Thompson v. Life Insurance Company of North America
OPINION AND ORDER granting 47 the ConAgra defendants' motion for judgment; dismissing Ms. Thompson's third amended complaint with prejudice; and denying Ms. Thompson's request for remand. To the extent the ConAgra defendants move for attorneys' fees and costs, their request is denied without prejudice. Signed by Judge Kristine G. Baker on 10/7/2016. (thd)
IN THE UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
Case No. 1:14-cv-00041 KGB
CONAGRA FOODS, INC., EMPLOYEE
COMMITTEE, and CONAGRA FOODS, INC.
LONG-TERM DISABILITY PLAN X60
OPINION AND ORDER
Plaintiff Evelyn Gayle Thompson brings this action against ConAgra Foods, Inc., the
Employee Benefits Administrative Committee, and the ConAgra Foods, Inc. Long-Term
Disability Plan X60 (collectively the “ConAgra defendants”) to recover long-term disability
benefits allegedly owed to her under the ConAgra Foods, Inc. Long-Term Disability Plan X60
(the “Plan”), an employee benefits plan governed by the Employee Retirement Income Security
Act of 1974 (“ERISA”). Before the Court is Ms. Thompson’s motion for judgment on the
administrative record (Dkt. No. 47), to which the ConAgra defendants have responded (Dkt. No.
50) and Ms. Thompson has replied (Dkt. No. 51). For the following reasons, the Court grants the
ConAgra defendants’ motion for judgment.
Ms. Thompson worked for ConAgra for over 30 years, beginning as a bookkeeper and
eventually serving as the controller of the ConAgra frozen food plant in Batesville, Arkansas
(Dkt. No. 47, at 1). As an employee, Ms. Thompson participated in the Plan, which entitled her
to benefits in the event she became disabled. The terms of the Plan provide that “disability”
(a) during the Elimination period and the next 24 months of Disability you are, as
a result of Injury or Sickness, unable to perform the Material and Substantial
Duties of your Own Occupation, and (b) for the remainder of the maximum
benefit period you are, as a result of Injury or Sickness, unable to perform with
reasonable continuity the Material and Substantial Duties of Any Occupation.
(Dkt. No. 50, at 4). The Plan defines “Any Occupation” as “any occupation a participant
becomes reasonably fit to perform based on training, education, experience, age, physical
and mental capacity” (Dkt. No. 50, at 4).
Ms. Thompson was first diagnosed with breast cancer in 2000.
She underwent a
mastectomy, which successfully removed the cancerous tissue (Dkt. No. 47, at 3). The breast
cancer returned in 2005, but the cancer went into remission after Ms. Thompson underwent
surgery and chemotherapy.
In August 2007, Ms. Thompson began to experience fatigue and exhaustion (Dkt. No. 47,
at 4). Her last day of work at ConAgra was June 2, 2008 (Dkt. No. 50, at 2). On June 3, 2008,
she had an ejection fraction of ten percent, and she was later diagnosed with cardiomyopathy and
congestive heart failure (Dkt. No. 47, at 4). Eventually, doctors implanted a biventricular
implantable cardiac defibrillator.
Ms. Thompson continues to have health issues, some of which the ConAgra defendants
dispute (Dkt. No. 47, at 4; No. 50, at 14-15). Ms. Thompson also suffers from mental health
issues, including anxiety, depression, mood disorders, and post-traumatic stress disorder
(“PTSD”), some of which the ConAgra defendants also dispute (Dkt. No. 47, at 4; No. 50, at 1516).
On December 2, 2008, Ms. Thompson was granted long-term disability benefits under
the Plan (Dkt. No. 50, at 5) after Dr. Robert Morrision, who reviewed the case for ConAgra,
concluded that “she was disabled . . . and that her condition ‘rarely improves’” (Dkt. No. 47, at
2). From 2008 to May 13, 2013, she continued receiving disability benefits. In 2009, she was
also awarded Social Security Disability benefits (Dkt. No. 47, at 2).
The Plan requires participants occasionally to provide proof of disability in order to
continue receiving benefits. ConAgra approved Ms. Thompson’s eligibility for benefits several
times from 2008 to 2013 (Dkt. No. 47, at 2-3). However, on May 13, 2013, ConAgra informed
Ms. Thompson that she “no longer met the definition of ‘Disabled’ under the LTD Plan” after
determining that, even with her health issues, she could work as a treasurer or department
manager in Batesville, Arkansas (Dkt. No. 50, at 10). She appealed the denial of her claim for
future benefits (Dkt. No. 50, at 11), and her appeal was denied on January 6, 2014 (Dkt. No. 50,
at 16). Rather than file a second appeal request, which she was entitled to do under the Plan, Ms.
