Brown v. J B Hunt Transport Services Inc

Filing 151

ORDER granting 133 Motion for Summary Judgment. Signed by Judge D. P. Marshall Jr. on 3/27/12. (kpr)

IN THE UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF ARKANSAS

WESTERN DIVISION

BARBARA BROWN

v.

PLAINTIFF

No. 4:08-cv-89-DPM

PRUDENTIAL INSURANCE
COMPANY OF AMERICA

INTERVENOR DEFENDANT

OROER
1.

Barbara Brown used to work as a truck driver for J.B. Hunt

Transport Services.

Prudential served as claims administrator for the

ERISA plan that J.B. Hunt sponsored. In 2005, Brown applied for long-term
disability benefits under the plan when she had to quit working because of
pain in her neck, back, and left knee, among other problems.

Because

Brown's knee injury prevented her from operating a clutch with her left
leg, Prudential found that she met the Plan's initial definition of "disabled"
under its "regular occupation" standard. Prudential therefore awarded
Brown benefits.

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In 2007, however, Prudential discontinued Brown's benefits. One
year of payments under the Plan triggers a less-stringent any gainful
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occupation" standard for disability.

Prudential decided that, although

Brown's knee pain prevented her from working as a truck driver, there
were other jobs that she could do.
Brown never filed a written appeal with Prudential because
Prudential would not produce the information she needed to perfect her
appeal. Instead, Brown sued. This Court dismissed Brown's complaint,
holding that she had failed to exhaust !:ter remedies. The Eighth Circuit
concluded, however, that Prudential had not offered Brown a reasonable
opportunity for full and fair review as required by 29 U.S.C. § 1132. Brown

v. J.B. Hunt Transport Services, Inc., 586 F.3d 1079, 1087 (8th Cir. 2009). The
Court of Appeals expressed no opinion on the merits of Brown's claim for
long-term disability benefits. Instead, it remanded the case to this Court
With instructions to remand to Prudential for an out-of-time appeal. Brown,
586 F.3d at 1087-88.
On remand, Prudential reviewed and upheld its decision to terminate

Brown's benefits.

Document No. 133-1, at 86-96.
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Because Brown had

e?hausted her remedies under the policy with the internal appeal, the
Court allowed her to reopen this case against Prudential.

29 U.S. C. §

1132(a)(1)(B); Document No. 130.

2. Brown claims that Prudential has denied her full and fair review
of its decision for two reasons: (1) lithe alleged medical review was not
provided to the Plaintiff for comment," and (2) there was no attempt to
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recognize Judge Wilson's criticism of the Dictionary of Occupational Titles"
in Jones v. Mountaire Corp. Long Term Disability Plan, No. 4:06-cv-1578­
WRW, 2007 WL 2351012 (E.D. Ark 16 August 2007), reversed and remanded,
542 F.3d 234 (8th Cir. 2008). Document No. 148, at 2.
Brown's arguments lack merit.
provide Brown with copies of

II

First, although Prudential must

all documents, records, and other

information relevant" to her initial claim for benefits, the independent
medical review performed during Prudential's appellate review is not a
IIrelevant" document or record as defined by the regulations. 29 C.F.R. §
2560.503-1 (h) (2)(iii) & (m)(8).
f

Brown's argument about the Dictionary of Occupational Titles goes

nowhere too. The Jones case differs factually: Jones's eligibility for benefits
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was being determined under the "regular occupation" standard, so the

DOT description of Jones's job played a far greater role in the benefits
determination than Brown's job description plays in the present case.
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Further, Brown fails to acknowledge that the Eighth Circuit reversed the
district court's decision in Jones and remanded for further briefing on the
DOT versus O*Net issue. (Because the case settled after remand, the issue
was never resolved.) Finally, although Brown is apparently critical of the
DOT, she has not shown how using the O*Net instead would have resulted
in any different outcome in her case. Despite Brown's attempt to convince
the Court otherwise, the record shows that Prudential gave Brown a full
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fair review this time around. Cf Brown, 586 F.3d at 1085-87.
3. The parties also disagree about the proper standard of review.

When an ERISA plan authorizes the claims administrator to determine
eligibility for benefits, the Court must decide whether the administrator
abused its discretion in making its determination. Darvell v. Life Insurance
Co. of North America, 597 F.3d 929, 934 (8th Cir. 2010). The Eighth Circuit

has identified five factors that guide this analysis:

(1) whether the

administrator's interpretation is inconsistent with the plan's goals, (2)
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whether it is contrary to the plan's clear language, (3) whether it is

inconsistent with prior interpretations of the same provisions, (4) whether
it conflicts with the substantive or procedural requirements of ERISA, and
(5) whether it renders the language of the plan meaningless, superfluous,
or internally inconsistent. Jones v. ReliaStar Life Insurance Co., 615 F.3d 941,
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945 (8th Cir. 2010).

