PUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
REBECCA DUPERRY,
Plaintiff-Appellee,
v.
No. 10-1089
LIFE INSURANCE COMPANY OF NORTH
AMERICA,
Defendant-Appellant.
Appeal from the United States District Court
for the Eastern District of North Carolina, at New Bern.
Louise W. Flanagan, Chief District Judge.
(5:08-cv-00344-FL)
Argued: December 8, 2010
Decided: January 24, 2011
Before TRAXLER, Chief Judge, WYNN, Circuit Judge,
and David A. FABER, Senior United States District Judge
for the Southern District of West Virginia,
sitting by designation.
Affirmed by published opinion. Chief Judge Traxler wrote the
opinion, in which Judge Wynn and Senior Judge Faber joined.
COUNSEL
ARGUED: Ian Taylor, DLA PIPER US LLP, Baltimore,
Maryland, for Appellant. Andrew O. Whiteman, HARTZELL
2 DUPERRY v. LIFE INSURANCE COMPANY
& WHITEMAN, LLP, Raleigh, North Carolina, for Appellee.
ON BRIEF: Christopher S. Gunderson, DLA PIPER US
LLP, Baltimore, Maryland; Michael T. Medford, MANNING
FULTON & SKINNER PA, Raleigh, North Carolina, for
Appellant.
OPINION
TRAXLER, Chief Judge:
Life Insurance Company of North America ("LINA")
appeals a district court order granting judgment to Rebecca
DuPerry on her claim that LINA wrongly denied her long-
term disability ("LTD") benefits in violation of the Employee
Retirement Income Security Act of 1974 ("ERISA"). See 29
U.S.C.A. § 1132(a)(1)(B) (West 2009). Finding no error, we
affirm.
I.
DuPerry worked as a payroll and benefits clerk for Railroad
Friction Products Corporation ("RFPC") until April 7, 2006.
While at RFPC, she participated in a group LTD benefits plan
administered by LINA and funded by an insurance policy that
LINA issued ("the Policy"). The parties agree that the LTD
plan is "an employee benefit plan," as that term is defined in
ERISA. See 29 U.S.C.A. § 1002(3). To qualify for LTD bene-
fits, participants must be "Disabled," and "must satisfy the
Elimination Period, be under the Appropriate Care of a Physi-
cian, and meet all the other terms and conditions of the Pol-
icy." J.A. 63. Until an employee has received 24 months of
LTD benefits, she is "Disabled"
if, solely because of Injury or Sickness, . . . she is:
1. unable to perform the material duties of . . . her
Regular Occupation; and
DUPERRY v. LIFE INSURANCE COMPANY 3
2. unable to earn 80% or more of . . . her Indexed
Earnings from working in . . . her Regular Occupa-
tion.
J.A. 58. Once disability benefits have been payable for 24
months, she is disabled if
solely due to Injury or Sickness, . . . she is:
1. unable to perform the material duties of any occu-
pation for which . . . she is, or may reasonably
become, qualified based on education, training or
experience; and
2. unable to earn 60% or more of . . . her Indexed
Earnings.
J.A. 58. An employee’s "regular occupation" is defined as
"[t]he occupation the Employee routinely performs at the time
the Disability begins." J.A. 74. LINA classified DuPerry’s
regular occupation as a payroll benefits HR administrator as
"sedentary," meaning that it required lifting, carrying, push-
ing, or pulling 10 pounds occasionally and that although it
involved mostly sitting, it could involve standing or walking
for brief periods. The Policy further provides that an
employee "must provide [LINA] . . . satisfactory proof of Dis-
ability before benefits will be paid." J.A. 63. Finally, "[t]he
Elimination Period is the period of time an Employee must be
continuously Disabled before Disability Benefits are pay-
able," J.A. 63, which was 180 days for DuPerry.
Following what DuPerry asserted was the expiration of her
elimination period, DuPerry first submitted a proof of loss
form to LINA on October 16, 2006, claiming that she was dis-
abled as a result of rheumatoid arthritis, osteoarthritis, and fibro-
myalgia.1
1
Rheumatoid arthritis is "an inflammatory disease of the joints that
causes the joints to swell and to stiffen. It is a chronic condition, perma-
4 DUPERRY v. LIFE INSURANCE COMPANY
In evaluating DuPerry’s claim, LINA reviewed medical
records of her primary care physician, Dr. Glenn Harris, and
her treating rheumatologist, Dr. Supen Patel, as well as "At-
tending Physician’s Statement of Disability" forms that the
doctors had completed. Dr. Harris’s form noted his diagnosis
of rheumatoid arthritis and stated that DuPerry was limited to
"0 hours" per day of climbing, balancing, stooping, kneeling,
crouching, crawling, reaching, walking, sitting, and standing,
and that DuPerry would "never" be able to return to work.
J.A. 795. Dr. Harris also indicated on a "Physical Ability
Assessment Form" that DuPerry could "[o]ccasionally" sit,
stand, walk, reach, engage in fine manipulation, grasp, lift,
carry, stoop, or push or pull up to 10 pounds, where
"[o]ccasionally" was defined alternatively as 1% - 33% of an
eight-hour workday or less than 2.5 hours. J.A. 768.
Dr. Patel’s Attending Physician’s Statement of Disability
form noted his diagnosis of rheumatoid arthritis and osteoar-
thritis. In a column titled "Cardiac – If applicable," Dr. Patel
marked a box for "Class 4 – Complete Limitation." J.A. 797.
In response to a question of when DuPerry would be able to
return to work, Dr. Patel wrote "Never – [DuPerry] is Perma-
nently disabled." J.A. 797. And, where the form asked for
DuPerry’s "maximum level of ability (sedentary, light,
medium, heavy)" for lifting, carrying, pushing, or pulling, Dr.
Patel selected the lowest available choice of "Sedentary = 10
lbs. maximum, walking occasionally." J.A. 797.
nent in nature." Moore v. J.B. Hunt Transport, Inc., 221 F.3d 944, 948
(7th Cir. 2000). Osteoarthritis is "a noninflammatory degenerative joint
disease . . . characterized by degeneration of the articular cartilage, hyper-
trophy of bone at the margins, and changes in the synovial membrane."
