[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT FILED
________________________ U.S. COURT OF APPEALS
ELEVENTH CIRCUIT
Aug. 11, 2009
No. 09-11287
THOMAS K. KAHN
Non-Argument Calendar
CLERK
________________________
D. C. Docket No. 07-01298-CV-BE-M
MIKE RUPLE,
Plaintiff-Appellant,
versus
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Northern District of Alabama
_________________________
(August 11, 2009)
Before BIRCH, HULL and KRAVITCH, Circuit Judges.
PER CURIAM:
Mike Ruple appeals a summary judgment ruling entered in favor of Hartford
Life and Accident Insurance Company (“Hartford”). Ruple filed this lawsuit
under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29
U.S.C. §§ 1001, et seq., seeking reinstatement of long-term disability benefits,
which Hartford had denied after determining that he was not disabled within the
meaning of the applicable benefits policy. The district court found that Hartford’s
decision to deny benefits was not wrong and granted summary judgment for
Hartford. We agree with the district court and affirm.
BACKGROUND
Ruple’s former employer had in place a disability benefits policy (“the
policy”) as part of its employee welfare benefit plan. The policy was originally
administered by Continental Casualty Company, aka CNA, (“CCC”), but in 2004
Hartford took over administration of claims made under the policy.
The policy had a short-term disability benefits portion providing disability
benefits if the employee was unable to perform his regular occupation. These
short-term benefits would be paid for 36 months. After the 36-month period, the
employee would have to demonstrate eligibility for long-term disability benefits in
order to continue receiving disability benefits.
The long-term disability portion stated:
After the Monthly Benefit has been payable for 36 months,
“Disability” means that Injury or Sickness causes physical or mental
impairment to such a degree of severity that You are:
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(1) continuously unable to engage in any occupation for which You
are or become qualified by education, training or experience; and
(2) not working for wages in any occupation for which You are or
become qualified by education, training or experience.
Additionally, the policy required the claimant to provide proof of disability.
The policy stated, in relevant part:
Proof of Disability
The following items, supplied at Your expense, must be a part of
Your proof of loss. Failure to do so may delay, suspend or terminate
Your benefits:
...
5. Objective medical findings which support Your Disability.
Objective medical findings include but are not limited to tests,
procedures, or clinical examinations standardly [sic] accepted in the
practice of medicine, for Your disabling condition(s).
Ruple ceased work for his employer in January 1999 due to back pain, and
began receiving short-term disability benefits from CCC. Later, CCC began
paying Ruple long-term disability benefits. At some point, CCC terminated long-
term benefits and Ruple filed suit. CCC and Ruple requested dismissal of the suit
pursuant to a settlement agreement in 2004; CCC then resumed paying long-term
disability benefits to Ruple. After Hartford took over administration of the policy,
Hartford reviewed Ruple’s claim, determined that he was not disabled within the
meaning of the policy that same year, and terminated his benefits.
3
Hartford’s administrative record contained the following evidence
submitted by Ruple in support of his claim that he was disabled from any
occupation and thus entitled to long-term disability benefits:
Ruple saw a neurosurgeon in August 1999 who noted that Ruple’s cervical
and lumbar MRI studies revealed “no evidence of any abnormality.” The surgeon
did not recommend surgery.
Records from the Birmingham Pain Center, where Ruple was a patient
starting in January 1999, indicated that Ruple was initially seen by Dr. Cheryl
Goyne who stated that Ruple had “chronic low back pain with symptoms
suggestive of right L5-S1 radiculopathy” and that “[h]is exam is quite benign.”
She also wrote “[j]ust need to keep the possibility in mind that this patient may
ultimately be seeking disability to help alleviate the burden of child support.” At
his next visit on February 25, 1999, Dr. Goyne noted that the C-spine MRI was
read out as normal but that some abnormalities were shown on the thoracic MRI.
