Patrick Burell v. Prudential Ins Co. of Ame , 820 F.3d 132 ( 2016 )


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  •      Case: 15-50035   Document: 00513459521    Page: 1   Date Filed: 04/11/2016
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE FIFTH CIRCUIT
    United States Court of Appeals
    Fifth Circuit
    No. 15-50035                            FILED
    April 11, 2016
    Lyle W. Cayce
    PATRICK BURELL; ARACELLI BURELL,                                        Clerk
    Plaintiffs–Appellants,
    v.
    PRUDENTIAL INSURANCE COMPANY OF AMERICA,
    Defendant–Appellee.
    Appeal from the United States District Court
    for the Western District of Texas
    Before STEWART, Chief Judge, and BARKSDALE and PRADO, Circuit
    Judges.
    Edward C. Prado, Circuit Judge:
    Plaintiff–Appellant Patrick Burell filed a claim for long-term disability
    benefits with Defendant–Appellee Prudential Insurance Company of America
    (“Prudential”). Prudential denied Burell’s initial claim and two subsequent
    appeals. Burell then filed suit against Prudential under the Employee
    Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq., alleging
    that its denial of his long-term disability-benefits claim was in error. The
    district court granted summary judgment in favor of Prudential, and we affirm.
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    No. 15-50035
    I. FACTUAL AND PROCEDURAL BACKGROUND
    In 1985, Burell began working as an entry-level technician for Methodist
    Healthcare Systems (“MHS”). After 26 years, he ended his career as Director
    of Biomedical Services for all San Antonio MHS facilities. As an employee of
    MHS, Burell participated in the company’s insurance plan (“the Plan”), which
    is provided through HCA Management Services, L.P. Prudential acts as both
    administrator and insurer of the Plan. In order to qualify for long-term
    disability benefits, a claimant must meet the following definition of “disabled”:
    the claimant must (1) be “unable to perform the material and substantial
    duties of [his or her] regular occupation due to [his or her] sickness or injury”;
    (2) be “under the regular care of a doctor”; and (3) suffer “a 20% or more loss in
    [his or her] monthly earnings due to that sickness or injury.”
    Burell was diagnosed with multiple sclerosis (“MS”) in 2008. Citing
    worsening symptoms of MS, in September 2011, Burell went on medical leave
    and filed for long-term disability benefits with Prudential, claiming that he
    qualified for benefits under the Plan due to MS, headaches, depression, and
    anxiety. In January 2012, he stopped working altogether, ending his
    employment with MHS. In support of his claim, Burell submitted medical
    records from his treating physicians and a psychiatrist. Prudential hired Heidi
    Garcia, a registered nurse, and Dr. Alan Neuren, who is board certified in
    neurology, to review Burell’s claim. Dr. Neuren found that Burell’s diagnosis
    of MS was unsupported by his medical records. He also found it unlikely that
    Burell suffered any cognitive impairments, opining that job stress is “likely the
    source of his complaints as opposed to a neurological disorder.” Garcia focused
    her review on Burell’s claim of depression and anxiety, ultimately finding that
    any cognitive symptoms he was experiencing were not sufficient to prevent him
    from working. Based on their reports and the medical records submitted,
    Prudential denied Burell’s claim for long-term disability benefits.
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    Burell then appealed the decision through Prudential’s internal review
    process. On appeal, his claim was reviewed by Dr. Stuart Isaacson, who is
    board certified in psychiatry and neurology, and Dr. James Boone, who is a
    clinical neuropsychologist. Dr. Isaacson found that Burell did not meet the
    diagnostic criteria for MS and did not have “any medically necessary
    restrictions and/or limitations from any one condition or combination of
    conditions.” Dr. Boone found that Burell’s “file records do not validly support
    psychological and/or cognitive symptoms” and that he has no “medically
    necessary restrictions and/or limitations.” Based on the opinions of these
    physicians   and     Burell’s   medical   records,    which    included    additional
    documentation submitted during the appeal process, Prudential again denied
    Burell’s claim.