McCoy v. Holland, 364 F.3d 166, 168 n.3 (4th Cir. 2004) (internal quota-
tion marks omitted) (alteration in original). Fibromyalgia is a rheumatic
disease with symptoms that include "significant pain and fatigue, tender-
ness, stiffness of joints, and disturbed sleep." Stup v. UNUM Life Ins. Co.
of Am., 390 F.3d 301, 303 (4th Cir. 2004) (internal quotation marks omit-
ted). Fibromyalgia is diagnosed "based on tenderness of at least eleven of
eighteen standard trigger points on the body." Id.
DUPERRY v. LIFE INSURANCE COMPANY 5
Two other documents that LINA considered in its initial
review are relevant to this appeal. First, a 2006 blood test
report showed DuPerry as having normal levels of hematocrit
and hemoglobin. Second, a physical therapist’s report dated
April 12, 2006, indicated that DuPerry had "made small
strength and endurance gains" and had "demo[nstrated] excel-
lent compliance." J.A. 813. The form also noted that DuPerry
was able to walk 10 laps around the approximately 170-foot
gym track in nine minutes.
Melissa Graham, the case manager handling DuPerry’s
claim for LINA, requested that a nurse case manager
("NCM") telephone Dr. Patel for clarification of the informa-
tion he had provided on his physician’s statement of disability
form, specifically his decision to circle "sedentary." Dr. Patel
spoke to the NCM on November 3, 2006, informing her that
fibromyalgia, fatigue and side effects from her pain medica-
tions prevented DuPerry from working, even though her rheu-
matoid arthritis was under control. He further explained that
DuPerry suffered from achiness and stiffness coinciding with
changes in the weather, and that she had been responding well
to medications. This assessment was consistent with notations
in LINA’s notes, which stated "[Return-to-work] date clear.
NO both [attending physicians] stating [claimant] is perma-
nently disabled."2 J.A. 903. Nevertheless, the NCM eventually
concluded that DuPerry had not submitted satisfactory proof
that she suffered from a continuing disability from her regular
occupation during the elimination period.
LINA informed DuPerry by letter dated November 10,
2006, of its decision to deny her claim because of a lack of
medical evidence of her disability. The letter referenced the
medical records LINA had reviewed, mentioning in particular
five office notes from Dr. Patel, six from Dr. Harris, and the
2
This note would appear to mean that there clearly is no return-to-work
date according to both attending physicians, who are stating that the claim-
ant is permanently disabled.
6 DUPERRY v. LIFE INSURANCE COMPANY
NCM’s telephone conversation with Dr. Patel. The letter con-
cluded:
Our NCM opined that we do not have medical infor-
mation on file to support the restrictions and limita-
tions given by your providers. Our NCM opined that
we do not have diagnostic testing to suggest severity
of illness precluding you from performing a seden-
tary occupation.
J.A. 309.
DuPerry appealed LINA’s initial denial by a letter dated
May 7, 2007, that referenced nearly 400 pages of documents
in support of her claim.
The appeal included letters from Drs. Harris and Patel. Dr.
Harris’s November 27, 2006, letter explained how DuPerry’s
situation had worsened over the years to the point that her
pain was almost unbearable in May 2005, and Harris had
urged her to stop work. The letter stated that DuPerry had
nevertheless attempted to continue working, but, by February
6, 2006, "she was at the point that even Percocet twice a day
was not quite enough to hold her," and she agreed to stop
work. J.A. 462.
Dr. Patel’s January 12, 2007, letter explained that while
DuPerry’s arthritis had "been reasonably well controlled" by
her medications and, although her fibromyalgia and fatigue
symptoms were managed with medications, they "make[ ] it
difficult for her to function." J.A. 518. Thus, Dr. Patel con-
cluded that "because of the above medical problems and com-
plications thereof and medications, [DuPerry] certainly is not
able to return to any previous work duties." J.A. 518. An
exam report also dated January 12, 2007, noted that DuPer-
ry’s pain seemed to be worse than it had been, and that while
she was taking 5 milligrams of Percocet three to four times a
DUPERRY v. LIFE INSURANCE COMPANY 7
day, Dr. Patel additionally prescribed 10 milligrams of Oxy-
Contin per day.3
Dr. Patel’s notes from May 9, 2007, reported that DuPer-
ry’s "pain seem[ed] to be better," but her fatigue had wors-
ened somewhat and she "still ha[d] not much energy level."
J.A. 228. Dr. Patel’s report dated July 3, 2007, stated that
DuPerry was experiencing "quite a bit of pain" in her back
from her osteoarthritis of the lumbar spine with intermittent
sciatic symptoms. J.A. 229. He noted that by that time, along
with the Percocet, DuPerry was using 20 milligrams of Oxy-
Contin twice a day, which was "making her sleepy and
drowsy." J.A. 229. He reported that DuPerry "needs to limit
her activities" such that if she did "five to ten minutes of
work," she needed to "rest[ ] for about 30 to 40 minutes
before returning . . . to work duties." J.A. 229. Dr. Patel’s
notes from September 17, 2007, reported that DuPerry was
"still symptomatic with pain and discomfort" and that he had
increased several of her medications, including increasing her
OxyContin to 30 milligrams. J.A. 224. He noted that she was
"having symptoms of constipation and excessive drowsiness
with the OxyContin." J.A. 224.
In addition to the medical records and letters, included in
the materials was a letter from DuPerry’s former boss, who
described DuPerry as having a "work ethic" that is "unsur-
passed." J.A. 463. He described DuPerry’s transition from
"one of the most valuable employees" he had known to some-
one "sitting at her desk trying valiantly to work" with "her
hands trembling so badly that she could hardly hold a pencil."
J.A. 463. DuPerry’s appeal also included a declaration, her
own DVD filmed at her home, supporting statements from
several relatives, and her prescription medication list. Her evi-
dence showed how she depended on help from her family for
most household chores, errands, and shopping and that at
times she used a cane, a walker, and a wheelchair. She gener-
3
Percocet and OxyContin are powerful narcotic painkillers.
8 DUPERRY v. LIFE INSURANCE COMPANY
ally remained in her bedroom, in which she had a hospital bed
and a refrigerator.