Dr. Goyne also wrote
The patient did bring up the subject of disability today. He
apparently has a good disability policy through work. I was very
clear with him that I do not think that this is a disabling lesion. I
think that it would be in his best interest to try to retrain to do
something else but I cannot say that he is disabled on the basis of
these small thoracic disks and I do think we can get him better with
proper pain management.
4
In May of that year, Dr. Goyne noted that Ruple was in a fair amount of
pain. In a follow-up appointment, however, Dr. Goyne found that he was “pretty
much back to baseline,” although still having some pain. She also stated
The big issue with him right now is disability. His short-term
disability will be up in six weeks . . . As I told him, my feeling is that
it would be most wise to retrain for another position within his
company. I did feel that it would be difficult for him to continue his
present work with the problems he has in his thoracic spine and do
consider his work somewhat risky given that it would not be difficult
for him to have thoracic compression if he were to rupture one of the
protruded disks. However, I do not feel that his present injury should
result in a permanent total disability and again I think he should look
towards retraining.
After that visit, Ruple switched to a different doctor at the Birmingham Pain
Center – Dr. Gossman. Dr. Gossman noted in June 1999 that Ruple seemed to be
experiencing pain, but that “[o]bviously, this is a situation where there could be
some addictive / manipulative problem. However, I am going to give him the
benefit of the doubt at this point in time and try to work with him.” In July, Dr.
Gossman wrote that Ruple is still not working and reported that the pain wakes
him at night. Dr. Gossman, however, stated that he was “a bit concerned” and that
Ruple’s “MRI does not look very significant,” that he “moves fairly comfortably
in the office when we are not discussing pain [including] bending over to pick up
things,” and that Ruple “really does not look that uncomfortable.” Dr. Gossman
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encouraged Ruple “to seek employment and talk with his workplace about the
possibility of working a modified schedule of some sort.” Over the next few
months, Ruple received a series of thoracic epidural steroid injections which
reportedly brought him significant relief.
In 2002, CCC determined that Ruple was no longer entitled to benefits
under the policy. Its letter referred to a report by Dr. Heather Sabo that Ruple was
able to perform alternative work with no lifting over 10 pounds, standing and
walking for 4 hours per day and sitting for 8 hours per day with breaks as needed.
CCC also discussed a vocation assessment which identified available gainful
occupations that Ruple could perform. This denial led to his first lawsuit which,
as stated above, ended in a settlement and reinstatement of benefits.
In November 2004 after taking over administration of the policy, Hartford
interviewed Ruple. Ruple stated that he could not pass a physical to work as a
truck driver because of all the pain medications he was taking and that he spent
most of his time in a recliner. He did not believe that he could retrain for another
occupation because he would not be able to sit through a class. Ruple also
revealed that he joined a 1000 acre hunting club where he hunted deer; the hunting
location was an hour away.
6
In March 2005, Hartford arranged for video surveillance of Ruple. On two
instances, Ruple was observed driving around town on errands and ambulating
normally. Hartford requested additional information from Ruple; the record shows
that Hartford noted that Ruple “advised that he does not cook, doesn’t tend to
laundry, performs no chores outside the home, no shopping, and limits his driving
to a few minutes at a time.”
Hartford requested updated information in January 2006 and informed
Ruple that two of his previous doctors indicated that they had not seen him for
many years. During a phone call with Hartford, Ruple admitted that he drove up
to two and a half hours at a time. Dr. Timothy Bunker, Ruple’s treating physician
at the Birmingham Pain Center, completed a functional assessment, in which he
expressed his opinion that Ruple was capable of doing full-time sedentary work.
Hartford assessed the above information, noted that Ruple had a GED, and
concluded that Ruple would be capable of performing a sedentary occupation,
including “sorter, appointment clerk, and credit card clerk.” Hartford found that
such positions were available in the area where Ruple lived and terminated his
long-term disability benefits. Ruple appealed through Hartford’s review process.
