VIRGINIA EMERSON HOPKINS, District Judge.
This case is brought under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. ("ERISA"). The plaintiff, Kimberly Fife, alleges that defendant Cooperative Benefit Administrators, Inc. ("CBA"), wrongfully denied her long term disability ("LTD") benefits allegedly due her under a long term disability plan (the "Plan") provided by her former employer, Cherokee Electric Cooperative ("Cherokee"). (Doc. 1-1, at 3). On January 8, 2013, the plaintiff filed a document entitled "Amended Complaint" which added the National Rural Electric Cooperative Association Group Benefits Program ("NRECA") as a defendant, alleging that "[p]laintiff has long term disability protection through the National Rural Electric Cooperative Association Group Benefit Plan which is administered by Cooperative Benefit Administrators, Inc." (Doc. 9 at 1).
The case is now before the court on the plaintiff's motion for summary judgment (doc. 36), the defendants' motion for summary judgment (doc. 50), the plaintiff's objection to and motion to strike portions of an affidavit offered in support of the defendants' motion for summary judgment (doc. 55), the plaintiff's objection to and motion to strike certain facts proffered in support of the defendants' motion for summary judgment (doc. 56),
The motion will be
It has long been the law in this circuit that, when deciding a motion for summary judgment, a district court may not consider evidence which could not be reduced to an admissible form at trial. See Macuba v. Deboer, 193 F.3d 1316, 1323 (11th Cir. 1999). But, until 2010, Rule 56 lacked a formal procedure to challenge such inadmissible evidence. In 2010, the advisory committee added Rule 56(c)(2), which provides:
Fed. R. Civ. P. 56(c)(2). Although the plaintiff has styled the motion as a motion to strike, the motion is, in substance, a challenge to the admissibility of the defendants' evidence. Therefore, the court will treat the motion as an objection under Rule 56(c)(2).
The advisory committee's note to Rule 56(c)(2) provides that:
Fed. R. Civ. P. 56 advisory committee's note to 2010 amendments (emphasis added).
The entirety of the plaintiff's short motion reads:
Plaintiff moves to strike the following:
(Doc. 55 at 1-2). The motion cites no rule of evidence, case, or other authority for why this evidence should be stricken.
This is the
Now, in response to the
In an undeveloped and unsupported argument, the plaintiff argues first that materials in the administrative record which relate to the plaintiff's condition and ability to work, but which were first considered before remand by this court, should not be considered herein because "[t]he only decision under review is the opinion of the Appeals Committee . . . after the remand by the [c]ourt." (Doc. 56 at 1). This objection is without merit and will be
The plaintiff also objects to any discussion of the plaintiff's respiratory and psychological issues "because Fife claims benefits due to pain, [f]ibromyalgia, and effects of medication." (Doc. 56 at 2). The court agrees that, to some extent, this information is irrelevant. However, as is noted in the summary judgment opinion which follows, some of that information is important to include to make the discussion of the plaintiff's medical history more clear. The objection will be
Under Federal Rule of Civil Procedure 56, summary judgment is proper if there is no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a); see also Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986) ("[S]ummary judgment is proper if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.") (internal quotation marks and citation omitted). The party requesting summary judgment always bears the initial responsibility of informing the court of the basis for its motion and identifying those portions of the pleadings or filings that it believes demonstrate the absence of a genuine issue of material fact. Celotex, 477 U.S. at 323. Once the moving party has met its burden, Rule 56(e) requires the non-moving party to go beyond the pleadings in answering the movant. Id. at 324. By its own affidavits — or by the depositions, answers to interrogatories, and admissions on file — it must designate specific facts showing that there is a genuine issue for trial. Id.
The underlying substantive law identifies which facts are material and which are irrelevant. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). All reasonable doubts about the facts and all justifiable inferences are resolved in favor of the non-movant. Chapman, 229 F.3d at 1023. Only disputes over facts that might affect the outcome of the suit under the governing law will properly preclude the entry of summary judgment. Anderson, 477 U.S. at 248. A dispute is genuine "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Id. If the evidence presented by the non-movant to rebut the moving party's evidence is merely colorable, or is not significantly probative, summary judgment may still be granted. Id. at 249.
How the movant may satisfy its initial evidentiary burden depends on whether that party bears the burden of proof on the given legal issues at trial. Fitzpatrick v. City of Atlanta, 2 F.3d 1112, 1115 (11th Cir. 1993). If the movant bears the burden of proof on the given issue or issues at trial, then it can only meet its burden on summary judgment by presenting affirmative evidence showing the absence of a genuine issue of material fact — that is, facts that would entitle it to a directed verdict if not controverted at trial. Id. (citation omitted). Once the moving party makes such an affirmative showing, the burden shifts to the non-moving party to produce "significant, probative evidence demonstrating the existence of a triable issue of fact." Id. (citation omitted) (emphasis added).
For issues on which the movant does not bear the burden of proof at trial, it can satisfy its initial burden on summary judgment in either of two ways. Id. at 1115-16. First, the movant may simply show that there is an absence of evidence to support the non-movant's case on the particular issue at hand. Id. at 1116. In such an instance, the non-movant must rebut by either (1) showing that the record in fact contains supporting evidence sufficient to withstand a directed verdict motion, or (2) proffering evidence sufficient to withstand a directed verdict motion at trial based on the alleged evidentiary deficiency. Id. at 1116-17. When responding, the non-movant may no longer rest on mere allegations; instead, it must set forth evidence of specific facts. Lewis v. Casey, 518 U.S. 343, 358 (1996). The second method a movant in this position may use to discharge its burden is to provide affirmative evidence demonstrating that the non-moving party will be unable to prove its case at trial. Fitzpatrick, 2 F.3d at 1116. When this occurs, the non-movant must rebut by offering evidence sufficient to withstand a directed verdict at trial on the material fact sought to be negated. Id.
Although there are cross-motions for summary judgment, each side must still establish the lack of genuine issues of material fact and that it is entitled to judgment as a matter of law. See Chambers & Co. v. Equitable Life Assur. Soc. of the U.S., 224 F.2d 338, 345 (5th Cir. 1955); Matter of Lanting, 198 B.R. 817, 820 (Bankr. N.D. Ala. 1996). The court will consider each motion independently, and in accordance with the Rule 56 standard. See Matsushita Elec. Indus. Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587-88 (1986). "The fact that both parties simultaneously are arguing that there is no genuine issue of fact, however, does not establish that a trial is unnecessary thereby empowering the court to enter judgment as it sees fit."