Nancy Ippolito, LINA’s appeal claim manager, requested a
full review of the claim by Dr. Charles McCool, a licensed
physician and a LINA employee. Dr. McCool’s resulting
report consisted of a half-page of largely illegible, handwrit-
ten notes. However, according to Ippolito’s summary of his
views, McCool recommended affirming the benefits denial
and noted that updated letters from DuPerry’s treating physi-
cians showed "minimal exam findings" and levels of hemato-
crit and hemoglobin of "around 11/32." J.A. 874. LINA
subsequently advised DuPerry that her appeal had been
denied. In its denial letter, dated May 31, 2007, LINA
acknowledged Dr. Patel’s diagnoses of rheumatoid arthritis
and fibromyalgia. LINA nevertheless emphasized that Dr.
Patel’s records demonstrated that DuPerry’s medications were
keeping her rheumatoid arthritis reasonably under control and
her fibromyalgia and fatigue were "secondary to the underly-
ing disease process and . . . managed with medication." J.A.
302. LINA also noted that Harris had "previously completed
a Physical Ability Assessment form in October of 2006 indic-
ative of sedentary capacity, but he has not released Ms.
DuPerry to return to work." J.A. 302. LINA further stated that
the physician who reviewed her file had determined that "the
records do not show a severe impairment that would prevent
Ms. DuPerry from performing at the sedentary demand level."
J.A. 302. In concluding, LINA stated:
Ms. DuPerry’s physicians have failed to provide
clinical data to correlate with an impairment that
would preclude work at the sedentary demand level.
The [reviewing physician] noted that there are only
minimal examination findings and the hematocrit
and hemoglobin are near normal and do not explain
fatigue. Furthermore the records document that Ms.
DuPerry’s conditions are under control with medica-
tion.
DUPERRY v. LIFE INSURANCE COMPANY 9
J.A. 302.
By letter dated November 26, 2007, DuPerry once again
appealed LINA’s denial of benefits. Along with her appeal,
she included additional medical records from Dr. Patel, Dr.
Harris, and Dr. Misty L. Sinclair. She also included a second
DVD documenting her condition. LINA assigned the second
appeal to a third claim manager, Andrea Russo, who
requested a review of DuPerry’s records from an independent
rheumatology consultant. That review was completed by Dr.
Marc Levesque, a board-certified rheumatologist with the
Duke University Medical Center.
Dr. Levesque produced two reports recommending denying
DuPerry’s appeal. In a report dated January 31, 2008, Dr.
Levesque noted Dr. Patel’s and Dr. Harris’s diagnosis of
DuPerry with "a combination of rheumatoid arthritis, osteoar-
thritis, and fibromyalgia," J.A. 172, but he concluded that Dr.
Patel’s and Dr. Harris’s restrictions nevertheless "are not sup-
ported," J.A. 174. Dr. Levesque noted that DuPerry’s "rheu-
matoid arthritis appears to be under excellent control with a
combination of medicines that are typically used for the treat-
ment of rheumatoid arthritis" and that "the video movements,
especially of [DuPerry’s] hands and also of her ambulation
would suggest that there is no permanent deformity and no
significant swelling associated with the patient’s rheumatoid
arthritis that would preclude most sedentary occupations,
including" DuPerry’s occupation. J.A. 173-74. As for her
fibromyalgia, Dr. Levesque stated that "given the absence of
physical limitations due to this problem, there is nothing that
would preclude [DuPerry] normally from pursuing a typical
sedentary occupation," and "[g]enerally, patients with fibro-
myalgia are able to work a sedentary occupation." J.A. 174.
Dr. Levesque did note that DuPerry’s chronic pain and fibro-
myalgia "appear[ed] to be complicated by the presence of
depression" but stated that whether the depression would pre-
vent DuPerry from being able to work was a question outside
of his area of expertise. J.A. 174.
10 DUPERRY v. LIFE INSURANCE COMPANY
In a subsequent report, dated February 10, 2008, Dr.
Levesque also considered the DVD DuPerry provided with
her second appeal.4 In the report, Dr. Levesque stated:
[a]s noted in the previous video, no deformity is
noted of [DuPerry’s] hands or other joints. There
appears to be relatively normal range of motion in
most of her joints, based on the limited video that is
available. The major area of stiffness and limited
range of motion appears to be in her back and the
limitation primarily appears to be due to pain rather
than other factors, based on the limited footage in the
video.
J.A. 144. Dr. Levesque also concluded that "with regards to
[DuPerry’s] work capacity, as in the previous video of
[DuPerry] in her home, this video supports the idea that
[DuPerry’s] primary problem is fibromyalgia and perhaps
some osteoarthritis of her knees." J.A. 144. He stated,
[The video] indicates that her rheumatoid arthritis is
not likely to be a significant cause of her inability to
work or her inability to perform most activities of
daily living given the fact that the underlying major
diagnosis for [DuPerry’s] pain appears to be fibro-
myalgia. Since it appears to be fibromyalgia, and
given the lack of physical findings associated with
this diagnosis, it does not adequately support the
4
LINA instructed Dr. Levesque to telephone DuPerry’s treating physi-
cians if Dr. Levesque had any questions he needed answered. When
DuPerry’s attorney learned that Dr. Levesque might be doing this, he sent
LINA a letter revoking any consent that DuPerry had given for her doctors
to speak to LINA’s physicians by phone, stating, "It has been my experi-
ence that such peer-to-peer contacts frequently result in disputes about
what was said by the treating physician." J.A. 215. The letter made clear,
however, that LINA was free to request DuPerry’s medical records and
submit any questions to the doctors in writing through DuPerry’s attorney.
DUPERRY v. LIFE INSURANCE COMPANY 11
limitations imposed on [DuPerry’s] ability to work
by her [treating physicians].
J.A. 144.
Based on Dr. Levesque’s review, by letter dated February
15, 2008, LINA once again affirmed its decision to deny
DuPerry’s claim for LTD benefits. The letter summarized Dr.
Levesque’s conclusions and stated that DuPerry had "ex-
hausted all administrative levels of appeal and no further
appeals w[ould] be considered." J.A. 165.
DuPerry filed this action pursuant to 29 U.S.C.A.