    Burell next sent Prudential a letter demanding the benefits he believed
    he was owed under the Plan. Prudential treated this demand letter as a second
    appeal and had the claim further reviewed by Dr. Omuwunmi Osinubi, who is
    board certified in anesthesiology and occupational medicine, and Dr. Melvyn
    Attfield. Dr. Osinubi found that although Burell’s medical records did in fact
    support a diagnosis of MS, he did not have any physical limitations due to the
    disease. Dr. Osinubi was unable to make a finding on Burell’s alleged cognitive
    impairments and suggested an additional neuropsychological review be
    performed. Upon Dr. Osinubi’s recommendation, Dr. Michael Chavetz, who is
    board certified in clinical neuropsychology, performed an independent
    neuropsychological evaluation, finding that Burell did not suffer any cognitive
    impairments. On the basis of these opinions and Burell’s medical records,
    which included additional documentation submitted during the second appeal
    process, Prudential denied Burell’s claim for a third time.
    In April 2013, Burell filed suit against Prudential under 29 U.S.C.
    § 1132(a)(1)(B) and (a)(3), alleging that Prudential wrongfully denied his claim
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    for long-term disability benefits. In December 2014, the district court granted
    summary judgment in favor of Prudential, and Burell timely appealed.
    II. DISCUSSION
    The district court had jurisdiction over this suit under 29 U.S.C.
    § 1132(e). This Court has jurisdiction pursuant to 28 U.S.C. § 1291.
    In ERISA actions, “[s]tandard summary judgment rules control.” Cooper
    v. Hewlett-Packard Co., 
    592 F.3d 645
    , 651 (5th Cir. 2009) (quoting Vercher v.
    Alexander & Alexander Inc., 
    379 F.3d 222
    , 225 (5th Cir. 2004)). This Court
    reviews a district court’s grant of summary judgment de novo, viewing “all
    facts and evidence in the light most favorable to the non-moving party.”
    Amerisure Mut. Ins. Co. v. Arch Specialty Ins. Co., 
    784 F.3d 270
    , 273 (5th Cir.
    2015). Summary judgment is appropriate “if the movant shows that there is no
    genuine dispute as to any material fact and the movant is entitled to judgment
    as a matter of law.” Fed. R. Civ. P. 56(a). A genuine dispute of material fact
    exists when “the evidence is such that a reasonable jury could return a verdict
    for the nonmoving party.” Savant v. APM Terminals, 
    776 F.3d 285
    , 288 (5th
    Cir. 2014) (quoting Anderson v. Liberty Lobby, Inc., 
    477 U.S. 242
    , 248 (1986)).
    A.    Underlying Standard of Review
    As a preliminary matter, Burell challenges the standard of review the
    district court used in analyzing Prudential’s denial of his claim. The district
    court reviewed the denial for an abuse of discretion, while Burell argues that
    the court should have reviewed the denial de novo. “‘Whether the district court
    employed the appropriate standard in reviewing an eligibility determination
    made by an ERISA plan administrator is a question of law’ that we review de
    novo.” Green v. Life Ins. Co. of N. Am., 
    754 F.3d 324
    , 329 (5th Cir. 2014)
    (quoting Ellis v. Liberty Life Assurance Co. of Bos., 
    394 F.3d 262
    , 269 (5th Cir.
    2004)).
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    Generally, in suits brought under 29 U.S.C. § 1132(a)(1)(B), district
    courts review the denial of a long-term disability-benefits claim de novo.
    Firestone Tire & Rubber Co. v. Bruch, 
    489 U.S. 101
    , 115 (1989). But, if the
    benefits plan the suit is brought under “gives the administrator or fiduciary
    discretionary authority to determine eligibility for benefits or to construe the
    terms of the plan,” 
    id., the denial
    of benefits is reviewed for an abuse of
    discretion, Holland v. Int’l Paper Co. Ret. Plan, 
    576 F.3d 240
    , 246 (5th Cir.