The plaintiff's submissions in support of her motion for summary judgment fail, in
Turning to the plaintiff's actual brief (doc. 38), it too fails to comply with this court's scheduling order. First, it fails to include a table of contents. (See, doc. 2 at 15 ("Briefs that exceed twenty pages must include a table of contents that accurately reflects the organization of the document.")). Second, the court's scheduling order states "[t]he parties' submissions in support of and opposition to summary judgment motions must consist of: (1) a brief containing, in separately identified sections, (i) a statement of allegedly undisputed relevant material facts and (ii) a discussion of relevant legal authorities." (Doc. 2 at 15). It also states that "[a]ll briefs submitted either in support of or opposition to a motion must
Also in contravention of this court's orders, pages 3-12 (up to the response to the defendants' statement of facts) of the plaintiff's opposition to the defendants' motion for summary judgment (doc. 57) includes additional facts and argument. That portion of document 57 will be
Finally, the court's scheduling order requires that the statement of facts themselves be "set out in separately numbered paragraphs. Counsel must state facts in clear, unambiguous, simple, declarative sentences. All statements of fact must be supported by specific reference to evidentiary submissions." (Doc. 2 at 16). The facts, as stated by the plaintiff, fail in several cases to follow these guidelines. (See doc. 38 at facts no. 1, 3, 10, 15). However, the court will not strike the plaintiff's facts, but will instead treat each
Fife was an employee of Cherokee which is a member of the NRECA. Among the services the NRECA provides for its members is a long-term disability plan ("the LTD Plan") which is a self-insured Plan subject to ERISA. CBA, the claims adjuster, is a wholly-owned subsidiary of the NRECA. Cherokee offered the LTD Plan to its employees.
The National Rural Electric Cooperative Association Group Benefits Program has an appeals administration agreement with Disability Management Services, Inc. (DMS) to review appeals of LTD claims. DMS, in turn, hired MLS National Medical Evaluation, Inc. to obtain medical record reviewers.
Under the Plan, a participant must be "prevented from performing any or all of the Material and Substantial Duties of [her] Own Occupation due to any accidental bodily injury [or] sickness. ..." (Doc. 52 at 36, § 2.04). After 24 months, a participant must be "unable to perform any or all of the Material and Substantial Duties of any Gainful Occupation." (Id.). "Material and Substantial Duties" are "the essential tasks of an occupation that cannot reasonably be modified or omitted, not including overtime work." (Doc. 52 at 37, § 2.12). The term "Own Occupation" is defined as
(Doc. 37 at § 2.15). Further, a claimant seeking disability payment is subject to a "Benefit Waiting Period" — a 13 week period during which she must demonstrate a "continuous Disability" before benefit payments could commence. (Doc. 52 at 35-36, 42, §§ 2.02, 7.07). Fife sought benefits in September 2010, claiming she could not work as an Accounting — Payroll Clerk.
Fife's employer confirmed that her position as an Accounting — Payroll Clerk was "sedentary work." Fife submitted her job description with her initial LTD claim on 9/21/10, which includes:
(Doc. 65-17 at 53-57).
Fife's complaints of fibromyalgia and neck/back pain were supported primarily by records from her treating physicians: Dr. Vishala L. Chindalore, a Rheumatologist at Anniston Medical Clinic, Dr. Ryan Rainer at Cherokee Health Clinic, and Dr. Odene H. Connor at the Pain and Wound Care Clinic.
Dr. Chindalore frequently noted the plaintiff's complaints of pain and her diagnosis of fibromyalgia. (Doc. 65-1 at 27 (January 23, 2009), 32 (March 16, 2009); 32-33 (April 24, 2009); 33 (July 21, 2009); 34 (December 21, 2009); and 37 (June 30, 2010)). But he also frequently noted that Fife had good range of motion: "Both the hands, wrists, elbows, shoulders, ankles, knees and hips have good range of motion without any effusions." (Doc. 65-1 at 27 (January 23, 2009); 32-33 (April 24, 2009); at 33 (July 21, 2009); 34, 37 (March 22, 2010); and 37 (June 30, 2010)). Dr. Chindalore reported numerous times that Fife's "[l]ow back appears benign." (Doc. 65-1 at 27 (January 23, 2009), 32 (March 16, 2009); 32-33 (April 24, 2009); 33 (July 21, 2009); 34 (December 21, 2009); and 37 (June 30, 2010)). Fife's lumbosacral "spine flexion" was consistently "within normal limits." (Doc. 65-1 at 27 (January 23, 2009), 32 (March 16, 2009); 32-33 (April 24, 2009); 33 (July 21, 2009); 34 (December 21, 2009); and 37 (June 30, 2010)).
Dr. Chindalore consistently noted that Fife's "[g]ait is normal." (Doc. 65-1 at 27 (January 23, 2009), 32 (March 16, 2009); 32-33 (April 24, 2009); 33 (July 21, 2009); 34 (December 21, 2009); and 37 (June 30, 2010)). Dr. Chindalore also consistently noted that Fife had "[n]o myopathy or radiculopathy." (Doc. 65-1 at 27 (January 23, 2009), 32 (March 16, 2009); 32-33 (April 24, 2009); 33 (July 21, 2009); 34 (December 21, 2009); and 37 (June 30, 2010)). Fife had "[n]o vasculitic lesions."(Doc. 65-1 at 27 (January 23, 2009), 32 (March 16, 2009); 32-33 (April 24, 2009); 33 (July 21, 2009); 34 (December 21, 2009); and 37 (June 30, 2010)). Dr. Chindalore frequently noted that Fife's neck was "supple with good C-spine range of motion." (Doc. 65-1 at 32 (March 16, 2009); 32-33 (April 24, 2009); 33 (July 21, 2009); 34 (December 21, 2009)). On April 24, 2009, Dr. Chindalore noted that "[s]he had a lot of joint pains last time. Toradol helped her a lot." (Doc. 65-1 at 32). On March 22, 2010, he noted that "[s]he is doing reasonably well on current therapy." (Doc. 65-1 at 34). Only on December 21, 2009, did Dr. Chindalore indicate that all of the fibromyalgia "trigger points" were positive. (Doc. 65-1 at 34). Other times, both before and after that date, Dr. Chindalore noted only that "some" or "a few" of the trigger points were positive. (Doc. 65-1 at 27 (January 23, 2009), 32 (March 16, 2009); 32-33 (April 24, 2009); 33 (July 21, 2009); and 37 (June 30, 2010)). She was a "no show" for her October 2010 appointment with Dr. Chindalore. (Doc. 65-12 at 27).
On August 13, 2009, the plaintiff presented to Dr. Rainer complaining of "diarrhea and abdominal cramping for 2 days," along with "obesity." (Doc. 65-17 at 3).
On November 30, 2009, the plaintiff presented to Dr. Rainer complaining of "low back and left sciatic pain of 4 days duration without lateralizing deficits but with spasm and tenderness to palpation." (Doc. 65-17 at 2). On exam it was noted that the plaintiff had "[t]enderness to palpation over left sciatic notch and lower lumbar area without deficits." (Doc. 65-17 at 2). Dr. Rainer's impression was "[l]eft sciatica/[l]ow back pain. (Doc. 65-17 at 2). His plan was to treat the plaintiff with medications. The record is difficult to read, but it appears that one of those medications was Percocet. (Doc. 65-17 at 2).