Thompson sought judicial review of the decision in the Circuit Court of Independence County,
Arkansas (Dkt. No. 47, at 3). Her action was removed to this Court.
The Review Process
The Plan provides that, in order to receive disability benefits, the employee must furnish
proof of disability and that the employee requires the regular attendance of a physician (AR 803).
Benefits under the Plan continue for the duration of the disability, so long as the employee
provides to the Plan Administrator proof of continued (1) disability; (2) regular attendance of a
physician; and (3) appropriate available treatment (AR 803). Proof must be provided upon
request by the Plan Administrator.
On January 3, 2013, CIGNA Group Insurance (“CIGNA”), the designated Plan
Administrator, notified Ms. Thompson that it would be reviewing her disability status (Dkt. No.
50, at 6). In its notification, CIGNA also: (1) requested that Ms. Thompson provide her
physician’s treatment plan and medical information pertaining to her diagnosis and functional
abilities; (2) asked that she complete a Disability Questionnaire and Activities of Daily Life
Form; and (3) notified Ms. Thompson that it intended to contact her medical providers and
obtain information from them. Ms. Thompson completed and returned the questionnaire and
form. She also spoke with a CIGNA representative about her claim on February 22, 2013, and
during that conversation she indicated that she was both mentally and physically disabled (AR
After speaking with Ms. Thompson, CIGNA representatives made two supplemental
requests for additional information and authorization to obtain certain medical records (Dkt. No.
50, at 7).
CIGNA assigned four individuals, including a claims manager, to conduct its initial
review of Ms. Thompson’s claim (Dkt. No. 50, at 8).
A Nurse Case Manager (“NCM”)
reviewed Ms. Thompson’s claim file, which included:
(1) a mental diagnostic evaluation
conducted on April 30, 2009, by Dr. Glen Adams for the purpose of determining Ms.
Thompson’s eligibility for Social Security Disability benefits; (2) Ms. Thompson’s
echocardiogram from July 2012; (3) office visit notes from 2012 to 2013 from Dr. Robert
Walton, Ms. Thompson’s primary care physician; (4) a letter dated April 8, 2013, from Dr.
Walton in which he concluded that Ms. Thompson was “medically disabled as a result of an
associated anxiety disorder with associated depression that followed the manifestations of her
cardiac illness in 2008;” and (5) an office visit note from Dr. Francis Gilliam, Ms. Thompson’s
cardiologist, dated February 27, 2013 (Dkt. No. 50, at 8). After reviewing the file, the NCM, a
licensed professional counselor and behavioral health specialist, issued a report concluding that
Ms. Thompson’s “medical records did not support restrictions and limitations related to mental
health issues” (Dkt. No. 50, at 9).
A board-certified psychiatrist reviewed Ms. Thompson’s claim file and the NCM’s
report. The psychiatrist concurred with the NCM, finding that “the medical data did not support
any restrictions” (Dkt. No. 50, at 9). In doing so, he rejected Dr. Adams’ diagnosis that Ms.
Thompson suffered from PTSD because “[f]irst, Dr. Adams failed to identify any specific trauma
to support a diagnosis of PTSD, and second, the objective tests performed by Dr. Adams
revealed that Plaintiff’s mental status was within normal limits, indicating no cognitive
impairment” (Dkt. No. 50, at 9).
CIGNA’s initial review also included analysis from a Rehabilitation Specialist, who
conducted a “Transferable Skills Analysis” to determine whether Ms. Thompson’s restrictions
and limitation prevented her from performing “any occupation,” as defined by the Plan (Dkt. No.
50, at 9-10). The Rehabilitation Specialist concluded that Ms. Thompson could work as a
treasurer or department manager in the current labor market in Batesville, Arkansas, based on her
medical conditions and job qualifications.
After completing the initial review, CIGNA notified Ms. Thompson that her claim was
closed because it was determined that she was no longer “disabled” under the Plan (Dkt. No. 50,
at 10-11). CIGNA offered Ms. Thompson the opportunity to appeal and informed her that she
could submit comments and additional documentation, including medical records, which would
be considered during the review process.
Ms. Thompson appealed after CIGNA’s initial review by submitting a letter from her
attorney; additional medical records from Cardiology Associates of Northeast Arkansas and
Arrhythmia Associates of Northeast Arkansas; and a letter signed by Dr. Walton (Dkt. No. 50, at
Her file, including this additional documentation, was reviewed by an “Appeals
Specialist, Board Certified Psychiatrist, and Board Certified Internal Medicine/Occupational
Medical Physician” (Dkt. No. 50, at 16). Both doctors reviewing the file were independent from
CIGNA’s claims review process (Dkt. No. 50, at 15-16).