While Hartford was reviewing Ruple’s appeal, Dr. Bunker submitted a letter
to Hartford dated April 26, 2006. In the letter, Dr. Bunker wrote that he had filled
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out Ruple’s functional assessment at a time when “he really didn’t have a good
handle to which patient” he was referring. He stated his updated opinion that
Ruple’s “function is actually less than sedentary. He is actually permanently and
totally disabled and this mostly due to the fact that he is on very strong narcotic
pain medication . . . I don’t feel a person requiring this heavy medication [is] able
to perform any gainful employment.” Hartford then collected Ruple’s medical
records from Dr. Bunker. The records included lab reports revealing Valium in
Ruple’s system, which had not been prescribed, and no Klonopin, which had been
prescribed. Ruple told Dr. Bunker in November 2005 that his lower and mid back
pain was “controlled to an ‘ok’ level.” In January 2006, Dr. Bunker reported that
Ruple “walks a lot” for exercise. In June 2006, Dr. Bunker terminated his patient
relationship with Ruple. He wrote to Ruple
On your last office visit with me and my staff, you had a urine drug
screen performed that was inconsistent with your controlled
medicines. On three separate occasions you tested positive for
Valium and on one occasion Xanax. You are not prescribed any of
these by this clinic . . . Also, you have been prescribed Klonopin,
which was never present in the urine drug screens.
Dr. Bunker also noted that when Ruple was asked to bring in his medicines for a
pill count, he failed to bring in all medications. Dr. Bunker noted that Ruple had
“been consistently non-compliant with my treatment plan,” and also referred him
8
to an “intensive in-patient detoxification and drug rehabilitation program if [Ruple
felt] that it is right for [him].”
After that time, Ruple began seeing Dr. Odene Connor for pain
management. The records submitted from Dr. Connor include MRIs showing mild
abnormalities. Ruple reported to Dr. Connor that his pain medication was “fair”
and “effective.” Dr. Connor did not submit an opinion on Ruple’s status.
Hartford requested that Dr. Dennis Ogiela, a board-certified orthopedist,
conduct a peer review opinion. Dr. Ogiela wrote that the most recent MRIs
showed “minimal objective changes” from previous images. Dr. Robert Pick,
another board-certified orthopedic surgeon, took over the peer review after Dr.
Ogiela became ill. After conducting a full review of Ruple’s medical records, Dr.
Pick stated
[I]t is my considered medical opinion, to a reasonable degree of
medical certainty, that as of 3/31/06 no substantive objective
orthopedic findings have been documented in the file and Mr. Ruple
was able – objectively – to engage in full time work activities in at
least the light-medium level category.
...
The medical documentation lacks any substantive objective findings
to validate and substantiate Mr. Ruple’s stated subjective symptoms
and complaints.
...
In summary, based on review of the records, it is my considered
medical opinion, to a reasonable degree of medical certainty, that the
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overwhelming issue at hand is Mr. Ruple’s stated subjective
symptoms and complaints.
Dr. Pick noted Ruple’s medication use, but believed that such use would not
“preclude him or render him incapacitated and unable to perform a sedentary level
occupation which requires an average level of intelligence and concentration . . . .”
After reviewing the above evidence, Hartford concluded that Ruple was not
eligible for long-term disability benefits under the policy and terminated his
benefits on February 23, 2007. Ruple filed the instant lawsuit, requesting review
of Hartford’s decision. Based on the administrative record, the Magistrate Judge
determined that Hartford was not wrong to deny Ruple long-term disability
benefits. The district court adopted the Magistrate Judge’s Report and
Recommendation and granted summary judgment to Hartford.
STANDARD OF REVIEW
We review the district court’s summary judgment ruling de novo, applying
the same legal standards that governed the district court’s decision. Williams v.
Bellsouth Telecommunications, Inc., 373 F.3d 1132, 1134 (11th Cir. 2004).