The plaintiff next saw Dr. Rainer on February 8, 2010, with complaints of "bilateral ear and intermittent hip pain." (Doc. 65-17 at 1). Dr. Rainer's impression was "BOM/Bilateral hip pain," and his plan was to treat her with medications. (Doc. 65-17 at 1). The names of the medications are unclear from the record.
The record reflects the following visits to Dr. Rainer solely for respiratory issues:
18, 2010, visit. Even then, the plaintiff only complained to Dr. Rainer about having a cough. (Doc. 65-16 at 22). She stated to Dr. Rainer that she was "scared to go back to work now because her job is demanding and she doesn't feel she can do it currently . . . . feels beat down right now." (Doc. 65-16 at 22). She noted that she had seen Dr. Grubbe for her respiratory issues. (Doc. 65-16 at 22). Dr. Rainer noted that the plaintiff had seen Dr. Connor that same morning for neck pain and Dr. Connor had prescribed Percocet and Lidocane patches. (Doc. 65-16 at 22). Dr. Rainer's assessment was she had "neck pain, asthma, and Allergic Rhinitis." (Doc. 65-16 at 23). His plan was for her to continue her current medications and see her specialists. (Doc. 65-16 at 23).
Dr. Rainer saw the plaintiff on September 20, 2010, for a check up. (Doc. 65-16 at 20). Her chief complaint on that visit concerned symptoms regarding her asthma. (Doc. 65-16 at 20). Although she also complained of "neck pain," Dr. Rainer noted that she was "seeing Dr. Connor for pain management," that it was "going well," and the her "TENS unit helps a lot." (Doc. 65-16 at 20). Dr. Rainer's assessment was:
(Doc. 65-16 at 21).
On December 3, 2010, Dr. Rainer completed a form entitled "Long Term
Disability Benefits Claim — Attending Physician's Statement of Disability." (Doc. 65-14 at 8-9).
The plaintiff was initially assessed at the Pain and Wound Care Center on August 18, 2010. (Doc. 65-5 at 25). It was noted that she had had pain for "7-8 years," and that she had "a herniated disc in [her] neck," "a lot of joint pain especially in her hips," and that she "complains of low back pain [which] can come in gradually." (Doc. 65-5 at 25). Dr. Connor also noted that the plaintiff has fibromyalgia. (Doc. 65-5 at 27). Dr. Connor noted only "moderately decreased" range of motion in the plaintiff's cervical and lumbar spine, while measuring strength in all extremities at a 4/5 level. (Doc. 65-5 at 26). These same results were noted in exams on September 1, 2010 (doc. 65-5 at 35), September 28, 2010 (doc. 65-5 at 38), October 27, 2010 (doc. 65-5 at 41), November 24, 2010 (Doc. 65-6 at 3), December 21, 2010 (doc. 65-6 at 9), January 25, 2011 (doc. 13), February 16, 2011 (doc. 65-6 at 16), March 16, 2011 (doc. 65-6 at 23), April 28, 2011 (doc. 65-6 at 25), May 24, 2011 (doc. 65-6 at 27), June 20, 2011 (doc. 65-6 at 31), July 19, 2011 (doc. 65-6 at 33), August 10, 2011 (doc. 65-6 at 35), September 26, 2011 (doc. 65-7 at 50), October 26, 2011 (doc. 65-8 at 4), November 22, 2011 (doc. 65-8 at 10), January 19, 2012 (doc. 65-8 at 15), February 23, 2012 (doc. 65-8 at 23), March 22, 2012 (doc. 65-8 at 25), April 17, 2012 (doc. 65-8 at 27). At some point, Dr. Connor prescribed a lumbar back brace to assist with thoracic and lumbar back pain, a cervical collar to assist with a cervical radiculopathy, and a TENS unit for pain relief.
Dr. Connor requested a cervical MRI without contrast which occurred on February 10, 2011. (Doc. 65-7 at 35). The report noted: "Very small broad-based subligamentous bulge at C6-7 causing mild impression upon on the ventral thecal sac but no significant spinal canal stenosis." (Doc. 65-7 at 35). Also at Dr. Connor's request, an MRI of plaintiff's lumbar spine was performed that same day which found no evidence of disc bulge, spinal canal stenosis or foraminal narrowing but noted a right-sided pseudomeningocele at L4 and L5 with questionable right S1 pseudomeningocele. (Doc. 65-7 at 36).
A September 27, 2010, "Electrodiagnostic Report" from Dr. Connor also appears in the record. In that report, Dr. Connor includes a presumptive diagnosis of "[c]ervical plexopathy without motor deficit." (Doc. 65-7 at 43). A January 20, 2011, "Electrodiagnostic Report" from Dr. Connor also appears in the record. In that report, Dr. Connor includes a presumptive diagnosis of "[l]umbosacral plexopathy without motor deficit." (Doc. 65-6 at 10). A February 21, 2012, "Electrodiagnostic Report" from Dr. Connor includes a presumptive diagnosis of "cervical plexopathy without motor deficit." (Doc. 65-8 at 18).
An April 27, 2010 cervical spine MRI described the abnormalities as: "Early spondylotic and degenerative changes C6 with associated spur and/or bar formation and concurrent mild broad-based bulging of the C6 intervertebral disc." (Doc. 65-14 at 80).
The plaintiff first saw Clay Alexander, a chiropractor, on January 23, 2009, where it was noted that the plaintiff had "[a] headache, neck pain, mid back pain." (Doc. 65-12 at 22). She visited Alexander's office with similar complaints of pain on:
On May 18, 2010, the plaintiff was seen by Dr. Ruiz at the Ruiz Neurosurgery Clinic. (Doc. 65-14 at 53). She complained of a "12-14 month history of mechanical cervical pain." (Doc. 65-14 at 53). She also complained of lumbar pain, but stated that the cervical pain was "definitely worse." (Doc. 65-14 at 53). Dr. Ruiz noted that the April 27, 2010, MRI "reveals an extruded and partially calcified C6 disk with an indention on the ventral portion of the thecal sac. There is a small, clinically unimportant spondylitic spur at C5." (Doc. 65-14 at 53). His impression was "Active right C7 radiculopathy secondary to C6 disk pathology, both degenerative and due to calcification in nature." (Doc. 65-14 at 54). He scheduled the plaintiff for an anterior cervical discectomy and fusion on June 23, 2010. (Doc. 65-14 at 54). The record does not indicate if the procedure was actually performed.