    2009). Therefore, in order to determine whether the district court applied the
    correct standard of review, we must consider whether the terms of the Plan
    grant Prudential the authority to interpret the Plan and make benefits
    decisions.
    As the district court correctly explained, the terms of the Plan expressly
    give Prudential discretionary authority. Specifically, the Plan defines “Claim
    Fiduciary” as follows:
    Claims Fiduciary means an individual or entity, designated in the
    Plan (including the Summary Plan Description, Insurance
    Contracts or appendices, which are part of the Plan) or otherwise
    appointed by the Plan Administration Committee, to have final
    discretionary authority to interpret the terms of the Plan and
    decide questions of fact, as necessary to make a determination as
    to whether the Claims presented to the Claims Fiduciary are
    payable, in whole or in part, in accordance with the terms of the
    Plan.
    The Summary Plan Description (“SPD”) designates Prudential as the Claims
    Fiduciary: “All claims and appeals are handled by Prudential. Prudential has
    absolute discretion in deciding claims and appeals.” As the Plan expressly gives
    Prudential discretionary authority, 1 the district court did not err in reviewing
    1 Burell also argues that there is a conflict between the Plan and the insurance
    contract because the insurance contract does not explicitly confer Prudential discretion and,
    as such, the language granting Prudential discretionary authority must be ignored. But, as
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    the denial of Burell’s long-term disability-benefits claim under an abuse of
    discretion standard.
    Burell argues that the district court improperly relied on language in the
    SPD. We find this argument unavailing. Typically, the terms of a SPD are not
    controlling unless the SPD is incorporated into the plan. See Engleson v. Unum
    Life Ins. Co. of Am., 
    723 F.3d 611
    , 620 (6th Cir. 2013); Eugene S. v. Horizon
    Blue Cross Blue Shield of N.J., 
    663 F.3d 1124
    , 1131–32 (10th Cir. 2011). In his
    brief, Burell concedes that “[o]nly the plan may subsume an [sic] SPD by
    integrating it in the plan’s express terms.” In this case, the Plan expressly
    integrates the SPD in several places. For example, the Plan states that “[t]he
    Plan document is comprised of this Plan document and, with respect to each
    benefit program included within the Plan, the summary plan description(s)
    applicable to that benefit program.” The definition of “Claims Fiduciary” above
    also expressly incorporates the SPD: “Claims Fiduciary means an individual
    or entity, designated in the Plan (including the Summary Plan Description,
    Insurance Contracts or appendices, which are part of the Plan).” Therefore,
    because the Plan expressly incorporates the SPD, the district court did not err
    in relying on its language.
    Burell makes several additional arguments in support of a less
    deferential standard of review. First, because Prudential serves as both the
    insurer and administrator of the Plan, Burell argues that a structural conflict
    of interest exists, and, as such, the district court should have deferred to
    Prudential’s denial on a “sliding scale.” A conflict of interest exists when the
    plan administrator “both evaluates claims for benefits and pays benefits
    claims.” Truitt v. Unum Life Ins. Co. of Am., 
    729 F.3d 497
    , 508 (5th Cir. 2013),
    the district court correctly concluded, just because “the insurance contract is silent on this
    issue does not create a meaningful conflict between” the Plan and the insurance contract.
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    cert. denied, 
    134 S. Ct. 1761
    (2014) (quoting Metro. Life Ins. Co. v. Glenn, 
    554 U.S. 105
    , 112 (2008)). Therefore, Prudential’s role as both administrator and
    insurer is a structural conflict of interest. But, a structural conflict alone does
    not entitle Burell to an altered standard of review, as this Court “no longer
    appl[ies] a ‘sliding scale’ standard.” 
    Holland, 576 F.3d at 247
    n.3. Rather, as
    discussed below, a structural conflict of interest is “but one factor among many
    that a reviewing judge must take into account” in determining whether an
    abuse of discretion occurred. 
    Id. at 248
    (quoting 
    Glenn, 554 U.S. at 116
    ).
    Second, Burell contends that the district court should have altered the
    standard of review because of Prudential’s “flagrant procedural violations.”
