Court: District Court, D. Massachusetts; September 14, 2015; Federal District Court
Julie Cowern has filed a lawsuit under the Employee Retirement Income Security Act (ERISA) against The Prudential Insurance Company of America, challenging the termination of her benefits under the Staples Voluntary Long Term Disability Plan (LTD Plan). Cowern seeks reinstatement of her benefits, retroactive payments with interest from the termination date, and statutory penalties, attorney’s fees, and costs under ERISA. Both parties have moved for summary judgment, with Cowern aiming to recover benefits and Prudential seeking dismissal of her claims. The Court has denied both motions, determining Prudential's decision to terminate benefits was arbitrary and capricious, and has remanded the case to Prudential for further proceedings.
Cowern was employed by Staples from July 1998 until her leave in April 2009 due to severe gastrointestinal symptoms that worsened over time. Despite an attempt to return to work in September 2009, she was advised by her physician to remain out of work indefinitely. The LTD Plan, sponsored by Staples and administered by Prudential, requires a claimant to be deemed disabled to receive benefits. Disability is defined as an inability to perform substantial duties of one’s occupation due to sickness or injury, alongside a significant loss in indexed monthly earnings. After 24 months, the definition shifts to an inability to perform any gainful occupation for which the claimant is reasonably suited.
A claimant classified as disabled under the Long-Term Disability (LTD) Plan may still face a benefit limitation of 24 months for certain conditions primarily based on self-reported symptoms, designated as the "SRS limitation." Self-reported symptoms are defined as manifestations of a condition communicated to a doctor that lack objective verification through standard medical tests. Examples include headache, pain, and fatigue. Prudential, which manages the LTD claims, provides guidelines for evaluating claims under the SRS limitation, emphasizing the need to differentiate between subjective reports and objective medical findings. If no objective link can be established between reported symptoms and verifiable medical evidence, the SRS limit may apply.
Prudential justified the application of the SRS limitation in Ms. Cowern's case, asserting that her condition was primarily based on self-reported symptoms lacking objective support. Ms. Cowern contests this decision and claims Prudential's review process was selective. The procedural history indicates that Ms. Cowern initially applied for short-term disability (STD) benefits due to inflammatory bowel disorder, which Prudential approved for a limited time. She later applied for LTD benefits, which were initially granted based on a medical review. However, subsequent evaluations by Prudential's medical staff led to a conclusion that her inability to work was based on self-reported symptoms without objective verification. Following covert surveillance and ongoing record reviews, Prudential notified Ms. Cowern that her LTD benefits would end after the initial 24-month period unless further evidence was provided.
On September 15, 2011, Prudential notified Ms. Cowern that her long-term disability (LTD) benefits would end on October 29, 2011, due to the application of the Self-Reported Symptoms (SRS) limitation and her failure to provide sufficient evidence of ongoing disability. Ms. Cowern appealed this decision on September 20, 2011, submitting additional medical documentation, which Prudential acknowledged on April 26, 2012. Prudential then sent her records to a multidisciplinary review panel, which included Dr. Elena Antonelli and Dr. Raj Vuppalanchi. On August 15, 2012, Prudential denied the first appeal, citing insufficient objective evidence to support her claims, stating her condition was primarily based on self-reported symptoms.
On February 7, 2013, Ms. Cowern filed a second appeal, which Prudential reviewed with another panel, including Dr. Antonelli and Dr. Thomas Liebermann, along with an additional review by Dr. Rajesh Wadhwa and a vocational report by Frances Grunden, MS, CRC. Prudential denied the second appeal on August 29, 2013, concluding that the records showed no objective evidence of pain or work-related limitations, asserting that Ms. Cowern could perform the duties of her sedentary occupation as a Principal Programmer Analyst.
Ms. Cowern filed a complaint in court on January 17, 2014, initially assigned to Judge Richard G. Stearns. On August 11, 2014, she sought limited pre-trial discovery related to Prudential’s alleged conflict of interest. Judge Stearns denied this request on October 16, 2014, citing a lack of evidence of irregularities or bias in the claims determination. The parties cross-moved for summary judgment on February 10, 2015, with subsequent filings made in March 2015. The action was reassigned to a different judge on March 24, 2015, who has since reviewed all briefs and the administrative record.