Fife was also examined for her claim for SSDI benefits by Dr. Born, a family practitioner. Dr. Born noted that the plaintiff complained "of numerous aches, pains, and muscular problems." (Doc. 65-13 at 22). Dr. Born did not opine that Fife was disabled, but noted a number of conditions that were either diagnosed or "probable." (Doc. 65-13 at 24). Dr. Born documented that, on exam, the plaintiff had intact muscle strength with no atrophy. (Doc. 65-13 at 23). She had "normal grip strength and normal finger/hand dexterity bilaterally." (Doc. 65-13 at 23). Dr. Born noted that the plaintiff "complain[ed] of weakness in all her muscles, but we do not see any atrophy and there is more of a subjective sensation of weakness than any real muscle atrophy or weakness." (Doc. 65-13 at 23). His exam showed intact muscle strength in the lower extremities as well. (Doc. 65-13 at 23). The plaintiff had no distress in her gait which Dr. Born described as "very good." (Doc. 65-13 at 23). He described her as being able to "move the neck fairly well." (Doc. 65-13 at 24). Despite point tenderness, he noted that the plaintiff "is moving actually pretty well." (Doc. 65-13 at 24). Examination of the shoulders, elbows, wrists, hands, and fingers revealed "normal range of motion" with "generalized tenderness." (Doc. 65-13 at 24). He also noted that "[e]verything seems to hurt, but there are no localizing findings." (Doc. 65-13 at 24). At the hips, knees, ankles, and feet, Dr. Born noted "no pain, no swelling, no tenderness, and no bogginess." (Doc. 65-13 at 24). Dr. Born noted that the plaintiff's "gait is only minimally slow. We asked the [plaintiff] to walk on her toes and heels and she does this fairly well. . . . We also asked the [plaintiff] to squat and arise and we can get her to do this too[.]" (Doc. 65-13 at 24). He noted that the plaintiff reported that she might have neck surgery, but that while "the CT scans of the neck [show] some abnormalities . . . it does not appear that there is anything that would warrant an operation at this time." (Doc. 65-13 at 24).
Dr. Born did note that the plaintiff had "point tenderness" on examination of the lumbosacral spine, and "pain on range of motion here and pain on straight leg raising at 60 degrees without radiation." (Doc. 65-13 at 24). His impression was: 1) fibromyalgia, 2) probable degenerative arthritis, 3) possible early rheumatoid arthritis, 4) degenerative arthritis, cervical spine and lumbosacral spine, 5) depression, and 6) recurrent asthma. (Doc. 65-13 at 24). He described her symptoms as "chronic" and stated that it is quite likely that they will persist. (Doc. 65-13 at 24).
Crunk evaluated Fife on October 24, 2011. (Doc. 65-9 at 29). Crunk's letter reflects that he interviewed the plaintiff, and also reviewed medical records from Dr. Henry Ruiz, Dr. Henry Born, and Dr. Connor. (Doc. 65-9 at 30).
On November 17, 2010, the plaintiff saw Dr. Bowen at Birmingham Neurosurgery Group. (Doc. 65-14 at 20). The plaintiff complained of "a history of neck pain and right arm pain . . . severe over the last three weeks. She also complains of numbness in the 4th and 5th digits of the right hand." (Doc. 65-14 at 20). Dr. Bowen noted "[c]omplaints of joint pain, leg cramps, thoracic pain, cervical pain, [r]ight [a]rm (burning, aching, numbness, tingling, weakness); [r]ight [l]eg (numbness, tingling, sharp shooting); [l]eft [l]eg (aching, numbness)." (Doc. 65-14 at 21). Dr. Bowen reviewed the April 27, 2010, MRI of the plaintiff and found that it showed "stenosis 6-7 bilaterally and some at C5-6 more to the left." (Doc. 65-14 at 22). He noted normal gait, posture, and strength in the upper and lower extremities. (Doc. 65-14 at 24). He opined that he "do[es] think that she has [cervical] stenosis and problems form this." (Doc. 65-14 at 25). He ordered a myelogram and wanted the plaintiff to follow up thereafter. There is no indication that the myelogram was performed, and there are no further records from Dr. Bowen.
Dr. Scholand is a pulmonologist affiliated with Medical Review Institute of America, Inc. She reviewed Fife's records and wrote:
(Doc. 65-14 at 2). Dr. Scholand also noted that: "[T]here is no evidence to support pulmonary functional impairment in this patient." (Doc. 65-14 at 4). There is no indication that Dr. Scholand spoke with Dr. Rainer.
Dr. Scholand stated that "after review it appears the [plaintiff] has an established diagnosis of fibromyalgia and cervical osteoarthritis with bone spurs and disc bulge that causes radicular pain that might be exacerbated by the specific duties of her job." (Doc. 65-14 at 3). She noted that "[t]he chart includes documentation of rheumatoid arthritis and sarcoid, both of which the [plaintiff] does not have." (Doc. 65-14 at 4). She also wrote: "Based on review of the documents and discussion with the treating physicians, the diagnoses of fibromyalgia, cervical stenosis/cervical radiculopathy and allergies are supported." (Doc. 65-14 at 4). Dr. Scholand was specifically asked if there was medical evidence to support functional impairment, to which she answered: "There is no evidence to support pulmonary functional impairment." (Doc. 65-14). She did not address the question as to the plaintiff's other issues. Dr. Scholand herself opined only that her radicular pain "
Dr. Lafavore, who is Board Certified in Anesthesiology and Pain Medicine, also reviewed Fife's records. (Doc. 65-13 at 37-41). He noted that the plaintiff's "pain related issues . . . are primarily and confined to the [plaintiff's] cervical pain." (Doc. 65-13 at 38). While he saw some objective evidence of abnormalities in Fife's cervical spine, he found no disabling orthopedic condition:
(Doc. 65-13 at 38-39). Dr. Lafavore also found that "[t]here is insufficient evidence presented to definitively support fibromyalgia." (Doc. 65-13 at 39). He found "no impairing pain conditions based on the records reviewed." (Doc. 65-13 at 39). He also noted that: "There [is] insufficient medical evidence to support functional impairment as related to cervical spinal stenosis and/or fibromyalgia." (Doc. 65-13 at 39). He stated that "[o]bjective testing" which "would include a functional capacity examination," "may define [the plaintiff's] limitations." (Doc. 65-13 at 39).
On March 1, 2011, Fife appealed the denial of her claim.
Dr. Kaplan reviewed Fife's allegations of orthopedic and pain-related limitations. Dr. Kaplan noted that "[n]umerous medical records in the file are handwritten and illegible to this reviewer." (Doc. 65-10 at 51). Later in his report, Dr. Kaplan identifies the specific records as those from Dr. Connor at the Pain and Wound Care Center, and from Clay Alexander. (Doc. 65-10 at 53).