DISCUSSION
Res Judicata
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Ruple first argues that Hartford is barred from denying that he is entitled to
long-term disability benefits because of the prior lawsuit and ensuing settlement
between Ruple and CCC. Because the prior lawsuit ended in a dismissal by
stipulation of the parties pursuant to a settlement agreement, preclusion depends
on the settlement agreement rather than on the complaint. Norfolk S. Corp. v.
Chevron, U.S.A., Inc., 371 F.3d 1285, 1288 (11th Cir. 2004) (“Where the parties
consent to such a dismissal based on a settlement agreement, however, the
principles of res judicata apply (in a somewhat modified form) to the matters
specified in the settlement agreement, rather than the original complaint.”). In
order to determine what claims are barred as a result of the settlement agreement,
we look to the agreement itself to determine what claims the parties intended to be
finally and forever barred by the dismissal. Id. “[T]he scope of the preclusive
effect of the . . . [d]ismissal should not be determined by the claims specified in
the original complaint, but instead by the terms of the Settlement Agreement, as
interpreted according to traditional principles of contract law.” Id.
Here, the parties disagree as to what was finally resolved in the settlement
agreement. Ruple contends that the parties agreed that Ruple was totally disabled
within the meaning of the policy and thus entitled to permanent long-term
benefits. Hartford asserts that the prior litigation resolved only Ruple’s disability
11
status as of July 2002 and left open the question of his long-term disability subject
to further inquiry. A thorough review of the record has not shown that a copy of
the settlement agreement was ever put into evidence. Nor has Ruple ever
discussed the content of the agreement in his arguments, and we are thus unable to
determine what claims the prior settlement agreement covered and would therefore
bar a subsequent lawsuit. Ruple, as the party attempting to assert res judicata,
bears the burden of proving that the preclusive doctrine applies. In re Piper
Aircraft Corp., 244 F.3d 1289, 1296 (11th Cir. 2001). Ruple has failed to
establish that the parties’ previous settlement bars the instant lawsuit.
Standard of Review
Ruple argues that the Magistrate Judge – and thus the district court by
adopting the Magistrate Judge’s Report and Recommendation – applied the wrong
standard of review to the summary judgment motions. The Magistrate Judge
stated that “the typical summary judgment analysis does not apply to ERISA
cases.” The Magistrate Judge is correct that the standard of review applicable to
ERISA cases is somewhat different than in other cases. In determining whether a
denial of benefits was proper we review the decision of the policy administrator
only to determine whether the administrator was arbitrary and capricious. Jett v.
Blue Cross & Blue Shield of Ala., 890 F.2d 1137, 1139 (11th Cir. 1989). To
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accomplish this review, the Supreme Court established three standards of review
depending on the level of discretion granted to the Administrator under the terms
of the plan: (1) de novo where the plan grants no discretion, (2) arbitrary and
capricious if the plan grants the Administrator discretion, and (3) heightened
arbitrary and capricious if the Administrator has discretion to grant or deny claims
but it has a conflict of interest (because the same entity decides eligibility for
benefits and pays out those benefits). Firestone Tire & Rubber Co. v. Bruch, 489
U.S. 101, 115 (1989).1
This court uses a multi-step analysis to guide these reviews of Administrator
decisions and the various standards of review. HCA Health Services of Georgia,
Inc. v. Employers Health Ins. Co., 240 F.3d 982, 993-95 (11th Cir. 2001). The
analysis involves six steps:
(1) Apply the de novo standard to determine whether the claim
administrator’s benefits-denial decision is “wrong” (i.e., the
court disagrees with the administrator’s decision); if it is not,
then end the inquiry and affirm the decision.
(2) If the administrator’s decision in fact is “de novo wrong,”
then determine whether he was vested with discretion in
reviewing claims; if not, end judicial inquiry and reverse the
decision.