    But, as Burell concedes, in Lafleur v. Louisiana Health Service and Indemnity
    Co., 
    563 F.3d 148
    (5th Cir. 2009), this Court specifically declined to “express
    [an] opinion on whether flagrant procedural violations of ERISA can alter the
    standard of 
    review.” 563 F.3d at 159
    . As none of Prudential’s alleged
    procedural violations rise to the level of flagrant, we again decline to address
    this question.
    Therefore, because the Plan expressly grants Prudential discretionary
    authority, we hold that the district court correctly reviewed Prudential’s denial
    for an abuse of discretion. As such, our de novo review of its summary judgment
    ruling will also apply the abuse of discretion standard. See 
    Cooper, 592 F.3d at 651
    .
    B.      Denial of Long-Term Disability-Benefits Claim
    Burell urges that even under an abuse of discretion standard, the district
    court should not have granted summary judgment in favor of Prudential. An
    abuse of discretion occurs when “the plan administrator acted arbitrarily or
    capriciously.” Meditrust Fin. Servs. Corp. v. Sterling Chems., Inc., 
    168 F.3d 211
    , 214 (5th Cir. 1999) (quoting Sweatman v. Commercial Union Ins. Co., 
    39 F.3d 594
    , 601 (5th Cir. 1994)). “A decision is arbitrary only if ‘made without a
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    rational connection between the known facts and the decision or between the
    found facts and the evidence.’” 
    Id. at 215
    (quoting Bellaire Gen. Hosp. v. Blue
    Cross Blue Shield of Mich., 
    97 F.3d 822
    , 828 (5th Cir. 1996)). Therefore, to
    survive summary judgment, Burell must raise a genuine dispute of material
    fact that Prudential’s denial of his long-term disability-benefits claim was
    arbitrary or capricious. Because Burell has failed to do so, we affirm the district
    court’s grant of summary judgment.
    Burell argues that Prudential abused its discretion by ignoring the
    findings of his treating physicians, emphasizing the fact that his treating
    physicians diagnosed him with MS. But, in its letter denying Burell’s second
    appeal, even Prudential concedes that “Burell may meet the clinical
    requirements for the diagnosis of MS.” Regardless of any disagreement
    between Prudential’s claim reviewers, a diagnosis of MS is not sufficient on its
    own for Burell to qualify for long-term disability benefits under the Plan. To
    qualify, Burell’s MS must also render him “unable to perform the material and
    substantial duties of [his] regular occupation.” None of the health care
    providers consulted by Prudential found that Burell had physical or cognitive
    impairments. Therefore, Prudential’s “decision simply came down to a
    permissible choice between the position of [the administrator’s] independent
    medical consultant[s], and the position of [the claimant’s physicians],” which
    does not amount to an abuse of discretion in this Circuit. 
    Sweatman, 39 F.3d at 602
    (third alteration in original) (quoting Donato v. Metro. Life Ins. Co., 
    19 F.3d 375
    , 380 (7th Cir. 1994)); see also Black & Decker Disability Plan v. Nord,
    
    538 U.S. 822
    , 825 (2003) (“Plan administrators are not obliged to accord special
    deference to the opinions of treating physicians”); Gothard v. Metro. Life Ins.
    Co., 
    491 F.3d 246
    , 249–50 (5th Cir. 2007) (“[P]lan fiduciaries are allowed to
    adopt one of two competing medical views.”). “This is so even if the consulting
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    physician only reviews medical records and never physically examines the
    claimant, taxing to credibility though it may be.” 
    Gothard, 491 F.3d at 249
    .
    Burell also argues that Prudential failed to give proper weight to the
    Social Security Administration’s (“SSA”) determination that he was disabled
    and entitled to benefits. But, as the district court noted, the eligibility criteria
    for Social Security benefits differ from the eligibility criteria under the Plan.