Dr. Kaplan acknowledged that Fife had certain orthopedic issues, but found the medical evidence demonstrated that she could work, noting, for example, that "multiple physical examinations and radiographic findings demonstrate excellent retained physical ability." (Doc. 65-10 at 56). His report reflects that he attempted to speak, without success, with Drs. Alexander, Dransfield, Connor, Grubbe, Bowen, and Chindalore. (Doc. 65-10 at 53-55). Dr. Kaplan did interview Dr. Rainer on May 2, 2011, and summarized their conversation in a letter (which Dr. Rainer acknowledged in writing) that noted: "[Dr. Rainer] feels that due to the claimant's overall joint pain, fatigue, and dyspnea, she would not be able to work at any job other than a solely sedentary job. Dr. Rainer feels that she likely could do a sedentary sitting job but the claimant perceives she is not able to do that. ..." (Doc. 65-11 at 21).
Notably, Dr. Kaplan also took into account Fife's fibromyalgia diagnosis, including Dr. Chindalore's December 2009, records which noted "positive flbromyalgia trigger points [and] painful range of motion" but also noted "normal gait and no myelopathy or radiculopathy." (Doc. 65-10 at 51). Dr. Kaplan noted that Dr. Chindalore diagnosed the plaintiff with "a flare up of arthralgias and myalgias as well as a chronic pain syndrome treated with Loricet and stable back pain, leg pain[,] and myalgias." (Doc. 65-10 at 51).
Dr. Kaplan also noted how Dr. Chindalore's March 22, 2010, records confirmed that Fife's "hands, wrists, shoulders, elbows, ankles, knees, and hips had good range of motion without any effusion," that her "low back appeared benign," her spine "demonstrated flexion within normal limits," and that her "gait was normal." (Doc. 65-10 at 51-52). Dr. Kaplan noted that Dr. Chindalore thought the plaintiff was doing reasonably well on her current therapy, but with continued pain in her neck and back. (Doc. 36-6 at 7). Dr. Kaplan also noted that Dr. Chaindalore described the April 27, 2010, MRI as "demonstrating early spondylitic and degenerative changes at multiple levels with no specific focal neurological deficits." (Doc. 65-10 at 52).
Dr. Kaplan also noted that, on May 6, 2010, the plaintiff had a neurosurgery evaluation by Dr. Bowen where she complained of "neck pain and right arm pain which was severe for several weeks with associated numbness in the 4th and 5th digits of the right hand." (Doc. 65-10 at 52). Dr. Kaplan noted that Dr. Bowen described "normal range of motion of all joints and with no deformity," a "normal cognitive examination," a "detailed motor neurological examination" that was "within normal limits," normal gait and an absence of paraspinal muscle spasm. (Doc. 65-10 at 52).
Dr. Kaplan also cited the May 18, 2010, neurosurgical evaluation done by Dr. Ruiz where Dr. Ruiz
(Doc. 65-10 at 52).
Dr. Kaplan noted that Dr. Connor has prescribed a back brace, cervical collar and TENS unit. (Doc. 65-10 at 53). Dr. Kaplan commented that the February 10, 2011, MRI "demonstrated a right-sided pseudomeningocele at L4 and L5 with a questionable right S1 pseudomeningocele. No spinal stenosis was identified. No disc bulge or spinal canal stenosis or foraminal narrowing was identified." (Doc. 65-10 at 53).
Dr. Kaplan noted that Dr. Gaunzra, a rheumatologust, "wrote a narrative report opining the claimant has the diagnosis of fibromyalgia versus less likely inflammatory arthritis. No erosive disease was identified on plain films of the hand." (Doc. 65-10 at 53).
He noted that "multiple physical examinations and radiographic findings demonstrate
(Doc. 65-10 at 57). In support of this conclusion, Dr. Kaplan noted:
(Doc. 65-10 at 56). He also noted that the April 27, 2010, MRI "demonstrated early spondylitic and degenerative changes." (Doc. 65-10 at 56).
After Fife filed this lawsuit, the parties agreed to a remand for review of Fife's July 2, 2012, award of SSDI benefits. Fife was awarded SSDI benefits based on the ALJ's conclusion that she was disabled by orthopedic issues, arthritis, fibromyalgia, asthma, and depression. (Doc. 65-2 at 52-60). Yet the ALJ also found that Fife "has the residual functional capacity to perform a significant range of light work as defined in 20 C.F.R. § 404.14567(b) except the claimant has distracting pain that is increased with physical activity to the abandonment of tasks, and medication side effects that limit effectiveness due to distraction, inattention, drowsiness, etc." (Doc. 65-2 at 58). In the decision, the ALJ noted that "[g]reater weight is given to the treating source records than the reports of the non-examining, reviewing sources at the State agency. ..." (Doc. 65-2 at 59). 71. The ALJ noted that "[m]edical improvement is expected, with appropriate treatment," and noted the need for another review in 18 months. (Doc. 65-2 at 60). The ALJ did not have, and therefore could not consider, certain evidence found in the administrative record here, including the opinions of Drs. Scholand, Lafavore, Cosmo, Kaplan, Litow, and Goldman, and the statements by two of Fife's treating physicians, Drs. Grubbe and Rainer.
The SSDI decision and other information Fife's counsel provided was reviewed in early 2013 in a court-approved remand. In that review, the Appeal Committee considered all of the evidence cited above including a new medical opinion from Dr. Francesca Litow, who is board certified in occupational medicine.
Regarding Fife's complaints of pain, Dr. Litow noted that Fife had a variety of complaints, but found her "conditions were noted to be chronic and stable." (Doc. 65 at 35).
Dr. Litow found no evidence of side effects from the plaintiff's medications. (Doc. 65 at 39).
ERISA does not contain a standard of review for actions brought under 28 U.S.C. § 1132(a)(1)(B) challenging benefit eligibility determinations. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 108-09 (1989) ("Although it is a `comprehensive and reticulated statute,' ERISA does not set out the appropriate standard of review for actions . . . challenging benefit eligibility determinations."). Moreover, the case law that has developed over time governing such standards has significantly evolved. A history of the evolution of these standards is useful to track its development and shed light on the current framework.