1
Firestone developed these standards to review Administrator interpretations of plan
language. Courts have also applied these standards to review factual determinations of benefits
eligibility. Shaw v. Connecticut General Life Ins. Co., 353 F.3d 1276, 1285 (11th Cir. 2003).
13
(3) If the administrator’s decision is “de novo wrong” and he
was vested with discretion in reviewing claims, then determine
whether “reasonable” grounds supported it (hence, review his
decision under the more deferential arbitrary and capricious
standard).
(4) If no reasonable grounds exist, then end the inquiry and
reverse the administrator’s decision; if reasonable grounds do
exist, then determine if he operated under a conflict of interest.
(5) If there is no conflict, then end the inquiry and affirm the
decision.
(6) If there is a conflict of interest, then apply heightened
arbitrary and capricious review to the decision to affirm or
deny it.
Williams, 373 F.3d at 1138; see also Doyle v. Liberty Life Assurance Co. of
Boston, 542 F.3d 1352, 1360-61 (11th Cir. 2008) (upholding a district court’s
analysis following the above steps after Metro. Life Ins. Co. v. Glenn, – U.S. –,
128 S.Ct. 2343 (2008)).2 The Magistrate Judge correctly recognized and applied
the above standard of review.
May Hartford and the Court Require Objective Medical Evidence of Disability?
Ruple argues that Hartford acted arbitrarily and capriciously by terminating
his benefits due to a lack of objective medical evidence supporting his claimed
disabling back pain. The policy involved in this case clearly requires “[o]bjective
medical findings which support [the claimant’s] Disability. Objective medical
2
Because we decide this case at the first step of the analysis, see infra, we need not
determine the level of discretion held by Hartford.
14
findings include but are not limited to tests, procedures, or clinical examinations
standardly accepted in the practice of medicine, for [the] disabling condition(s).”
Accordingly, Hartford did not act arbitrarily or capriciously in requiring the kind
of evidence that is explicitly required under the policy.
Additionally, when the court makes its own determination of whether the
administrator was “wrong” to deny benefits under the first step of the Williams
analysis, the court applies the terms of the policy. See 29 U.S.C. § 1104(a)(1)(D)
(providing that an ERISA plan administrator must “discharge his duties with
respect to a plan . . . in accordance with the documents and instruments governing
the plan insofar as such documents and instruments are consistent with the
provisions of [ERISA].”); Oliver v. Coca-Cola Co., 497 F.3d 1181, 1195 (11th
Cir. 2007) (“To determine whether the administrator’s denial of benefits was
arbitrary and capricious, we begin with the language of the Plan itself.”).3 Thus,
the Magistrate Judge did not acted improper by requiring objective medical
findings where such evidence is required under the terms of the policy. Doyle v.
Liberty Life Assurance Co. of Boston, 542 F.3d 1352, 1358 (11th Cir. 2008) (“The
3
The policy involved in this case actually requires objective medical findings within its
terms; this case is thus distinguishable from those cases where we have found that the plan
administrator acted arbitrarily and capriciously in demanding objective evidence not required by
the plan itself. See Oliver, 497 F.3d at 1196-97 (rejecting the administrator’s denial of benefits
due to a lack of objective evidence of disability where no “provision of the Plan requires
‘objective evidence’ of a disability”).
15
policy defines ‘proof’ as including ‘chart notes, lab findings, test results, x-rays
and/or other forms of objective medical evidence in support of a claim for
benefits.’ Therefore, it was reasonable for Liberty Life to rely only on objective
medical evidence supporting Doyle’s claim . . . .”) (emphasis in original).
What Medical Evidence Does the Court Review?
Ruple next argues that he was entitled to submit new evidence to the court
for consideration in the court’s review of Hartford’s decision. Our law is clear,
however, that even under the first step of the BellSouth analysis, where the court
determines whether the administrator was wrong under a “de novo” standard,
“[w]e are limited to the record that was before [the administrator] when it made its
decision.” Glazer v. Reliance Standard Life Ins., 524 F.3d 1241, 1247 (11th Cir.
