Sanderson v. Continental
Casualty Co., 2003 WL 470539 (D.
District Court Judge Sleet
Defendant, in assessing Plaintiff’s claim for benefits, reviewed
statements of the employer and employee, plaintiff’s treating physicians,
occupational Physical Demands analysis. The
following doctors treated the Plaintiff: Dr.
Nancy G. Murphy; Dr. Kenneth Brumberger (submitted Magnetic Resonance Imaging
reports on wrist and right hand); Dr. Peter Townsend (carpel tunnel release
surgery); Plaintiff’s statement of daily activities.
Plaintiff’s claim was denied, with the explanation that the file did not
support a functional impairment that would prevent Plaintiff from performing her
occupation. Plaintiff sought
reconsideration. New medical
documentation was submitted by Dr. James Newman (an expert in fibromyalgia), Dr.
Thomas W. Fiss, and Dr. Alan Ken Matsumoto (an expert in fibromyalgia), all
regarding her rheumatoid arthritis symptoms.
Dr. Eugene Truchelut conducted a peer review of the claim on the
Defendant’s behalf. Defendant again denied Plaintiff’s claim.
Plaintiff appealed, and the appeals committee also denied her claim.
During the appeals process, Plaintiff was approved for receipt of Social
Security Disability income, and this information was submitted as a part of her
file.
This matter came before the court on cross motions for summary judgment.
In applying the heightened arbitrary and capricious standard, this court
denied Plaintiff’s motion for summary judgment, granted in part and denied in
part Defendant’s motion for summary judgment.
In response to Defendant’s motion for summary judgment, Plaintiff asserted
that Defendant was self-serving in the consideration of the evidence presented
in her case. She asserted that it
gave more weight to the evidence that favored the refusal of benefits, while
giving her own treating physicians’ reports little consideration.
The court agreed. It noted
that Plaintiff’s expert treating physicians, Dr. Newman and Dr. Matsumoto,
both determined that Ms. Sanderson was physically disabled from working due to
fibromyalgia. Yet, Continental relied heavily on the report of Dr. Truchelut,
the peer review physician, to support its decision.
Dr. Truchelut never made any determination as to Plaintiff’s
fibromyalgia, but confined his review to carpal tunnel syndrome and rheumatoid
arthritis. He never contacted the
Plaintiff or her treating physicians. The
court specifically noted that Dr. Truchelut’s paper review of the file is also
troubling because fibromyalgia is a condition which manifests itself through
clinical symptoms, and is not to be considered any less disability because its
diagnosis often turns on subjective information the patient supplies.
The Plaintiff’s subjective complaints of pain appeared to have been
entirely discounted. The court held
that a strong emphasis on objective evidence to the resulting exclusion of the
subjective evidence is improper. There
was nothing in the record to indicate that Dr. Truchelut’s opinion was any
more supported or reliable that Plaintiff’s treating physicians.
The court denied Continental’s motion for summary judgment since its
decision was arbitrary and capricious.
This court granted Defendant Rhodia, Inc.’s motion for summary judgment,
as it did not control the administration of the policy.
Plaintiff’s motion for summary judgment was denied, as the court was
unwilling to make the determination itself that the Plaintiff was disabled.
The court concluded that remand to the plan administrator was the
appropriate remedy.