    Despite this difference, during Burell’s second appeal Prudential specifically
    requested that Burell submit documentation related to the SSA’s benefit
    award for consideration in Prudential’s review process. Prudential’s failure to
    give even further weight to the SSA’s decision cannot be characterized as
    unreasonable.
    As noted above, because Prudential is both the Plan administrator and
    the insurer, a structural conflict of interest exists. This conflict of interest
    influences our analysis of whether an abuse of discretion occurred. “[C]onflicts
    are but one factor among many that a reviewing judge must take into account”
    and “[a]ny one factor will act as a tiebreaker when the other factors are closely
    balanced.” 
    Truitt, 729 F.3d at 508
    (first alteration in original) (quoting 
    Glenn, 554 U.S. at 116
    –17). “The conflict of interest . . . should prove more important
    (perhaps of great importance) where circumstances suggest a higher likelihood
    that it affected the benefits decision, including, but not limited to, cases where
    an insurance company administrator has a history of biased claims
    administration.” 
    Id. at 508–09
    (quoting 
    Glenn, 554 U.S. at 117
    ). Burell has
    failed to point to anything in the record that indicates Prudential’s conflict of
    interest actually affected the denial of his claim.
    Relatedly, while not an independent basis for finding an abuse of
    discretion, procedural unreasonableness “is a factor that informs whether the
    ‘reviewing court may give more weight to [the plan administrator’s] conflict of
    interest.’” 
    Id. at 510
    (alteration in original) (quoting Schexnayder v. Hartford
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    Life & Accident Ins. Co., 
    600 F.3d 465
    , 469–71 (5th Cir. 2010)). Even assuming
    that Burell’s allegation of procedural irregularities is true, in light of
    Prudential’s thorough claim review and appeal process, Burell has failed to
    demonstrate that this one factor is sufficient to raise a genuine dispute of
    material fact that Prudential abused its discretion. See 
    Holland, 576 F.3d at 248
    –49.
    Burell also argues that Prudential abused its discretion by ignoring and
    failing to properly investigate two grounds for long-term disability benefits—
    anxiety and depression. Prudential argues that Burell waived this argument
    by failing to raise it in the district court. “If a party fails to assert a legal reason
    why summary judgment should not be granted, that ground is waived and
    cannot be considered or raised on appeal.” Keelan v. Majesco Software, Inc.,
    
    407 F.3d 332
    , 339 (5th Cir. 2005) (quoting Keenan v. Tejeda, 
    290 F.3d 252
    , 262
    (5th Cir. 2002)). To preserve an argument, it must be raised “to such a degree
    that the district court has an opportunity to rule on it.” 
    Id. at 340
    (quoting N.Y.
    Life Ins. Co. v. Brown, 
    84 F.3d 137
    , 141 n.4 (5th Cir. 1996)). In his response to
    Prudential’s summary judgment motion, Burell made only passing reference
    to this argument in the fact section of his summary judgment response. This
    brief reference was insufficient to give the district court an opportunity to rule
    on the argument, and it is therefore waived.
    Even assuming that the argument is not waived, we cannot say that
    Prudential acted arbitrarily or capriciously with regard to Burell’s anxiety and
    depression claim, particularly in light of the fact that our “review of the
    administrator’s decision need not be particularly complex or technical; it need
    only assure that the administrator’s decision fall somewhere on a continuum
    of reasonableness—even if on the low end.” Corry v. Liberty Life Assurance Co.
    of Bos., 
    499 F.3d 389
    , 398 (5th Cir. 2007) (quoting Vega v. Nat’l Life Ins. Servs.,
    Inc., 
    188 F.3d 287
    , 297 (5th Cir. 1999), overruled on other grounds by Glenn,
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    554 U.S. 105
    ). During each level of review, Prudential addressed Burell’s
    depression and anxiety claim. In its first denial letter, Prudential
    acknowledged that Burell’s medical records document “work related stress and
    anxiety since April 2011” but that Burell was under treatment from a
    psychiatrist and his symptoms were improving. In its letter denying Burell’s
    first appeal, Prudential stated that “based on the medical evidence, functional
    impairment is not supported from a physical, psychological or cognitive
    perspective.” And in its final denial of the claim, Prudential stated that “[w]hile
    Mr. Burell does have depression and anxiety, typically depression and anxiety
    do not cause large changes in cognitive functioning, and in Mr. Burell’s[] case
    there is no evidence of valid cognitive impairment from any source.”