§ 1132(a)(1)(B) of ERISA, in federal district court on July 18,
2008, alleging that she was wrongly denied benefits under the
Policy. LINA answered, denying that DuPerry was eligible
for benefits. On August 10, 2009, the district court granted
judgment to DuPerry, ordering LINA "to pay [DuPerry] dis-
ability income benefits as calculated under the provisions of
the Policy, from the expiration of plaintiff’s elimination
period through the date of this order." J.A. 1014.
Observing that "[t]his case falls into that difficult class of
ERISA disability cases involving subjective complaints of
pain as a primary cause and driver of the insured’s claim of
disability," J.A. 1008, the district court noted that no language
in the plan specifically concerned the evaluation of claims
involving subjective complaints of pain. The court reasoned:
Where the plan documents do not provide a proce-
dure for dealing with disability claims based on sub-
jective complaints of pain, a plan administrator
employing a principled reasoning process need not
simply accept a claimant’s subjective complaints of
pain without question, especially if there is other
conflicting evidence in the record. Neither, however,
can a plan administrator in such a situation simply
dismiss such subjective complaints of pain out of
12 DUPERRY v. LIFE INSURANCE COMPANY
hand, especially where there is objective medical
proof of a disease that could cause such pain.
J.A. 1009.
LINA pointed to statements in six health care records as
conflicting with DuPerry’s complaints of disabling pain and
fatigue. The district court concluded, however, that the
alleged conflicts were only "minor inconsistencies," not "the
type of substantial conflicting evidence that a plan administra-
tor can use to justify a denial of benefits." J.A. 1012. While
LINA attempted to use some of this evidence to justify a con-
clusion that Dr. Patel may not have actually believed that
DuPerry was unable to return to work, the court concluded
that the remaining evidence in the record clearly demonstrated
that Dr. Patel believed DuPerry could not return, and that
LINA’s own notes reflected that. As for Dr. Levesque’s
reports, the court noted that Dr. Levesque dismissed the
notion that DuPerry’s fibromyalgia was disabling "because of
‘the absence of physical limitations due to this problem’ and
‘the lack of physical findings associated with this diagnosis.’"
J.A. 1013. But, the court noted that the presence of painful
trigger points that are indicative of fibromyalgia "were amply
documented," J.A. 1013 n.11, and the court concluded that
Dr. Levesque offered no basis for his rejection of DuPerry’s
evidence that her pain from that condition was physically dis-
abling. To the extent that Dr. Levesque believed that DuPerry
was in fact unable to work but was not "disabled" because her
inability to work was due only to pain or other self-reported,
subjective symptoms, the court reasoned that Dr. Levesque
was utilizing a definition of "disabled" plainly at odds with
the one given in the plan. Thus, the court concluded that "[b]y
adopting Dr. Levesque’s opinion, [LINA] essentially grafted
a new limitation regarding disability onto the plan" that the
language of the plan did not support. J.A. 1014.
LINA moved to alter the judgment to limit payment of ben-
efits to the period running from the expiration of DuPerry’s
DUPERRY v. LIFE INSURANCE COMPANY 13
elimination period through October 5, 2008, which is the end
of the term for which LINA determines disability according
to DuPerry’s ability to perform the duties of her regular occu-
pation ("the regular-occupation period"). LINA argued that
the district court could not award benefits for the subsequent
"any-occupation" period because LINA had not considered
DuPerry’s claim under the standard that applied for that
period. Thus, LINA requested that the court remand to the
plan administrator for a decision regarding benefits for this
period. The district court denied the motion, concluding that
remand was not appropriate because the record clearly
showed the DuPerry was entitled to benefits for both periods.
The court also awarded prejudgment interest and attorney’s
fees.
II.
LINA first argues that the district court erred in concluding
as a matter of law that LINA abused its discretion in denying
DuPerry’s claim. We disagree.
In reviewing the denial of benefits under an ERISA plan,
a district court first must consider de novo whether the rele-
vant plan documents confer discretionary authority on the
plan administrator to make a benefits-eligibility determina-
tion. See Johannssen v. District No. 1-Pac. Coast Dist.,
MEBA Pension Plan, 292 F.3d 159, 168 (4th Cir. 2002).
"When a plan by its terms confers discretion on the plan’s
administrator to interpret its provisions and the administrator
acts reasonably within the scope of that discretion, courts
defer to the administrator’s interpretation." Colucci v. Agfa
Corp. Severance Pay Plan, 431 F.3d 170, 176 (4th Cir. 2005).
The parties agree that the plan confers discretionary authority
upon LINA, as the plan administrator, to make benefit deci-
sions according to the plan’s terms.
Under the abuse-of-discretion standard, the reviewing court
will set aside the plan administrator’s decision only if it is not
14 DUPERRY v. LIFE INSURANCE COMPANY
reasonable. See Stup v. UNUM Life Ins. Co. of Am., 390 F.3d
301, 307 (4th Cir. 2004). The administrator’s decision is rea-
sonable "if it is the result of a deliberate, principled reasoning
process and if it is supported by substantial evidence," Bern-
stein v. CapitalCare, Inc., 70 F.3d 783, 788 (4th Cir. 1995)
(internal quotation marks omitted), which is "evidence which
a reasoning mind would accept as sufficient to support a par-
ticular conclusion," LeFebre v. Westinghouse Elec. Corp.,
747 F.2d 197, 208 (4th Cir. 1984) (internal quotation marks
omitted).
In Booth v. Wal-Mart Stores, Inc. Associates Health & Wel-
fare Plan, 201 F.3d 335 (4th Cir. 2000), we set forth eight
nonexclusive factors to be considered by courts in reviewing
the a plan administrator’s decision for reasonableness:
1) the language of the plan; (2) the purposes and
goals of the plan; (3) the adequacy of the materials
considered to make the decision and the degree to
which they support it; (4) whether the fiduciary’s
interpretation was consistent with other provisions in
the plan and with earlier interpretations of the plan;
(5) whether the decisionmaking process was rea-
soned and principled; (6) whether the decision was
consistent with the procedural and substantive
requirements of ERISA; (7) any external standard
relevant to the exercise of discretion; and (8) the
fiduciary’s motives and any conflict of interest it
may have.
Id. at 342-43. These factors continue to guide our abuse-of-
discretion review under ERISA. See Williams v. Metropolitan
Life Ins. Co., 609 F.3d 622, 630 (4th Cir. 2010).