Ms. Cowern has received treatment for her abdominal condition since the 1990s from at least ten medical professionals, including gastroenterologists and rheumatologists. She also consulted an occupational therapist and a vocational consultant for her disability claim and has visited emergency rooms multiple times. In July 2011, she underwent exploratory laparoscopic surgery, but a definitive diagnosis remains elusive. Medical professionals retained by Prudential, including six board-certified physicians and two registered nurses, reviewed her records without conducting physical examinations. They suggested she might be experiencing “narcotic bowel syndrome” due to prolonged morphine use, with Prudential's Medical Director noting that narcotic use complicates her clinical picture.
Prudential engaged FactualPhoto for covert surveillance of Ms. Cowern in January and March 2010, and the footage was evaluated by various medical professionals who reached different conclusions regarding her ability to work in a sedentary role. While both parties agree that her role as a programmer/analyst is sedentary, opinions diverged on her capacity to fulfill these duties. Notably, Dr. Liebermann, a Prudential-retained gastroenterologist, expressed doubts about her ability to work full-time due to her symptoms and narcotic dependence.
The administrative record, exceeding 2,000 pages, contains conflicting opinions. Dr. Joseph Harrington, Ms. Cowern’s primary care physician since 2002, documented her chronic abdominal pain and episodes of diarrhea and lethargy in November 2009, asserting her long-term disability status and inability to maintain employment due to her condition.
On September 16, 2010, Dr. Harrington indicated that most physicians involved in Ms. Cowern's care believe she has a variant of inflammatory bowel disease, supported by CT scans showing colonic inflammation, colonoscopy findings of hemorrhagic colitis, and consistent biopsy results. In an update on April 4, 2012, he described her exacerbations characterized by frequent, often bloody diarrhea, fever, severe fatigue, and loss of appetite. Objective findings included elevated white blood cell counts and a CT scan revealing thickening of the right colon. He concluded that Ms. Cowern would likely not be able to return to her previous job without significant improvement in her condition.
Dr. Steven Fine, Ms. Cowern’s gastroenterologist, wrote on June 1, 2012, acknowledging a lack of clear diagnosis but stating that her issues are multi-systemic and inflammatory in nature. He asserted that her case aligns with some variant of inflammatory bowel disease affecting her bowel, joints, and skin. He countered Prudential's claims about the absence of objective findings, noting evidence of leukocytosis, bowel inflammation from biopsies and CT scans, and inflammatory changes observed by her rheumatologist in her joints. He emphasized the importance of considering self-reported symptoms alongside objective findings.
Dr. Norton Greenberger, another gastroenterologist, expressed in a letter dated May 3, 2011, that Ms. Cowern’s symptoms could be attributed to narcotic bowel syndrome due to her long-term morphine use, which can cause alternating diarrhea and constipation. He noted that extensive evaluations by Dr. Fine and Dr. Harrington had ruled out unusual causes of abdominal pain, asserting no evidence of inflammatory bowel disease, and suggested that she might have mast cell activation syndrome.
Dr. Eileen Winston, Ms. Cowern’s rheumatologist from at least 2009 to 2011, documented on October 1, 2009, that Ms. Cowern had experienced recurrent attacks over the past ten years characterized by malaise, abdominal pain with nausea, diarrhea, skin lesions consistent with erythema nodosum, and low-grade fevers often accompanied by chills. She reported severe abdominal pain that could last from weeks to months.
Dr. Winston diagnosed Ms. Cowern with potential Crohn’s disease and noted acute abdominal pain, fever, and skin lesions consistent with erythema nodosum, while dismissing significant mental health issues. In a report from August 9, 2011, he observed her ongoing symptoms of febrile syndrome, worsening stomach upset, severe diarrhea, and stable fevers.
Dr. Bonnie Bermas examined Ms. Cowern on May 12, 2009, and documented her severe intermittent abdominal pain requiring emergency care, diarrhea, nausea, vomiting, and occasional constipation. She indicated the possibility of inflammatory bowel disease but found no rheumatologic disorder explaining the symptoms.
Dr. Jonathan Coblyn assessed Ms. Cowern on March 14, 2012, noting abdominal tenderness, right knee swelling, and limited cervical spine motion. He diagnosed her with an undiagnosed febrile syndrome, abdominal pain, rash, and arthritis, while being uncertain about inflammatory bowel disease. In a follow-up on December 19, 2012, he observed subtle swelling in her hands and a trace effusion in her right knee.
Gail Breeze, an occupational therapist, evaluated Ms. Cowern on April 1, 2013, concluding that she lacked the physical capacity for her role as a principal program analyst, performing below a sedentary level. Breeze highlighted Ms. Cowern's significant bathroom needs during the evaluation.