2008); Jett, 890 F.2d at 1139. Accordingly, the Magistrate Judge appropriately
refused to allow Ruple to submit new evidence not contained in the administrative
record before Hartford. Thus, we will not review Ruple’s affidavit or the opinion
of Dr. Salisbury, Ruple’s current pain management physician, which Ruple
acknowledges were not part of the record before Hartford.
It is unclear whether Ruple’s Social Security disability award was part of
the record before Hartford. Ruple asserts that he submitted evidence of the award
to CCC, Hartford’s predecessor, and yet also argues that the award is “new
16
evidence” which the court should have considered in its de novo review of the
administrator’s decision. A letter from Hartford dated March 14, 2005
acknowledges that Ruple received Social Security benefits, but did not discuss the
details of the decision to award those benefits. Regardless of whether the award
was before Hartford, Hartford did not err in rejecting the award as evidence of
Ruple’s disability. The Social Security Administration’s determination that an
individual is or is not disabled under its statutes and regulations does not dictate
whether that same individual is disabled under the terms of an ERISA policy.
Whatley v. CNA Ins. Cos., 189 F.3d 1310, 1314 n.8 (11th Cir. 1999) (“We note
that the approval of disability benefits by the Social Security Administration is not
considered dispositive on the issue of whether a claimant satisfies the requirement
for disability under an ERISA-covered plan.”). Although the court may consider
the award in reviewing an ERISA administrator’s decision, Kirwan v. Marriott
Corp., 10 F.3d 784, 790 n. 32 (11th Cir. 1994), the court is not bound to do so.4
4
Furthermore, the Social Security Administration explicitly limited its decision. In its
September 11, 2002 decision, the Administrative Law Judge stated that “[c]laimant is a younger
individual and, with proper medical treatment, his condition would be expected to improve over
time; it is therefore recommended that the claimant’s file be reviewed in eighteen months to
determine if he has experienced sufficient medical improvement to return to gainful
employment.” This language makes clear that the Social Security award is not relevant to the
question of Ruple’s long-term disability status beyond the eighteen months for which the Social
Security decision stated it would apply. Hartford’s decision to deny benefits was rendered in
March 2006, significantly beyond eighteen months past September 2002, and therefore neither
Hartford nor this court was required to consider the Social Security award.
17
The Burden of Proof
Ruple next argues that the burden should have been on Hartford to prove
that he was no longer entitled to benefits. Although Ruple acknowledges that the
burden ordinarily rests with the person claiming benefits under an ERISA plan,
see Horton v. Reliance Standard Life Ins. Co., 141 F.3d 1038, 1040 (11th Cir.
1998), he contends that because Hartford once gave benefits the burden shifts to
Hartford to prove that he is no longer entitled to benefits. Ruple relies on
Levinson v. Reliance Standard Life Ins. Co., 245 F.3d 1321 (11th Cir. 2001) to
support his argument that the burden shifts to the administrator to disprove
disability once the administrator has begun paying benefits. We disagree with
Ruple’s reading of Levinson. Levinson does discuss a “burden shifting” away
from the claimant and onto the administrator because the claimant had carried his
burden of proving that he was “totally disabled” within the meaning of the plan.
Id. at 1331. Levinson does not hold that one payment of benefits binds the
administrator to payments forever. Furthermore, Levinson is distinguishable from
the present case. In that case, the court found that the medical evidence was
completely one-sided; the claimant had produced ample evidence of his continuing
disability and there was scant evidence in the administrative record supporting the
administrator’s finding that the claimant was not disabled. Id. Here, the evidence
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was not so one-sided or conclusive in favor of a finding that Ruple was disabled
so as to shift the burden to Hartford.5 Additionally, the policy required Ruple to
produce evidence of an ongoing disability. Nothing in the policy stated or implied
that once long-term benefits were granted, the claimant would forever be entitled
to them.