Prior to the Supreme Court’s issuance of Metropolitan Life
Insurance Co. v. Glenn, 554 U.S. 105 (2008), our precedent
called for review of a plan administrator’s decision under a
"modified abuse-of-discretion" standard. See Ellis v. Metro-
DUPERRY v. LIFE INSURANCE COMPANY 15
politan Life Ins. Co., 126 F.3d 228, 233 (4th Cir. 1997).
Under this standard, when a plan administrator had a conflict
of interest because the administrator was responsible for both
evaluating and paying claims, courts would afford less defer-
ence to the administrator’s decision. See id. In Glenn, how-
ever, the Supreme Court clarified that the presence of such a
conflict does not alter the applicable standard of review, but
rather is "but one factor among many that a reviewing judge
must take into account." Glenn, 554 U.S. at 116. In the pres-
ent case, because LINA insures the plan as well as administer-
ing it, LINA has a "structural conflict of interest," Williams,
609 F.3d at 632, and we therefore consider this factor in
determining the reasonableness of LINA’s decision, see
Glenn, 554 U.S. at 112.
LINA points to seven items of evidence in defending the
reasonableness of its decision to deny DuPerry’s claim:
• Dr. Patel’s statement in his May 31, 2006,
Attending Physician Statement that DuPerry
could perform some "[s]edentary" job functions.
J.A. 797.
• Dr. Patel’s November 3, 2006, telephone mes-
sage stating that DuPerry’s arthritis was "con-
trolled" and that she had had a "good response"
to medications and had "not called [with] com-
plaints" since September 2006. J.A. 898.
• Dr. Harris’s statement in his October 25, 2006,
Physical Ability Assessment form that DuPerry
was able to perform functions associated with
sedentary work.
• Dr. Patel’s letter dated January 12, 2007, stating
that DuPerry’s "arthritis is moderately active and
has been reasonably well controlled with . . .
medications" and that her "fibromyalgia and
16 DUPERRY v. LIFE INSURANCE COMPANY
fatigue symptoms are secondary to her underly-
ing disease process and are all managed with . . .
medications." J.A. 518.
• DuPerry’s physical therapist’s note in an assess-
ment that DuPerry demonstrated excellent com-
pliance, made small strength and endurance
gains, could complete ten laps around the gym
track in nine minutes, and did not note any limi-
tations or restrictions due to pain.
• DuPerry’s blood tests showing normal levels of
hematocrit and hemoglobin.
• Dr. Levesque’s determination that DuPerry’s
doctors’ opinions that she could not return to
work were unsupported.
Of course, we begin with the language of the Policy. Dur-
ing the regular-occupation period, the Policy provided that
DuPerry was "[d]isabled"
if, solely because of Injury or Sickness, . . . she
[wa]s:
1. unable to perform the material duties of . . . her
Regular Occupation; and
2. unable to earn 80% or more of . . . her Indexed
Earnings from working in . . . her Regular Occupa-
tion.
J.A. 58. DuPerry’s case turned on the question of whether she
was in fact unable to perform the material duties of her job.
LINA makes no argument that even if DuPerry was unable to
perform those duties, her inability was not "solely because of
DUPERRY v. LIFE INSURANCE COMPANY 17
Injury or Sickness."5 Thus, it is the former issue on which we
focus our discussion.
Initially, we note, as a global matter, that the pieces of evi-
dence LINA identifies tend to show, first, that DuPerry was
able to perform, for relatively brief periods, certain tasks
involved in sedentary work and, second, that certain individ-
ual diseases and physical problems that afflicted her were not
sufficient, in isolation, to render her unable to do such work.
However, to perform her job, DuPerry obviously would be
required to do much more than perform a small subset of her
duties for a relatively short duration. Moreover, in so doing,
she would have to overcome the combined effect of all of the
problems caused by her diseases, not just a select few.
Now we will address the individual pieces of evidence that
LINA has identified and "the degree to which they support"
LINA’s decision to deny benefits. Booth, 201 F.3d at 342.
First, in a question on a form asking for "the maximum level
of ability . . . of your patient to" lift, carry, push, and pull, Dr.
Patel marked the choice "Sedentary = 10 lbs. maximum,
walking occasionally." J.A. 797. While that answer certainly
was some evidence of the fact that Dr. Patel believed that
DuPerry could at times complete those individual tasks, as we
have explained, that is a separate question altogether from
whether she could perform the material duties of her job,
which required many hours of work several days per week
apart from these tasks. See Stup, 390 F.3d at 309 (explaining
that even if two-and-a-half-hour functional capacity examina-
tion "had shown conclusively that [the claimant] could per-
form sedentary tasks for the duration of the test," the results
would "provide no evidence as to [the claimant’s] abilities for
a longer period"). Dr. Patel left no doubt regarding the latter
question as he wrote on that very form that DuPerry could
5
Nor does LINA argue that even if she was unable to perform her regu-
lar occupation, she could earn at least 80% of her indexed earnings.
18 DUPERRY v. LIFE INSURANCE COMPANY
"[n]ever" return to work because she was "[p]ermanently dis-
abled." J.A. 797.
For similar reasons, Dr. Harris’s checking "[o]ccasionally"
in a number of blocks on a Physical Ability Assessment Form
concerning how often DuPerry could perform certain tasks
such as sitting, standing, and walking did not conflict with his
opinion that she could not return to work. J.A. 768. Aside
from the fact that performing these individual tasks comprised
only a small part of DuPerry’s workday, it is noteworthy that
the form defined "[o]ccasionally" alternatively as 1% to 33%
of an eight-hour day or less than 2.5 hours.6 J.A. 768.
The physical therapist’s note that DuPerry had made "small
strength and endurance gains" obviously also falls well short
of creating a conflict with DuPerry’s doctors’ opinions for the
same reason. J.A. 813. That DuPerry made small gains in no
way calls into question DuPerry’s doctors’ opinions that she
still was not able to return to work. Nor does the physical
therapist’s note stating that she was able to complete ten laps
around a 170-foot track in nine minutes create such a conflict.
Aside from the fact that this pace is only slightly more than
two miles per hour, the test lasted only nine minutes. It could
hardly be found to be instructive on the question of whether
DuPerry could endure the rigors of a full workday or work-
week. The same can be said of LINA’s citation to DuPerry’s
"excellent compliance" with her strength and conditioning
exercises, which indicates only that DuPerry was giving her
best effort. J.A. 813.
