr. Additionally, the Committee agreed to offer Rhodes the opportunity to be examined by a psychiatrist selected by it to give a second opinion as to whether he was totally and permanently disabled due to Post Traumatic Stress Disorder, "since there appeared to be apossibility that he could be" so disabled from the inconclusive language of Dr. Edward Levy's report.
The reports of Drs. Williams and Edward Levy were requested by the Plan in connection with the Social Security determination.
Dr. Edward Levy's report merely stated that "it seems unlikely that he [i.e., Rhodes] is capable of pursuing gainful employmentat this time." (AR-32). He stated no opinion whatsoever with regard to "permanent and total disability" in his assessment of Rhodes. As previously mentioned, the plan administrator has no duty to seek out medical evidence that might possibly contradict the medical evidence which has been submitted for review.
Given that the plan administrator complied with statutory and regulatory requirements, and further that prior to the confirmation of denial of benefits the plan administrator afforded Rhodes the opportunity for independent psychiatric evaluation by another psychiatrist for a second opinion, Rhodes can hardly complain that the plan administrator acted in "bad faith" or that the procedures followed were unfair. In Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 54, 107 S.Ct. 1549, 1556, 95 L.Ed.2d 39 (1987), the Supreme Court stated, the civil enforcement scheme of 29 U.S.C. § 1132 "represents a careful balancing of the need forprompt and fair claims settlement procedures against the public interest in encouraging the formation of employee benefit plans."Id. (emphasis added). Based upon this Court's review, the summary judgment record leaves no doubt that Rhodes received a full and fair review.
The Claims Committee in the case at bar had before it the following medical documentation: (1) the Emergency Room Report by Dr. Mallernee; (2) Report of Dr. Adatto; (3) three letters from Dr. Judice to Dr. Cinnater; (4) two letters from Dr. Richard Warren Levy to Kenneth LaBorde; (5) one letter from Dr. Richard Warren Levy to Mr. Van Hoven of ITT Hartford; (6) the April 6, 1992 letter from Dr. Beeks to Rebecca Shepard; (7) the transmittal letter from Rebecca Shepard to Dr. Beeks which included copies of the physicians' reports upon which the Social Security based its award of benefits to Rhodes; (8) the July 15, 1992 letter from Dr. Beeks; and (9) the opinion of psychiatrist Dr. Freed.
There is no dispute concerning the definition of Plan's term "totally and permanently disabled" (i.e., permanently unable to perform any job for which he is suited by education, training and experience). The initial denial of longterm disability benefits, as well as the confirmation by the Committee in the present case was based upon the documentary medical evidence submitted to it by the plaintiff and obtained by the Plan Committee from the Social Security Administration, all of which are contained in the administrative record.
See The Plan, at p. 2. (Plan Exhibit 9)
In making the determination that plaintiff was not entitled to benefits, it is apparent from the record that the Committee placed particular importance on the opinions of the Plan's medical consultant, Dr. Beeks, and Dr. Freed, the psychiatrist consulted for purposes of a second opinion regarding Rhode's psychological condition.
The Court agrees with the defendant in this case, that although the administrative record contains conflicting medical evidence, there is "substantial evidence" to support the Plan's determination that plaintiff was not permanently and totally disabled. The term substantial evidence has been defined as follows:
In Wilbur v. Arco Chemical Co., 974 F.2d 631, 637 (5th Cir. 1992), the court reiterated its confidence in the maxim that "if a decision is supported by substantial evidence and is not erroneous as a matter of law, it is not arbitrary and capricious.Id. (citing, Sandoval, 967 F.2d 377 and n. 4 (10th Cir. 1992)).
"`Substantial evidence is such evidence that a reasonable mind might accept as adequate to support the conclusion reached by the [decisionmaker].' Substantial evidence requires `more than a scintilla but less than a preponderance.'"
Sandoval, 967 F.2d at 382 (citing, Flint v. Sullivan, 951 F.2d 264, 266 (10th Cir. 1991)).
In the case at bar, the Committee thoroughly reviewed the plaintiff's claim for benefits. Regarding any permanent and totalphysical disability, Dr. Adatto's report supports a determination that the plaintiff was permanently and totally disabled. However, also contained in the administrative record were the contradictory reports of Drs. Donald Judice, Richard Warren Levy, and others.
Dr. Judice's report indicates that he was unable to find any neurological basis for the plaintiff's subjective complaints of pain and that he could find no evidence of abnormalities upon review of the CT Scan, X-rays, EMG and nerve conduction studies performed on the plaintiff. Moreover, he noted that there was a great deal of emotional overlay to plaintiff's complaints and he could not otherwise account for the plaintiff's symptoms of pain. (AR-10).
Dr. Richard W. Levy's reports echo Dr. Judice's opinion that Rhodes' had no neurological deficit. Dr. Levy further was of the opinion that the plaintiff could return to work. (AR-13). Having reviewed the plaintiff's MRI scan dated June 10, 1991, Dr. Levy concluded that there was no posterior disc bulge at any level. He explained that the axial views were slightly tilted which accounts for the apparent prominence of the discs and vertebrae on the left as opposed to the right. (AR-17).
Dr. Beeks, the Plan's consulting physician, noted the "almost total absence of any objective findings" and explained that plaintiff's degenerative disc disease at one level in his cervical spine and a spondylolisthesis in his lumbar spine "are not terribly uncommon in the general population and certainly do not by and of themselves lead to permanent and in particular total disability." (AR-20)
The mere fact that plaintiff's claim for longterm disability benefits was handled in an expeditious manner as required by law affords no inference of bad faith and raises no issue of material fact with respect to the determination at issue. In summary, there exists substantial evidence in the administrative record supporting the decision to deny benefits on the basis that the plaintiff was not physically permanently and totally disabled within the meaning of the plan.
The same can be said for the psychological component of the plaintiff's claim herein. As previously discussed above, there is no duty on the part of the plan administrator to seek out medical evidence, particularly medical records that the plaintiff had every opportunity to submit to the Committee for review. In the case at bar, the Plan Committee did seek out evidence upon which the Social Security Administration based its determination, and further, referred the plaintiff to a psychiatrist, Dr. Freed, for an independent evaluation and a second opinion. Under the circumstances, the Court would be hard-pressed to find that the actions of the Committee in handling the instant claim were arbitrary and capricious, or that its determination constituted an abuse of discretion. Dr. Freed's opinion was to the effect that notwithstanding the fact that plaintiff suffers from Post Traumatic Stress Disorder, such condition does not impair his ability to seek employment. Certainly, the medical opinion of Dr. Freed constitutes "substantial evidence" within the meaning of the law.
Finally, inasmuch as the focus of plaintiff's claims is the denial of benefits under the PTD Plan, an employee welfare benefit plan governed exclusively by ERISA, 29 U.S.C. § 1001 et seq., all of the plaintiff's claims herein should be dismissed as a matter of law, there being no disputed issue of material fact. There is no question but that the PTD Plan Administrator, acting through its Claims Committee, relied on the opinions of qualified physicians, and reviewed all medical evidence submitted by the plaintiff, and more. The subject determination denying the plaintiff longterm disability benefits was not arbitrary and capricious. Accordingly, and for all of the above and foregoing reasons,
IT IS ORDERED that the defendant Panhandle Eastern Corporation Long Term Disability Plan's motion for summary judgment is hereby GRANTED and plaintiff Donald J. Rhodes, Jr.'s claims in the captioned case are hereby DISMISSED with prejudice at plaintiff's cost.
The Clerk of Court is hereby directed to enter judgment in accordance herewith.