Eligibility for Benefits
Having resolved Ruple’s procedural arguments, we turn to the merits of
Ruple’s claim that Hartford acted arbitrarily and capriciously in denying him long-
term disability benefits. Under the Williams analysis, we start with the question of
whether, in our opinion, Hartford was wrong to deny benefits. 373 F.3d at 1138.
After a thorough review of the record before Hartford, we conclude that Hartford
was not wrong to deny Ruple long-term disability benefits under the policy.
The policy clearly requires that a claim for disability must be supported by
“objective medical findings.” Ruple’s records show a dearth of such objective
evidence. The first neurosurgeon that Ruple saw in 1999 found no evidence of
abnormality in his MRI scans. Dr. Goyne, his first physician at the Birmingham
Pain Center, acknowledged his subjective reports of pain and some slight
5
Because we hold that Levinson does not apply to these facts, we need not address
Hartford’s contention that Levinson has been overruled.
19
abnormalities on his thoracic MRI , but expressed that she did “not think that this
is a disabling lesion.” She also stated her belief that she did “not feel that his
present injury should result in a permanent total disability” and advised him to
“look towards retraining” for alternative employment. The MRI images submitted
by Dr. Connor did reveal disc bulges, early degenerative disc disease, and some
central disc herniation. No opinion from Dr. Connor was submitted, however,
which indicated that such abnormalities supported Ruple’s assertions of pain. Dr.
Pick, who performed the peer review, stated that the latest MRIs showed little
change from prior tests, gave his opinion that there were “no substantive objective
orthopedic findings,” and wrote that he believed Ruple capable of full time work
in the light to medium level category. These doctors all felt that there was an
absence of objective medical findings – as required by the policy – establishing
Ruple’s disability. Furthermore, although Dr. Bunker did submit a letter asserting
his opinion that Ruple required high levels of pain medications and was totally
disabled, Dr. Bunker later withdrew from the physician-patient relationship with
Ruple, noting Ruple’s non-compliance with treatment and prescriptions.
To the extent that Ruple’s subjective pain alone could support a claim for
long-term disability benefits, there is a lack of clear evidence of such pain and
significant evidence supporting Hartford’s conclusion that his pain was not as
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extensive or debilitating as Ruple reported it to be. Dr. Goyne repeatedly
expressed her opinion that Ruple’s pain was not so severe that he should be
considered permanently disabled and unable to work. Dr. Gossman initially gave
Ruple the “benefit of the doubt” despite Ruple’s soured relationship with Dr.
Goyne, but later indiciated skepticism about Ruple’s pain levels. Dr. Gossman
noted that Ruple “moves fairly comfortably in the office when we are not
discussing pain [including] bending over to pick up things” and that he “really
does not look uncomfortable.” After seeing this ease of movement, Dr. Gossman
advised Ruple to seek employment. Additionally, Hartford’s surveillance and
interviews with Ruple revealed more mobility than reported by Ruple. Ruple
reported that he had joined a hunting club, would hunt deer at a location an hour’s
drive away, and had at times driven up to two and a half hours at a time. The
surveillance showed Ruple driving around town and running errands – activities
which Ruple had earlier stated he could not perform. Also, Dr. Bunker noted that
Ruple was able to walk a lot for exercise. This evidence substantially undercuts
Ruple’s claims that he was totally disabled as a result of experiencing extreme
pain. Even though the record before Hartford did contain some evidence from
Ruple that he was experiencing debilitating pain, the weight of the evidence favors
a conclusion that his pain was not completely disabling.
21
Accordingly, the above evidence demonstrates that Hartford was not
“wrong” to deny Ruple long-term disability benefits under the policy.
CONCLUSION
For the foregoing reasons, we AFFIRM the decision of the district court to
grant summary judgment in favor of Hartford.
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