Dr. Matthew Lundquist, the Internal Medicine/Occupational Medical Physician, reviewed
all of Ms. Thompson’s available medical records, conducted a peer-to-peer phone call with Dr.
Walton, and attempted to contact Dr. Gilliam (Dkt. No. 50, at 14). Dr. Lundquist concluded that
Ms. Thompson “was not ‘physically functionally limited due to her history of breast cancer,
cardiomyopathy, and Sjogren’s syndrome’ and that there was ‘a lack of clinical evidence in the
medical records provided for review to support any medically necessary work activity
restrictions’” (Dkt. No. 50, at 14).
Dr. Roy Sanders, a Board Certified Psychologist, evaluated Ms. Thompson’s eligibility
for disability based on her mental health. Dr. Sanders reviewed the medical records provided by
Ms. Thompson, and found that: “(1) the records did not include a comprehensive mental status
exam, (2) the records did not discuss Plaintiff’s symptoms, nor did they identify any specific
psychiatric or psychological concern, and (3) the data available was ‘so very sparse’ that
essentially no medical evidence existed to support a diagnosis of cognitive, mental, or behavioral
impairment from May 14, 2013 onward” (Dkt. No. 50, at 16).
Based on Dr. Lundquist and Dr. Sanders’ reports, as well as reviewing Ms. Thompson’s
complete file, CIGNA upheld its denial of Ms. Thompson’s claim for ongoing benefits.
Specifically, CIGNA found that “the medical evidence provided did not support limitations and
restrictions that would prevent Plaintiff from performing the duties of Any Occupation” (Dkt.
No. 50, at 16). CIGNA informed Ms. Thompson that she had the option of filing a second
appeal request and suggested that she consider providing medical records including “a
neuropsychological/psychological evaluation, a mental status exam, and/or, a functional capacity
exam” (Dkt. No. 50, at 17). Rather than file a second appeal, Ms. Thompson initiated this action.
Standard of Review
Where the plan gives the plan administrator “discretionary authority to determine
eligibility for benefits,” the Court reviews the administrator’s decision for abuse of discretion.
Anderson v. U.S. Bancorp, 484 F.3d 1027, 1032 (8th Cir. 2007) (quoting Firestone Tire &
Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989)). Ms. Thompson and the ConAgra defendants
agree that the appropriate standard of review in this case is abuse of discretion (Dkt. Nos. 47, at
5; 50, at 18).
Under the abuse of discretion standard, the Court considers “whether the administrator
abused its discretion—that is, whether its interpretation of the plan was reasonable, and whether
its decision was supported by substantial evidence.” Pralutsky v. Metropolitan Life Ins. Co., 435
F.3d 833, 838 (8th Cir. 2006). Substantial evidence is “more than a scintilla but less than a
preponderance.” Schatz v. Mutual of Omaha Ins. Co., 220 F.3d 944, 949 (8th Cir. 2000). If the
Court finds that a decision was supported by substantial evidence, “it should not be disturbed
even if a different, reasonable interpretation could have been made.” Johnson v. United of
Omaha Life Ins. Co., 775 F.3d 983, 989 (8th Cir. 2014).
Review for Abuse of Discretion
Ms. Thompson argues that the ConAgra defendants’ decision was unreasonable and not
supported by substantial evidence because it “relied almost exclusively” on Dr. Lundquist and
Dr. Sanders’ medical reports, which she claims “are deeply flawed and should be given no
weight” (Dkt. No. 47, at 7). Specifically, she contends that “Dr. Lundquist summarily dismissed
Dr. Walton’s opinions” as to Ms. Thompson’s eligibility under the Plan, while “fail[ing] to
provide any explanation of his opinions” (Dkt. No. 47, at 8). Similarly, she maintains that Dr.
Sanders’ report is “specious” because she alleges that it contains incorrect statements of fact and
“summarily concluded that Mrs. Thompson’s treating medical professionals were wrong”
without providing an explanation for the basis of that conclusion (Dkt. No. 47, at 9). She argues
that both Dr. Lundquist and Dr. Sanders failed to point to “specific evidence to indicate that Dr.
Walton or Dr. Adams’s diagnoses and opinions were inaccurate” and “hand-picked the records
upon which they relied” (Dkt. No. 47, at 9-10). According to Ms. Thompson, the ConAgra
defendants’ reliance on this “paper review” was arbitrary and capricious (Dkt. No. 47, at 9).