In Firestone, the Supreme Court initially established three distinct standards for courts to employ when reviewing an ERISA plan administrator's benefits decision: "(1) de novo where the plan does not grant the administrator discretion; (2) arbitrary and capricious where the plan grants the administrator discretion; and (3) heightened arbitrary and capricious where the plan grants the administrator discretion and the administrator has a conflict of interest." Capone v. Aetna Life Ins. Co., 592 F.3d 1189, 1195 (11th Cir. 2010) (citing Buckley v. Metro. Life, 115 F.3d 936, 939 (11th Cir. 1997) (discussing Firestone, 489 U.S. at 115)). In Williams v. Bellsouth Telecomms., Inc., 373 F.3d 1132, 1137 (11th Cir. 2004), overruled on other grounds by Doyle v. Liberty Life Assurance Co. of Boston, 542 F.3d 1352 (11th Cir. 2008), the Eleventh Circuit fleshed out the Firestone test into a six-step framework designed to guide courts in evaluating a plan administrator's benefits decision in ERISA actions. When the Eleventh Circuit created the Williams test, the sixth step of the sequential framework required courts reviewing a plan administrator's decision to apply a heightened arbitrary and capricious standard if the plan administrator operated under a conflict of interest. See id. The Eleventh Circuit later modified this step in response to the Supreme Court's ruling in Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105, 115-17 (2008), which concluded that a conflict of interest should be weighed merely as "one factor" in determining whether an administrator abused its discretion. See Doyle, 542 F.3d at 1359 ("As we now show, Glenn implicitly overrules and conflicts with our precedent requiring courts to review under the heightened standard a conflicted administrator's benefits decision."). The Eleventh Circuit's current iteration of the Firestone standard-of-review framework is found in Blankenship v. Metro. Life Ins. Co., 644 F.3d 1350 (11th Cir. 2011), cert. denied, 132 S.Ct. 849:
Id. at 1355.
This court has previously held that the "[t]he more deferential arbitrary and capricious standard will be applied to the decision to deny benefits," and that "[t]here is no conflict here." (Doc. 46 at 33, 41). Accordingly, even if the decision to deny benefits was wrong, it will be upheld if "reasonable" grounds supported it.
Under the above cited framework, Fife bears the burden of proving that she is disabled and that the benefit decision is wrong. Herring v. Aetna Life Ins. Co., 517 F. App'x 897, 899 (11th Cir. 2013) (citing Glazer v. Reliance Standard Life Ins. Co., 524 F.3d 1241, 1247 (11th Cir.2008)). If Fife satisfies this burden, she then must demonstrate that the decision to deny her LTD benefits was arbitrary and capricious; that is, she must show that the defendants had no reasonable grounds to support the decision. Herring, 517 F. App'x at 899 (citing Glazer, 524 F.3d at 1247)). It is not the defendants' burden to show that the denial was correct or reasonable.
Under the Plan, a participant must (among other things) be "prevented from performing any or all of the Material and Substantial Duties of [her] Own Occupation due to any accidental bodily injury [or] sickness. ..." (Doc. 52 at 36, § 2.04). After 24 months, a participant must be "unable to perform any or all of the Material and Substantial Duties of any Gainful Occupation." (Id.). "Material and Substantial Duties" are "the essential tasks of an occupation that cannot reasonably be modified or omitted, not including overtime work." (Doc. 52 at 37, § 2.12). The term "Own Occupation" is defined as
(Doc. 37 at § 2.15). Further, a claimant seeking disability payment is subject to a "Benefit Waiting Period" — a 13 week period during which she must demonstrate a "continuous Disability" before benefit payments could commence. (Doc. 52 at 35-36, 42, §§ 2.02, 7.07).
In this case, the basis for the plaintiff's claim is that she is disabled, as that term is defined under the policy, because of pain.
The court exhaustively set out the evidence above and will not do so again here. However, the court will note that the
Instead, the plaintiff merely writes that "[c]ounsel has summarized the evidence of disability on pages 4-7 of this brief," and then refers the court to several pages of her brief which the court has already stated it will strike for failure to comply with its scheduling order. (Doc. 38 at 34) (referring the court to doc. 38 at 6-8). However, even if the pages were not stricken, they do not help the plaintiff. The plaintiff writes:
(Doc. 38 at 6-8).
Further, without going into extensive detail again, the court notes by way of summary that the medical evidence supports the Appeals Committee's opinion that she is not disabled. Certainly there is evidence that Fife complained to some of her regular physicians about pain. However, none of the records of these of physicians reflect that plaintiff was "disabled" as defined by the Plan.
There is no evidence that primary treating physicians thought she was disabled. Dr. Connor's records consistently noted only a moderate decrease in cervical range of motion while measuring strength in all extremities at a 4/5 level. In May of 2011, Dr. Rainer, one of the physicians to whom she complained of pain, opined that the plaintiff "likely could do a sedentary . . . job." (Doc. 65-11 at 21). Finally, Dr. Chindalore frequently noted that Fife had good range of motion, that her low back appears benign, that her lumbosacral "spine flexion" was consistently "within normal limits, she had normal gait, no myopathy or radiculopathy, no vasculitic lesions, her neck was supple with good C-spine range of motion. Only on December 21, 2009, did Dr. Chindalore indicate that all of the fibromyalgia "trigger points" were positive. (Doc. 65-1 at 34). Other times, Dr. Chindalore noted that only "some" or "a few" of the trigger points were positive. (Doc. 65-1 at 27 (January 23, 2009), 32 (March 16, 2009); 32-33 (April 24, 2009); 33 (July 21, 2009); and 37 (June 30, 2010)). The plaintiff offers no analysis or explanation as to how these findings do not at least reasonably support the decision of the Appeals Committee.
Further, the results from two cervical spine MRIs on the plaintiff's back conducted in April 27, 2010, and February 10, 2011, described only "[e]arly spondylotic and degenerative changes," "mild broad-based bulging of the C6 intervertebral disc," and a "[v]ery small broad-based subligamentous bulge at C6-7," which was causing a "mild impression upon on the ventral thecal sac but no significant spinal canal stenosis." (Doc. 65-7 at 35; doc. 65-14 at 80). The plaintiff cites no opinion of any expert, and does not otherwise explain how these test results
Dr. Born documented normal upper and lower extremity strength (with no atrophy in extremity muscles), normal sensory exam, normal reflexes, and normal gait. (Doc. 65-13 at 23-24). Dr. Lafavore wrote: "There [is] insufficient medical evidence to support functional impairment as related to cervical spinal stenosis and/or fibromyalgia." (Doc. 65-13 at 39). Dr. Scholand could only opine that the plaintiff's radicular pain "
Finally, reviews by Drs. Litow and Kaplan found that the plaintiff was not functionally limited. Dr. Litow noted that Fife had a variety of complaints but found her "conditions were noted to be chronic and stable." (Doc. 65 at 35). He also found "no physical conditions supported by the clinical evidence that are functionally impairing." (Doc. 65 at 37). He supported this conclusion with:
While Dr. Kaplan acknowledged that Fife had certain orthopedic issues, he found the medical evidence demonstrated that she could work noting:
Dr. Kaplan noted that the plaintiff has been diagnosed with firbomyalgia "with very limited objective impairing factors." (Doc. 65-10 at 56). He concluded that:
(Doc. 65-10 at 57).
Based on the evidence in the record, the court determines that the decision of the Appeals Committee was both de novo correct and, even if it was not de novo correct, that it was supported by reasonable grounds.