Dr. Patel’s telephone message of November 3, 2006, also
creates no conflict. According to that message, Dr. Patel
reported:
[DuPerry] unable to work [due to] Fibromyalgia,
fatigue as well as side effects of pain meds – these
6
1% of an eight-hour workday is less than five minutes.
DUPERRY v. LIFE INSURANCE COMPANY 19
are what is limiting [DuPerry], symptoms overall w/
achiness and stiffness w/ weather changes, no other
major complaints at this time, to continue on meds-
having good response so far – has not called w/ com-
plaints, have not se[e]n since Sept – Rheumatoid
arthritis is controlled at this point in time –
[DuPerry] not able to work [due to] pain and
fatigu[ ]e as well as pain med side effects.
J.A. 898. LINA focuses on the part of the message stating that
DuPerry’s arthritis is under control, but it is hard to see how
that matters much in light of Dr. Patel’s statement that her
pain, fatigue, and side effects from her medications were pre-
venting her from working.
Similarly, Dr. Patel’s January 12, 2007, letter does not
undercut his opinion that DuPerry was disabled. The letter
reported:
[DuPerry’s] arthritis is moderately active and has
been reasonably well controlled with the medications
she is on . . . . However, her fibromyalgia and fatigue
symptoms are secondary to her underlying disease
process and are all managed with the medications. It
makes it difficult for her to function and return back
to previous work duties. At this time, she certainly
has some limitations requiring a hospital bed at
home to sleep comfortably on. She has trouble get-
ting up and around, although the pain is reasonably
well controlled with the pain medications. At this
time, because of the above medical problems and
complications thereof and medications, she certainly
is not able to return to any previous work duties.
J.A. 518. Again, the fact that her arthritis was under control
and that her pain may have been well controlled with pain
medications does not conflict at all with Dr. Patel’s view that
the combination of DuPerry’s pain, fatigue, and the effects of
20 DUPERRY v. LIFE INSURANCE COMPANY
her medication prevented her from engaging in gainful
employment.
As for Dr. McCool’s note that DuPerry’s blood test results
showed her "hematocrit and hemoglobin around 11/32," J.A.
874, LINA does not explain how this advances its cause.
LINA maintains, without explanation, that this note indicates
that the results "contradicted [DuPerry’s] subjective com-
plaints of fatigue." Brief of Appellant at 12. DuPerry, how-
ever, argues that low scores on these blood tests are indicative
of anemia and that DuPerry did not claim to be suffering
from anemia, which is not a by-product of arthritis or fibro-
myalgia. See MedicineNet.com, http://www.medicinenet.com/
hematocrit/article.htm (last visited Dec. 16, 2010); Medicine-
Net.com, http://www.medicinenet.com/hemoglobin/page2.htm
(last visited Dec. 16, 2010). LINA does not explain how these
blood tests conflict with DuPerry’s claim that she is disabled.
In short, LINA has not satisfactorily explained how any of
the first six pieces of evidence it identifies creates any signifi-
cant reason to doubt the correctness of the opinions offered by
Drs. Patel and Harris that "solely because of Injury or Sick-
ness," DuPerry was "unable to perform the material duties of
. . . her Regular Occupation." J.A. 124 (Policy). That leaves
LINA only with Dr. Levesque’s reports, to which we now
turn.
Dr. Levesque acknowledged in both reports that DuPerry
suffers from rheumatoid arthritis and fibromyalgia, but he
found no reason for concluding that either disease prevented
DuPerry from being able to work. In his January 31, 2008,
report, he stated that while "[t]he records amply document"
DuPerry’s "problems with chronic pain and fibromyalgia . . .
given the absence of physical limitations due to [fibromyal-
gia], there is nothing that would preclude [DuPerry] normally
from pursuing a typical sedentary occupation." J.A. 174
(emphasis added). He added that "[g]enerally, patients with
fibromyalgia are able to work a sedentary occupation." J.A.
DUPERRY v. LIFE INSURANCE COMPANY 21
174. In his February 10, 2008, report Dr. Levesque further
acknowledged that fibromyalgia is the "underlying major
diagnosis for [DuPerry’s] pain" but stated that "given the lack
of physical findings associated with the diagnosis, it does not
adequately support the limitations imposed" on DuPerry’s
ability to work by her treating physicians. J.A. 144 (emphasis
added).
Dr. Levesque’s reasoning is cryptic, to be sure, and it is not
for us to second-guess LINA’s reading of the reports to the
extent it was reasonable. Nevertheless, we agree with the dis-
trict court that under any permissible reading, the reports do
not provide a reasonable basis for denial of DuPerry’s claim.
We will address the possible meanings of the reports seriatim.
First, it is possible that Dr. Levesque simply concluded that
DuPerry did not produce the type of evidence that would
show that the pain and fatigue caused by her fibromyalgia and
other conditions was so substantial that she could not perform
the material duties of her job. However, DuPerry produced
the only types of evidence a claimant in her situation could
produce, her own description of the severity of her subjective
symptoms, videos showing how she moved in her condition,
and her treating physicians’ opinions that the pain and fatigue
rendered her unable to work. As the Policy contained no pro-
vision precluding DuPerry from relying on her subjective
complaints as part of her evidence of disability, LINA could
not reasonably deny her claim because of such reliance. Cf.
Smith v. Continental Cas. Co., 369 F.3d 412, 420 (4th Cir.
2004) (discussing plan stating that limited benefits would be
provided for a disability "due to a diagnosed condition which
manifests itself primarily with Self-Reported Symptom(s)").
Second, it is possible that Dr. Levesque simply was not per-
suaded that DuPerry was rendered unable to work by the pain
and fatigue she experienced from her fibromyalgia and her
other conditions. If that was Dr. Levesque’s opinion, we can-
not conclude that the opinion was "deliberate" or "principled."
22 DUPERRY v. LIFE INSURANCE COMPANY
Although Dr. Levesque did not examine DuPerry, he noted
that review of her videos indicated that her rheumatoid arthri-
tis was sufficiently controlled that it would not prevent her
from working. However, he did not report seeing anything in
the videos that would cause him to doubt her claim and those
of her treating doctors that her pain and fatigue from her
fibromyalgia and her other conditions prevented her from
enduring the rigors of the workweek. Dr. Levesque, of course,
noted that "[g]enerally, patients with fibromyalgia are able to
work a sedentary occupation." J.A. 174 (emphasis added).