Ms. Thompson also argues that the ConAgra defendants’ decision was unreasonable
because “[t]he review upon which the denial was based focused on peripheral mental health
issues rather than Mrs. Thompson’s extensive history of serious cardiac conditions” (Dkt. No.
51, at 1). She asserts that the ConAgra defenadnts “all but ignored the physical basis for Mrs.
Thompson’s disability” and that “ConAgra devoted its entire review of Mrs. Thompson’s claim
to an analysis of peripheral mental health conditions and subsequently used that review in an
attempt to gain traction for denial of her claim” (Dkt. No. 51, at 3). For these reasons, she argues
that the ConAgra defendants abused their discretion in denying her claim.
The Court finds that the ConAgra defendants did not abuse their discretion in denying
Ms. Thompson’s claim.
Under the terms of the Plan, Ms. Thompson has the burden of
producing sufficient proof that she continues to be disabled in order to receive benefits (AR 803).
For the following reasons, a reasonable person could have found that she failed to prove that she
was unable to work in “any occupation.” Prezioso v. Prudential Ins. Co. of Am., 748 F.3d 797,
805 (8th Cir. 2014).
The ConAgra defendants conducted a “full and fair review” before denying Ms.
Thompson’s appeal. Id. at 805-06. The ConAgra defendants, acting through the designated Plan
Administrator, “considered all comments, medical records, and other information supplied by
Plaintiff” (Dkt. No. 50, at 19). Ms. Thompson argues that, in its initial review of her claim, the
ConAgra defendants “did not consult with her physicians, nor did it obtain an independent
medical opinion from any other medical professional” (Dkt. No. 47, at 7).
ConAgra defendants obtained two independent medical opinions and consulted, or attempted to
consult, her physicians during the appeal of its initial decision (Dkt. No. 50, at 14). Therefore,
Ms. Thompson fails to identify any specific evidence that the ConAgra defendants neglected to
consider in its review of her claim. 1
Dr. Lundquist and Dr. Sanders did not conduct an in-person examination with Ms.
Thompson as part of their review, while Dr. Walton and Dr. Adams did. Ms. Thompson argues
that the ConAgra defendants acted arbitrarily and capriciously by relying on Dr. Lundquist and
Dr. Sanders’s reports, as opposed to the reports of those who actually saw her (Dkt. No. 47, at 9).
The Court disagrees. “[T]reating physicians are not automatically entitled to special
weight in disability determinations under ERISA.” Midgett v. Washington Grp. Int'l Long Term
Disability Plan, 561 F.3d 887, 897 (8th Cir. 2009). If a treating physician concludes that his or
her patient is disabled, but a reviewing physician disagrees, “the plan administrator has
discretion to find that the employee is not disabled unless ‘the administrative decision lacks
support in the record, or . . . the evidence in support of the decision does not ring true and is . . .
The ConAgra defendants contend that CIGNA “also did not abuse its discretion by
placing little to no weight on the Social Security Administration’s decision to award Plaintiff
disability benefits” (Dkt. No. 50, at 27). The Court agrees under the facts and circumstances of
this case, as “SSA disability awards are not binding on ERISA plan administrators.” Waldoch v.
Medtronic, Inc., 757 F.3d 822, 833 (8th Cir. 2014), as corrected (July 15, 2014).
overwhelmed by contrary evidence.’” Coker v. Metro. Life. Ins. Co., 281 F.3d 793, 799 (8th Cir.
Dr. Lundquist and Dr. Sanders concluded that Dr. Walton and Dr. Adams’ opinions
regarding Ms. Thompson were not supported by sufficient objective medical evidence (AR 187188, 199). Both identified the basis of their conclusion. The Court finds that Dr. Lundquist and
Dr. Sanders’s opinions are not overwhelmed by contrary evidence in the record, meaning that the
ConAgra defemdamts’ reliance on their opinions was not arbitrary and capricious.
Ms. Thompson also argues that “ConAgra devoted its entire review of Mrs. Thompson’s
claim to an analysis of peripheral mental health conditions and subsequently used that review in
an attempt to gain traction for denial of her claim” (Dkt. No. 51, at 3). As a preliminary matter,
the Court notes that Ms. Thompson herself identified mental health issues as a major basis for
her disability claim. When asked why she could not work in her own or any occupation, Ms.