The plaintiff claims that the decision of the Appeals Committee should be reversed because it failed to explain why it reached a decision that the plaintiff was not disabled when the Social Security Administration reached the opposite conclusion. She states that the committee "failed to explain the discrepancy between a favorable SSA Award and a denial of LTD benefits for `own' occupation." (Doc. 38 at 31; doc. 53 at 5-6; doc. 57 at 30-32).
In support of her argument, she cites to the following language in Metro. Life Ins. Co. v. Glenn (Glenn), 554 U.S. 105, 118, 128 S.Ct. 2343, 2352, 171 L. Ed. 2d 299 (2008):
Glenn, 554 U.S. at 118. She then states that "[c]ircuit courts across the nation have confirmed that . . . Glenn held that insurers have a `burden of explanation' to address the contrary conclusion reached by the Social Security Administration (SSA)." (Doc. 53 at 4 (citing Schexnayder v. Hartford Life and Accident Insurance Company, 600 F.3d 465, 470-471 (5th Cir. 2010); Montour v. Hartford Life & Acc. Ins. Co., 588 F.3d 623 (9th Cir. 2009); Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 679 (9th Cir. 2011); DeLisle v. Sun Life Assurance Co. of Canada, 558 F.3d 440 (6th Cir. 2008)).
First, the phrase "burden of explanation," in the context of divergent decisions on benefits, appears nowhere in Glenn or the other cases cited by the plaintiff.
There are many reasons
Blair v. Metro. Life Ins. Co., 955 F.Supp.2d 1229, 1247 (N.D. Ala. 2013) aff'd, 13-13463, 2014 WL 2809138 (11th Cir. June 23, 2014). That is not to say, of course, that a decision by the SSA is never relevant. But it is important to note
Glenn was an appeal from a Sixth Circuit decision. The Sixth Circuit had noted in its opinion that it was "entitled to take into account the existence of a conflict of interest that results when, as in this case, the plan administrator who decides whether an employee is eligible for benefits is also obligated to pay those benefits." Glenn v. MetLife, 461 F.3d 660, 666 (6th Cir. 2006) aff'd sub nom. Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 128 S.Ct. 2343, 171 L. Ed. 2d 299 (2008). The Sixth Circuit held:
Glenn, 461 F.3d at 666 (internal citations omitted). Then the Sixth Circuit wrote:
Id. at 666-67 (emphasis added). The Sixth Circuit's opinion stands for the proposition that a contrary disability determination by the Social Security Administration is relevant,
The Supreme Court's decision on appeal did not broaden the scope of the relevance of an SSA decision. Indeed, that specific issue was not before the court. The issues before the Court were only: 1) "whether a plan administrator that both evaluates and pays claims operates under a conflict of interest in making discretionary benefit determinations," and 2) "`how' any such conflict should `be taken into account on judicial review of a discretionary benefit determination.'" Glenn, 554 U.S. at 110. After determining that there was a conflict of interest in the circumstances before it, the Supreme Court held that "when judges review the lawfulness of benefit denials, they will often take account of several different considerations of which a conflict of interest is one." Id. at 117. The Court then noted that "[t]he Court of Appeals' opinion in the present case illustrates the combination-of-factors method of review." Id. at 118. It then included the passage cited by the plaintiff which, again, reads:
Glenn, 554 U.S. at 118 (emphasis added).
Placed in context, it is clear that the Supreme Court's decision only notes the relevance of an SSA decision
Importantly, this case was
(Doc. 36-6 at 13). The Eleventh Circuit has found that this type of "explanation" is enough. See, Blair v. Metro. Life Ins. Co., 13-13463, 2014 WL 2809138 at *4 (11th Cir. June 23, 2014) ("[C]ontrary to Blair's assertions, MetLife did consider her favorable SSA award. MetLife's January 30, 2009 determination makes note of the award and explains that the awarding of SSA benefits does not guarantee the approval or continuation of LTD benefits because the SSA benefits decision is separate from and governed by different standards than MetLife's review and determination under the Plan. Accordingly, this argument fails.").
The plaintiff picks out, and finds fault with, the following phrase form the Appeals Committee's decision: "The Committee notes that the information available is insufficient to support Ms. Fife's inability to perform the functions of her sedentary occupation beyond October 22, 2010." (Doc. 36-6 at 14). Under the Plan, a participant must (among other things) be "prevented from performing
The Appeals Committee's
(Doc. 36-6 at 14) (emphasis added). This language exactly tracks the Plan language. The Appeals Committee did not use the wrong definition of disability.
Crunk evaluated Fife on October 24, 2011. (Doc. 65-9 at 29). He opined that "[s]he would be considered totally disabled as it related to work." (Doc. 65-9 at 30). This opinion was not discussed in the Appeals Committee's decision of March 20, 2013. In its decision of December 30, 2011, the Appeals Committee did consider the decision and appeared to give it no weight noting "there is no objective information regarding her functional limitations or restrictions." (Doc. 65-9 at 27). The plaintiff writes that
(Doc. 38 at 31, 32; doc. 53 at 6; doc. 57 at 37) (citations omitted) (emphasis in original). The plaintiff provides no other discussion or analysis. The plaintiff has not explained why failing to consider Crunk's opinion under these circumstances was first incorrect,
Further, while the Appeals Committee did not mention Crunk's letter in its final decision, it is clear (and the plaintiff agrees) that it
Howard, 929 F. Supp. 2d at 1295. The plaintiff has not explained why the Appeals Committee's conclusion in this regard was incorrect. Further, she has not shown why, once the committee disregarded this opinion in the Second Appeal, it was error to fail to mention it in the Third Appeal. Finally, the plaintiff has not shown why, even if Crunk's opinion was considered, the decision would not still have a reasonable basis in light of the numerous opinions from medical doctors which support the decision.
(Doc. 38 at 31-32; doc. 53 at 6)(quoting doc. 36-6 at 4) (emphasis in original). The plaintiff makes substantially the same argument in document 57 at page 36, but also adds the following paragraph from the Appeals Committee's March 20, 2013, opinion:
(Doc. 57 at 36) (quoting doc. 36-6 at 8). The plaintiff provides no further explanation as to why these facts might be important.
The first quote is based upon the same finding by Dr. Scholand that the plaintiff has pain which
Further, in setting out these quotes, the plaintiff seems to be arguing that the mere
Sarchet v. Chater, 78 F.3d 305, 307 (7th Cir. 1996). The plaintiff has failed to show how the quoted sections provide medical evidence of an inability to work.
(Doc. 38 at 32; doc. 53 at 6; doc. 57 at 37). The plaintiff does not explain, nor provide authority for why, considering all of the opinions already in the record, and the multiple reviews by independent examiners, this additional review was necessary and/or would have made a difference. This underdeveloped argument is without merit.