    In light of this record, Burell has failed to raise a genuine dispute of
    material fact that Prudential abused its discretion in denying his claim for
    long-term disability benefits.
    III. CONCLUSION
    For the foregoing reasons, the district court’s grant of summary
    judgment is AFFIRMED.
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    RHESA HAWKINS BARKSDALE, Circuit Judge, dissenting:
    For considering the summary judgment at issue, I agree with the majority
    that our de novo review is for a genuine dispute of material fact vel non for
    whether the plan administrator abused its discretion. But, I disagree with the
    majority’s holding there was none. In that regard, it fails to “constru[e] all facts
    and evidence in the light most favorable to the non-moving party”:          Burell.
    Amerisure Mut. Ins. Co. v. Arch Specialty Ins. Co., 
    784 F.3d 270
    , 273 (5th Cir.
    2015). Our deferential standard of review, together with the rarity of an ERISA
    appeal’s having a genuine dispute of material fact, must not obscure that, on this
    record, summary judgment should be denied and a trial held. Therefore, I must
    respectfully dissent.
    Burell’s action is distinguishable from those on which the majority relies,
    for which our court held a plan administrator’s denial of benefits to be reasonable:
    that is, not arbitrary and capricious. In Gothard v. Metropolitan Life Insurance
    Co., 
    491 F.3d 246
    (5th Cir. 2007), and Sweatman v. Commercial Union Insurance
    Co., 
    39 F.3d 594
    (5th Cir. 1994), the conflicting evidence for the claimants’
    disability was between the claimants’ treating physicians and the insurance
    companies’ reviewers.      There, our court held it reasonable to make the
    “permissible choice between the position of [the plan administrator’s medical
    reviewer], and the position of [the claimant’s treating physician]”. 
    Sweatman, 39 F.3d at 602
    ; see also 
    Gothard, 491 F.3d at 249
    –50.
    For Burell, conversely, Prudential’s reviewers disagreed among themselves
    regarding whether his MS amounted to disability under the long-term disability
    (LTD) plan. We have never addressed whether such a conflict was a “permissible
    choice”. 
    Sweatman, 39 F.3d at 602
    . One of Prudential’s reviewers, Dr. Osinubi,
    confirmed a diagnosis of MS, as the majority notes; but, she also observed the
    “consensus amongst his treating providers that [MS] is impairing his ability to
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    function at work, and the intensity of treatment with MS medications . . . all tend
    to support the level of severity and functional impairment that the [claimant] is
    reporting and all of his healthcare providers are endorsing”.           Moreover, Dr.
    Osinubi stated “there is scientific literature to indicate that the manifestation of
    MS may be . . . variable[,] as there are significant individual differences in the
    cognitive presentation of MS”.           The administrative record supports that
    statement; Dr. Attfield, the other third-round reviewer, reported “there is no
    indication [Burell] is frankly malingering”, contradicting the report of
    Prudential’s previous reviewer, Dr. Boone, and next reviewer, Dr. Chafetz.
    And, as the majority notes, because Prudential, as plan administrator, both
    evaluates claims and pays benefits, there is an inherent conflict of interest. Truitt
    v. Unum Life Ins. Co. of Am., 
    729 F.3d 497
    , 508 (5th Cir. 2013), cert. denied, 
    134 S. Ct. 1761
    (2014). “[W]here circumstances suggest a higher likelihood that [the
    conflict] affected the benefits decision”, structural conflict should weigh more
    heavily in the court’s abuse-of-discretion analysis. Holland v. Int’l Paper Co. Ret.