Thompson wrote, “I can no longer deal with the stress of deadlines and demands of large
business group. My attention span is limited. My memory no longer can retain important facts
and details” (AR 364). When asked to identify the primary mental or physical conditions
preventing her from working, she wrote, “[h]ypertension – from stress and anxiety. Need to
keep my heart rate stable. Tire easily. I could not work an 8 hour day without many breaks and
resting” (AR 364). In her own words, Ms. Thompson identifies both mental and physical
disabilities preventing her from working. Therefore, the Court concludes that the ConAgra
defendants’ review of her mental health issues was not a pretext for denying her claim.
The record contradicts Ms. Thompson’s assertion that the ConAgra defendants ignored
Ms. Thompson’s physical limitations in its review. In its initial review, the ConAgra defendants’
rehabilitation specialist reviewed and considered Ms. Thompson’s physical restrictions and
limitations (as provided by Dr. Walton) in completing the transferable skills analysis (Dkt. No.
50, at 9-10). On appeal, the ConAgra defendants enlisted Dr. Lundquist for the specific purpose
of analyzing Ms. Thompson’s disability eligibility based on her physical condition (Dkt. No. 50,
at 14-15). In his report, Dr. Lundquist addresses Dr. Walton’s professional opinion about Ms.
Thompson’s physical condition and analyzes whether the opinion is supported by sufficient
evidence (AR 199).
The ConAgra defendants did not ignore Ms. Thompson’s
limitations in its review.
The ConAgra defendants engaged in additional procedures that the Eighth Circuit Court
of Appeals has found contribute to a “full and fair review.” After Ms. Thompson appealed its
initial denial of her claim, the ConAgra defendants “referred the appeal to a different
decisionmaker (sic)” and “did not afford deference to the initial decision” (AR 103-04);
Prezioso, 748 F.3d at 805. The two reviewing physicians, Dr. Lundquist and Dr. Sanders, were
neutral and qualified, and the ConAgra defendants obtained an additional report from a qualified
vocational expert as part of its initial evaluation. In accordance with the Eighth Circuit’s
analysis in Prezioso, the Court finds that this was a full and fair review.
The ConAgra defendants’ decision was supported by substantial evidence, and the Court
rejects Ms. Thompson’s argument regarding the sufficiency of Dr. Lundquist and Dr. Sanders’s
reports. Both physicians reviewed all medical documentation submitted by Ms. Thompson in
support of her claim. Both found that the evidence was insufficient to support finding that Ms.
Thompson’s mental and physical condition at the time of the review rendered her unable to work
in certain occupations (Dkt. No. 50, at 22, 26). The Plan requires Ms. Thompson to submit proof
showing that she qualifies as being disabled. Both physicians specifically found that she failed
to meet that burden with objective medical evidence, and both physicians explained why they
believed such evidence was lacking. The Court finds that their reports did not “summarily
dismiss” Dr. Walton and Dr. Adams’s opinions.
For these reasons, the Court finds that the ConAgra defendants’ decision was reasonable
because it was based on substantial evidence and was not arbitrary and capricious. The ConAgra
defendants conducted a full and fair review. Under the lenient abuse of discretion standard, the
Court will not disturb the ConAgra defendants’ decision.
Request for Remand
After the administrative record closed on November 9, 2013, Ms. Thompson suffered a
significant relapse in her condition (Dkt. No 47, at 11). She claims that her medical records for
the issues arising after the administrative record closed “vindicate Dr. Walton’s opinion and
prove conclusively that Mrs. Thompson’s conditions are totally disabling” (Dkt. No. 47, at 12).
She asks the Court to not dismiss her complaint if it finds that the ConAgra defendants’ decision
was reasonable, but rather “remand the case to the plan administrator, in order to consider the
additional medical evidence related to her ongoing cardiac condition” (Dkt. No 47, at 12).
The Court’s role in reviewing the ConAgra defendants’ decision is to determine whether
it was reasonable when made. In doing so, the Court “must focus on the evidence available to
the plan administrators at the time of their decision and may not admit new evidence or consider
post hoc rationales.” Conley v. Pitney Bowes, 176 F.3d 1044, 1049 (8th Cir. 1999). The Court
concludes that the ConAgra defendants’ decision regarding Ms. Thompson’s disability eligibility
was reasonable and that the ConAgra defendants conducted a full and fair review. Therefore, the
Court’s role in this matter is complete and remand would be an inappropriate extension of its
For the foregoing reasons, the ConAgra defendants’ motion for judgment is granted. To
the extent the ConAgra defendants move for attorneys’ fees and costs, their request is denied
The ConAgra defendants may refile a request for fees and costs with
evidentiary support. Ms. Thompson’s third amended complaint is dismissed with prejudice, and
her request for remand is denied.
So ordered this 7th day of October, 2016.
Kristine G. Baker
United States District Judge
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