(Doc. 38 at 32; doc. 53 at 7; doc. 57 at 37). This underdeveloped argument does not explain
Black & Decker, 538 U.S. at 834. Accordingly, even if the plaintiff has identified certain favorable opinions of her treating physicians, which she has not, they would be entitled to no special weight, and the decision would not be unreasonable simply because of a disagreement between the plaintiff's treating physician and the Plan's record reviewers.
The plaintiff argues that the Eleventh Circuit's opinion in Oliver v. Coca Cola Co., 497 F.3d 1181, 1197 (11th Cir. 2007) "held that it is arbitrary and capricious to require objective evidence and to disregard a treating physician's opinion in favor of a medical reviewer's opinion." (Doc. 57 at 35). She then argues that the Appeals Committee erred when it "[r]equired objective evidence contrary to Oliver." Again, this underdeveloped argument does not explain how the Appeals Committee required such objective evidence.
First, as has been noted:
Tippitt v. Reliance Standard Life Ins. Co., CIV.A.1:02-CV1140JEC, 2007 WL 4054664 (N.D. Ga. Nov. 7, 2007) aff'd, 276 F. App'x 912 (11th Cir. 2008). Further, in this case, as opposed to Oliver, it is undisputed that the plaintiff has pain
Similarly in this case, there is no evidence that the defendants required the plaintiff to prove, by objective evidence, that she had any of the ailments of which she complains.
(Doc. 57 at 36). First, the plaintiff provides no cite for the court to determine to what tests Dr. Litow was referring. However, the court notes that Litow was asked to review the plaintiff's claims to see if she was disabled for pulmonary reasons as well as for pain. Accordingly, it was not inappropriate to rely on this opinion that pulmonary tests were normal.
The plaintiff may be arguing that this line of the opinion is misleading in that it implies that
In arguing that the opinion of Dr. Litow is "flawed," "biased," and "not based on substantial evidence,"
These arguments have already been addressed as to the Committee decision. For those same reasons, they fail here as well.
The plaintiff also argues that Dr. Litow "filed to address the opinion of Dr. Rainier and the records and report of Dr. Conner, stating that Dr. Conner's records were illegible." (Doc. 38 at 33; doc. 53 at 7; doc. 57 at 38). On the contrary, the record clearly shows that he found "no physical conditions supported by the clinical evidence that are functionally impairing" (doc. 65 at 37), a conclusion he supported in part by medical records from Dr. Connor, ranging in dates from August 18, 2010 through April 17, 2012, which consistently noted only a moderate decrease in cervical range of motion while measuring strength in all extremities at a 4/5 level. (Doc. 65 at 37).
(Doc. 38 at 33; doc. 53 at 7-8; doc. 57 at 38-39) (emphasis in original). Needless to say, this vague argument, which makes no attempt to explain which portions of what favorable evidence were omitted by Dr. Litow, fails to satisfy the plaintiff's burden. Further, the argument that the "big picture" was not considered is undercut by the vast amount of evidence that Dr. Litow states she reviewed, and the fact that she considered whether the plaintiff was disabled based on
The plaintiff claims that Dr. Litow "[f]ailed to mention Fife's pain caused by fibromyalgia or the effects of pain medications," and quotes the following question and answer from her report:
(Doc. 38 at 34; doc. 53 at 8; doc. 57 at 39) (quoting doc. 65 at 37). This argument is without merit. Dr. Litow clearly considered voluminous medical records and test results in reaching her opinion that the plaintiff was not functionally impaired. Her report noted that the plaintiff's medical conditions included "neck pain, back pain, [and] fibromyalgia." (Doc. 65 at 36). She also noted and considered the plaintiff's complaints of pain which were documented in the various medical records. (Doc. 65 at 36-37). She also noted that the medical records she reviewed "do not support any evidence of side effects from the claimant's medications." (Doc. 65 at 39). The plaintiff has pointed to no records or alleged side effects from medications which Dr. Litow did not consider.
The plaintiff argues that Dr. Litow "
The plaintiff's motion for summary judgment will be
For the reasons stated herein the following will be ordered:
A separate order will be entered.
Fed. R. Civ. P. 8(a). The original and amended complaints are each six sentences long.
(Doc. 61 at 1-2). The court does not see the motion as asking the court to reconsider an earlier ruling. The defendants' response does not explain why the evidence might be relevant.
(Doc. 42 at 1). The court applies this order retroactively to the plaintiff's brief in support of her motion for summary judgment.
(Doc. 38 at 6-8). She has technically "cited" this evidence. However, this technique basically just alleges that, somewhere in these records, there is medical and vocational evidence which supports her claim. She puts the onus on the court to "dig it up" on her behalf. Literally hundreds of pages of records have been cited without any explanation as to which portions of what records constitute "substantial and convincing evidence of disability." The plaintiff might have just as well have cited to "the court file" generally. Still, the court has made an effort to review and summarize here the key portions of the records cited by the parties. However, the court cannot be faulted for failing to consider some aspect of those records upon which the plaintiff relies but which she failed to specify. "`There is no burden upon the district court to distill every potential argument that could be made based upon the materials before it on summary judgment. Rather, the onus is upon the parties to formulate arguments.'" McIntyre v. Eckerd Corp., 251 F. App'x 621, 626 (11th Cir. 2007) (quoting Resolution Trust Corp. v. Dunmar Corp., 43 F.3d 587, 599 (11th Cir.1995). The court also notes that the plaintiff's counsel refers to a summary of medical records that he prepared. (Doc. 38 at 7-8 (citing 65-10 at 4-12)). The court
(Doc. 65-10 at 7). If Dr. Connor's statement appears in the record somewhere other than in this summary, it has not been cited by the parties and the court has not been able to find it. This "summary," which is not evidence, cannot and will not be considered by the court. The court has found where a disability questionnaire was forwarded to Dr. Connor, in response to which someone in his office replied "Dr. Connor does not fill out [d]isability forms." (Doc. 65-13 at 5).
(Doc. 57 at 41). Even if the court were bound to follow these cases, the record clearly shows that the Appeals Committee did not rely "solely" on record reviewers.
Id. at 12. The plaintiff says that "[a]n appropriate decision in this case would be to substitute the name of Dr. Chindalore, the treating physician for Dr. McLain." (Doc. 57 at 43). However, she provides no additional information, argument, or citations explaining why that would be the case. The court notes that Dr. Chindalore's records support the conclusion that the plaintiff had no functional impairment. Further, only on December 21, 2009, did Dr. Chindalore indicate that all of the fibromyalgia "trigger points" were positive. (Doc. 65-1 at 34). Unlike Dr. McLain in Williams, in the instant case the plaintiff cites no opinion of Dr. Chindalore where her condition is considered "disabling," or any other opinion regarding her level of pain. Again, as with most of the plaintiff's argument, she seems to merely point to the medical records and ask the court to find supportive evidence for her.