However, even if fibromyalgia were the only condition
afflicting DuPerry, Dr. Levesque’s observation would be
insufficient to create any conflict with DuPerry’s claim absent
evidence that DuPerry’s symptoms were no worse than aver-
age in severity. And, of course, fibromyalgia was not DuPer-
ry’s only condition.
Considering all of the evidence together, we simply see no
reasonable basis in the record for LINA’s denial of DuPerry’s
claim. It is undisputed that DuPerry suffers from chronic dis-
eases that are potentially debilitating. She has presented sub-
stantial evidence from her physicians that these diseases do,
in fact, prevent her from working. And, she has presented her
own declaration and declarations from her family and even
her former employer confirming the severity of her symp-
toms. The only evidence of any consequence that LINA can
point to as conflicting with DuPerry’s entitlement to benefits
are the reports of Dr. Levesque. However, these reports con-
tain no significant basis supporting a conclusion that the
symptoms from DuPerry’s fibromyalgia, either by themselves
or combined with the symptoms from her other conditions,
are not sufficiently severe as to prevent her from enduring the
rigors of her workweek. Especially in light of the structural
conflict present here by virtue of LINA’s dual role as insurer
and administrator of the plan, we conclude that LINA’s denial
of DuPerry’s claim was unreasonable and an abuse of its dis-
cretion. Cf. Stup, 390 F.3d at 308 (explaining in pre-Glenn
case applying modified-abuse-of-discretion standard that
DUPERRY v. LIFE INSURANCE COMPANY 23
"while an administrator does not necessarily abuse its discre-
tion by resolving an evidentiary conflict to its advantage, the
conflicting evidence on which the administrator relies in
denying coverage must be ‘substantial’—especially when, as
in this case, the administrator has an economic incentive to
deny benefits").
III.
LINA next contends that the district court erred in import-
ing a Social Security Disability Income rule into the ERISA
arena. Of course, we have decided de novo that LINA abused
its discretion in denying DuPerry’s claim. Nevertheless, to the
extent that LINA’s argument would apply to our analysis as
well, we will address it.
LINA notes that the district court reasoned:
[W]here an ERISA plan does not provide procedures
for dealing with subjective complaints of pain and a
claimant puts forth objective evidence of a disease
that could cause her subjective complaints of pain, it
seems that a principled reasoning process necessarily
requires the administrator to address the claimant’s
subjective complaints of pain in a thorough, mean-
ingful way if the administrator is to deny the claim.
J.A. 1009-10. LINA maintains that that rule is at odds with
our decision in Smith, in which we rejected a similar rule. We
disagree.
In Smith, the district court, rather than applying the lan-
guage in the plan under which the plaintiff claimed benefits,
imported the Social Security Act ("SSA") rule that
[o]nce an underlying physical or mental impairment
that could reasonably be expected to cause pain is
shown by medically acceptable objective evidence,
24 DUPERRY v. LIFE INSURANCE COMPANY
such as clinical or laboratory diagnostic techniques,
the adjudicator must evaluate the disabling effects of
a disability claimant’s pain, even though its intensity
or severity is shown only by subjective evidence.
Smith, 369 F.3d at 418 (internal quotation marks omitted). We
reversed and remanded to the district court, holding that the
language of the plan controls even if applying the plan terms
would produce a different result than would be produced by
the SSA rules. See id. at 419-20. The critical difference in the
present case is that although the district court in the case at
bar applied a rule similar to that applied by the district court
in Smith, the district court in the case at bar derived that rule
from a common-sense interpretation of the plan language
rather than by importing the rule from SSA. In fact, the dis-
trict court in this case specifically acknowledged that SSA
rules would not necessarily apply.
LINA maintains that under the rule the district court
applied, LINA was essentially required to award benefits sim-
ply based on DuPerry’s subjective complaints. But that is not
the case at all. As the district court explained, LINA was not
required to "simply accept [DuPerry’s] subjective complaints
of pain without question," but neither could LINA "simply
dismiss such subjective complaints of pain out of hand, espe-
cially where there is objective medical proof of a disease that
could cause such pain." J.A. 1009. Neither LINA nor Dr.
Levesque gave any principled reason for rejecting DuPerry’s
claim that her symptoms prevented her from returning to
work, and in fact none exists in the record. The mere fact that
Dr. Levesque offered the conclusion that DuPerry had not
adequately supported her claim that she could not return to
work was not sufficient to support the benefits denial, espe-
cially considering LINA’s conflict of interest.
LINA also argues that the district court’s "rule would viti-
ate years of ERISA case law upholding plan administrators’
interpretations of their plans to require more than just subjec-
DUPERRY v. LIFE INSURANCE COMPANY 25
tive complaints to support a claim for benefits." Brief of
Appellant at 37. Even assuming, however, that subjective
complaints cannot be sufficient, by themselves, to support a
disability benefits claim, that is not the case we have here
because DuPerry’s subjective complaints were only part of
the evidence of her condition. The existence of objective evi-
dence that DuPerry suffered from rheumatoid arthritis, osteo-
arthritis, and fibromyalgia is not disputed. That a person with
these diseases would suffer significant pain and fatigue is also
well established. DuPerry’s subjective complaints served only
to pinpoint the precise intensity of her symptoms and her
inability to endure them over the course of a workweek. In the
absence of any significant basis for rejecting the account of
DuPerry and her treating physicians and in light of the struc-
tural conflict of interest that LINA faced as the result of its
dual role as administrator and insurer, LINA’s denial of bene-
fits constituted an abuse of discretion.
IV.
Having determined that LINA abused its discretion in
denying DuPerry’s benefits claim, we next must determine
what remedy to apply.