    Plan, 
    576 F.3d 240
    , 247 n.3, 248–49 (5th Cir. 2009) (quoting Metro. Life Ins. Co.
    v. Glenn, 
    554 U.S. 105
    , 117 (2008)). That is especially true in reviewing this
    summary judgment. In Holland, the claimant “adduced no evidence . . . [the plan
    administrator’s]   conflict   affected    its   benefits   decision”;   therefore,   the
    administrator did not abuse its discretion in denying benefits. 
    Id. at 249.
    On the
    other hand, the inconsistencies in Prudential’s procedure point to a genuine
    dispute of material fact for whether Prudential’s inherent conflict of interest
    affected its decision-making for Burell’s claim.
    Burell asserts Prudential’s decision was procedurally unreasonable because
    Prudential failed to follow its own review procedures.            Here, following Dr.
    Osinubi’s review, Dr. Chafetz conducted an independent neurocognitive exam for
    Prudential. Similar to some of Prudential’s previous reviewers, he was skeptical
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    of whether Burell was presenting credibly, and stated the evidence in the record
    did not support functional impairment based on cognitive deficiencies.
    But, Dr. Chafetz was the first reviewer who was not provided all of the
    reports of Prudential’s previous reviewers; based on this summary-judgment
    record, it appears Dr. Chafetz did not receive for his review Drs. Osinubi and
    Attfield’s reports, which suggested disability as a result of Burell’s MS.        By
    contrast, Prudential had provided to Dr. Boone the report by Dr. Isaacson, dated
    just a week before Dr. Boone conducted his review.           In fact, based on this
    summary-judgment record, every reviewer prior to Dr. Chafetz was provided with
    Burell’s entire claim file.
    Furthermore, although the district court ruled Drs. Osinubi and Attfield’s
    conclusions “irrelevant” to Dr. Chafetz’ testing Burell’s cognitive abilities (which,
    of course, is not considered in our de novo review of the summary judgment),
    Burell v. Prudential Ins. Co. of Am., No. 5:13-CV-359 at 11 (W.D. Tex. 16 Dec.
    2014), Drs. Isaacson and Boone received for their reviews arguably “irrelevant”
    reports from prior Prudential reviewers Dr. Neuren and Nurse Garcia. And, as
    Drs. Osinubi and Attfield were the first whose reports leaned in favor of Burell,
    and Dr. Chafetz was the first of Prudential’s reviewers not to receive the reports
    of the previous reviewers, the independence of Prudential’s procedural process is
    called seriously into question.
    Additionally, Prudential’s not adequately considering Burell’s diagnoses of
    anxiety and depression points to a genuine dispute of material fact. The majority
    holds this assertion is waived for failure to adequately raise it in district court;
    however, as Burell asserts, he presented the issue in his response to Prudential’s
    summary-judgment motion.          Therefore, it is not waived.   Drs. Chafetz and
    Isaacson and Nurse Garcia noted these diagnoses. Dr. Isaacson and Nurse Garcia
    deferred judgment on whether these cognitive issues resulted in disability; and,
    in part because Dr. Chafetz received no reports to the contrary (i.e. from Drs.
    14
    Case: 15-50035     Document: 00513459521       Page: 15   Date Filed: 04/11/2016
    No. 15-50035
    Osinubi and Attfield), he found the record showed “extensive invalidity” as to
    impairment.
    In addition, Prudential considered other grounds causing Burell’s medical
    complaints that did not require it to provide LTD benefits, such as work stress,
    despite Burell’s having been Director of Biomedical Services for all San Antonio
    hospital facilities since 1999, nine years before his MS diagnosis.           When
    considered alongside the other factors pointing to Prudential’s unreasonableness,
    its failure to consider alternative grounds provides further support for the
    requisite genuine dispute of material fact.
    For the foregoing reasons, I would vacate the judgment and remand this
    action for trial.   Because the majority holds otherwise, I must respectfully
    dissent.
    15
    

Document Info

Docket Number: 15-50035

Citation Numbers: 820 F.3d 132

Filed Date: 4/11/2016

Precedential Status: Precedential

Modified Date: 1/12/2023

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