The ultimate question, however, is whether the

administrator's interpretation was reasonable. Ibid. A reasonable decision
is one "supported by substantial evidence." Darvell, 597 F.3d at 934.
The Plan language here grants Prudential the discretion to determine
eligibility for benefits.

Brown argues, however, that the Court should

review Prudential's determination de novo based on the insurer's conflict of
interest. A conflict of interest arises when the insurer also acts as the claims
administrator. But this kind of conflict alone does not change the standard
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of review. Rather, the conflict of interest is a factor to be considered in
determining whether the administrator abused its discretion. Chronister v.
Unum Life Insurance Co. of America, 563 F.3d 773, 775 (8th Cir. 2009).

Brown's argument for de novo review fails. The Court will review
Prudential's decision for an abuse of discretion.

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4. This Court must determine whether Prudential's denial of Brown's
long-term benefits under the policy was reasonable based on the record as
a whole. Manning v. American Republic Insurance Co., 604 F.3d 1030, 1038
(8th Cir. 2010).

"Any reasonable decision will stand, even if the court

would interpret the language differently as an original matter." Ibid.
Considering the record as a whole and the governing law, the Court
concludes that Prudential did not abuse its discretion by denying Brown
flJrther benefits under the Plan's"any gainful occupation" provision. The
Plan, the medical records, and the vocational report all support this
conclusion.
Brown was entitled to more benefits only if she was"disabled" under
the Plan. After the first twelve months of disability, the Plan considers
Brown "disabled" if, because of the same injury, she is "unable to perform
the duties of any gainful occupation for which [she is] reasonably fitted by
education, training, or experience." Document No. 133-1, at 27. On appeal,
Ptudential determined that Brown did not meet this standard and thus no
longer qualified for long-term disability benefits under the Plan. It based
its decision on an independent medical-records review by an experienced

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doctor, Brown's treating chiropractor's opinions, and a vocational

assessment.

Prudential was entitled to rely on this evidence.

Black &

Decker Disability Plan v. Nord, 538 u.s. 822,825 (2003).
Dr. Hugo Pfaeffle reviewed Brown's medical history and records in
April 2011. He found that Brown had "problems with bilateral shoulder
rotator cuff tendinitis, bursitis, and impingement syndrome, and left knee
arthritis./I Document No. 133-1, at 13. Nonetheless, Dr. Pfaeffle concluded
that Brown could work: "[Brown] should be able to work at a medium
work duty level with 50 pounds maximum lifting and frequent lifting and
carrying up to 25 pounds./I Ibid. Because of Brown's impairments, Dr.
Pfaeffle said that Brown's occupational standing and walking would have
to be limited to two hours a day each and that she could not do any
climbing, crawling, squatting, or overhead lifting. He placed no limitations
on Brown's sitting or "simple grasping, pushing, pulling, or fine
manipulation./I Ibid.
The updated medical records from Brown's chiropractor, Dr. Ward,
suggested slightly greater restrictions on Brown's activities: in March 2007,
he recommended that Brown do no lifting over thirty pounds. Document
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No. 133-1, at 57. This was an increase, however, from a restriction to
twenty-pound lifting in February and ten-pound lifting in January.

Document No. 133-1, at 55 & 59. In light of the recommendations from
Brown's chiropractor, it would appear that Brown's ability to work was
increasing, not decreasing, in 2007.
A 2007 Employability Assessment identified four gainful occupations
for which Brown was suited, taking into account her education, training,
and experience: semiconductor bonder, surveillance system monitor, food
checker, and assembler.

A vocational specialist reviewed Brown's

Employability Assessment again in 2011 and confirmed that these
occupations were still suitable options for Brown and were within the
scope of her restrictions and limitations. These jobs are all classified as
"sedentary" or "light," and none of them would require Brown to lift more
than the maximum thirty pounds recommended by her chiropractor.
The record as a whole shows that Prudential's decision was a
reasonable one. Brown can do some available jobs. Prudential therefore
did not abuse its discretion when it determined that Brown was not
disabled within the meaning of the any gainful occupation" provision.
II

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Neither Brown's own doctor nor Prudential's concluded that she could not
work at all. The issue is not close; so Prudential's conflict of interest does
not break a tie in the proof in Brown's favor.

***
Motion, Document No. 133, granted.

Brown is not entitled to

reinstatement of long-term disability benefits, an award of past benefits, or

any other relief.
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So Ordered.

D.P. Mafshall Jr. '

Untied States District Judge

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