As noted earlier, "[d]isabled" is defined in two different
ways in the Policy. First, during the regular-occupation
period, a participant is disabled if, because of injury or sick-
ness, she is "unable to perform the material duties of . . . her
Regular Occupation" and "unable to earn 80% or more of . . .
her Indexed Earnings." J.A. 58. This is the definition that was
applicable to DuPerry’s claim when LINA denied it. How-
ever, once Disability Benefits have been payable for 24
months, the "any-occupation" period begins and a participant
is considered to be disabled only if, because of injury or sick-
ness, she is "unable to perform the material duties of any
occupation" and is "unable to earn 60% or more of . . . her
Indexed Earnings." J.A. 58. DuPerry’s any-occupation period
of disability began on or about October 5, 2008.
26 DUPERRY v. LIFE INSURANCE COMPANY
LINA notes that it has not received evidence regarding, nor
made any determination of, DuPerry’s right to any-occupation
disability benefits. LINA contends that the record thus is not
sufficient to support an analysis of whether DuPerry was enti-
tled to such benefits because, among other things, "there is no
evidence as to the universe of occupations for which DuPerry
would be eligible. Nor is there any evidence as to the potential
earnings DuPerry could realize from these occupations." Brief
of Appellant at 53-54. We conclude, however, the district
court acted correctly.
It is true that generally a claimant must exhaust the admin-
istrative remedies provided in an employee benefit plan
before prosecuting an ERISA claim in federal court. See
Hickey v. Digital Equip. Corp., 43 F.3d 941, 945 (4th Cir.
1995). However, a "clear and positive" showing that such
exhaustion would be futile will circumvent this requirement.
Makar v. Health Care Corp. of Mid-Atlantic (CareFirst), 872
F.2d 80, 83 (4th Cir. 1989) (internal quotation marks omit-
ted). We review for abuse of discretion a district court’s deci-
sion regarding whether to remand an ERISA benefits claim
for exhaustion of administrative remedies. See Oliver v. Coca
Cola Co., 497 F.3d 1181, 1200 (11th Cir.), vacated in part on
other grounds, 506 F.3d 1316, 1317 (11th Cir. 2007) (per
curiam); Dozier v. Sun Life Assurance Co. of Canada, 466
F.3d 532, 534 (6th Cir. 2006); Hickey, 43 F.3d at 945.
In this case, DuPerry can hardly be blamed for not applying
to LINA for benefits during the any-occupation period as
LINA, having denied DuPerry’s claim under the regular-
occupation standard, would have surely denied a claim under
the any-occupation standard as well. See Dozier, 466 F.3d at
535. And, while LINA has not yet passed on the question of
whether DuPerry could satisfy the any-occupation standard, in
this case there is no indication that the change in standard
would affect the result. Specifically, it is apparent from the
record that DuPerry’s inability to work was not the result of
particular duties specific to her regular occupation. Dr. Patel
DUPERRY v. LIFE INSURANCE COMPANY 27
indicated that DuPerry was "[p]ermanently disabled" and that
she could "[n]ever" return to work. J.A. 797. As her dosage
of pain medication continued to increase, he reported that
DuPerry "need[ed] to limit her activities" such that if she did
"five to ten minutes of work," she needed to "rest[ ] for 30 to
40 minutes before returning . . . to work duties." J.A. 229. Dr.
Harris stated that he informed DuPerry in May 2005 "that she
needed to stop work," but that she continued working until
February 6, 2006, when she simply could not control her
increasing pain. J.A. 462. As of November 27, 2006, Harris
opined that DuPerry was "unable to continue any gainful
employment." J.A. 462. As we have explained, there was no
principled basis in the record to reject these doctors’ opinions.
Thus, we believe this is one of those rare cases where a
remand to the plan administrator would serve no purpose.
Under the circumstances of this case, we hold that the district
court was within its discretion in awarding DuPerry benefits
up to the date of its decision in lieu of remanding to LINA.
See Oliver, 497 F.3d at 1200 (affirming district court decision
that because remand to plan administrator would have been
futile, claimant was entitled to benefits during any-occupation
period as well as during regular-occupation period even
though claimant had applied for benefits during regular-
occupation period); Dozier, 466 F.3d at 535-37 (in case in
which district court granted judgment to claimant based on
satisfaction of regular-occupation standard of disability,
reversing district court’s dismissal of claim for benefits made
under any-occupation standard of disability when remand to
administrator would have been futile).
V.
Finally, LINA contends that the district court abused its
discretion in awarding attorneys’ fees to DuPerry. See Caro-
lina Care Plan, Inc. v. McKenzie, 467 F.3d 383, 390 (4th Cir.
2006) (standard of review). We disagree.
28 DUPERRY v. LIFE INSURANCE COMPANY
We have adopted a five-factor test to guide courts’ discre-
tion in determining whether an attorneys’ fee award is war-
ranted under ERISA. The five factors are:
(1) degree of opposing parties’ culpability or bad
faith;
(2) ability of opposing parties to satisfy an award of
attorneys’ fees;
(3) whether an award of attorneys’ fees against the
opposing parties would deter other persons acting
under similar circumstances;
(4) whether the parties requesting attorneys’ fees
sought to benefit all participants and beneficiaries of
an ERISA plan or to resolve a significant legal ques-
tion regarding ERISA itself; and
(5) the relative merits of the parties’ positions.
Quesinberry v. Life Ins. Co. of N. Am., 987 F.2d 1017, 1029
(4th Cir. 1993).
The district court concluded that on balance these factors
weighed in favor of a fee award. Regarding the first and fifth
factors, the court noted that while LINA’s "conduct may not
rise to the level of bad faith, [LINA] certainly demonstrates
some degree of culpability in its dismissal of [DuPerry’s] sub-
jective complaints without meaningful inquiry." J.A. 1047.
The court noted that LINA "patently abused the claim review
procedure" by "overlook[ing] substantial evidence from
[DuPerry’s] treating physicians that she was unable to work"
and relying instead "on minor inconsistencies in and disingen-
uous interpretations of these physicians’ reports." J.A. 1047.
The court also found that "awarding attorneys’ fees may pro-
duce a deterrent effect by encouraging plan administrators to
DUPERRY v. LIFE INSURANCE COMPANY 29
inquire more meaningfully into disability claims that rely on
subjective complaints of pain." J.A. 1047.
In our view, the district court analyzed the Quesinberry fac-
tors reasonably, and we find that the decision to award attor-
neys’ fees did not constitute an abuse of discretion.
VI.
In sum, we find no error in the district court’s resolution of
the questions before it. We therefore affirm.
AFFIRMED