James Parker, a vocational consultant, conducted two assessments in July 2012 and August 2013, determining that Ms. Cowern was totally disabled from work suitable to her qualifications, with a prognosis of remaining so in the foreseeable future.
Mr. Parker evaluated a video surveillance report commissioned by Prudential, asserting that the report reflects inactivity rather than activity indicative of Ms. Cowern's capacity to work. He emphasized that video surveillance cannot accurately assess her fluctuating symptoms and that her activities align with her medical records. Parker concluded that the surveillance data lacks validity for predicting her work capability. In his follow-up assessment on August 9, 2013, he determined that Ms. Cowern is unable to fulfill the essential functions of her occupation or any other gainful employment due to documented limitations, leading to her classification as totally disabled by the Social Security Administration (SSA) since August 2010.
Parker further analyzed a Functional Capacity Evaluation (FCE) conducted by Ms. Breeze, concluding that the documented deficits completely preclude Ms. Cowern from performing her role as a Programmer Analyst or any job for which she is qualified. Dr. David Dickison, a board-certified occupational medicine physician, initially noted in 2009 that Ms. Cowern's inflammatory bowel disease symptoms seemed short-lived and questioned the continuity of her condition since April 2009 due to insufficient recent medical records. After consulting with Ms. Cowern's primary care physician, Dr. Harrington, and reviewing additional records, Dr. Dickison later affirmed that Ms. Cowern lacks sustained capacity for work, attributing her impairment primarily to self-reported symptoms, but recognized Dr. Harrington's concerns about her condition. His assessments contributed to Prudential's initial approval of long-term disability benefits in October 2009.
Dr. Richard Day, Prudential's Vice-President and Medical Director, conducted two assessments of Ms. Cowern's medical records. In his first review on February 17, 2010, he identified her chronic abdominal pain as self-reported and lacking objective medical findings. He suggested a potential behavioral condition contributing to her limitations, concluding that her inability to work was not medically justified. He expressed a guarded prognosis for improvement due to the long duration of symptoms and the absence of a definitive diagnosis, recommending a senior review of her claim.
In his second assessment on September 14, 2010, Dr. Day considered updated records and surveillance footage, which showed Ms. Cowern engaging in normal activities like driving and walking. He noted her complicated medical history lacked a unifying diagnosis, with evaluations yielding unremarkable results. Consequently, Prudential informed Ms. Cowern on September 20, 2010, that her long-term disability (LTD) benefits would terminate after 24 months.
Dr. Elena Antonelli, a board-certified occupational medicine physician, reviewed Ms. Cowern's records during two internal appeals, providing a detailed report on June 21, 2012. She and gastroenterologist Dr. Vuppalanchi concluded that Ms. Cowern had a complicated medical history but minimal objective findings to support ongoing impairment. Surveillance footage confirmed her functionality, as she was observed driving and entering stores. Dr. Antonelli opined that Ms. Cowern could likely perform light-duty work, noting that while she may continue to experience symptoms, there was no evidence of total impairment from all productive work. A follow-up review on July 23, 2012, considered additional medical records from Ms. Cowern's treating gastroenterologist.
Dr. Antonelli maintained that the new documentation did not change her previous assessment of Ms. Cowern's condition, highlighting a lack of significant physical findings and intermittent symptoms that did not support a claim of substantial impairment. In a multidisciplinary review with gastroenterologist Dr. Liebermann, she noted the complexity of the case, the absence of a clear diagnosis, and concerns about the extensive treatments undertaken without definitive findings. Dr. Antonelli indicated that the claimant was capable of sedentary work and that her restrictions were likely permanent due to a lack of improvement and no clear diagnosis. Prudential denied both of Ms. Cowern's internal appeals based on these findings.
Dr. Vuppalanchi, also part of the initial appeal panel, echoed Dr. Antonelli's conclusions, stating that there was no objective evidence to restrict Ms. Cowern from sedentary work and that her symptom severity appeared largely self-reported. He referenced surveillance footage showing her functioning without limitations.
In a subsequent report, Dr. Liebermann agreed with Dr. Antonelli, identifying a functional gastrointestinal disorder potentially exacerbated by narcotic use, which could account for Ms. Cowern's abdominal pain episodes.
Ms. Cowern has a history of numerous emergency room visits, hospitalizations, and diagnostic evaluations, including a diagnostic laparoscopy that revealed no abnormalities. Dr. Liebermann diagnosed her with a pain-predominant form of irritable bowel syndrome and narcotic bowel syndrome, asserting that the extensive medical records support this diagnosis rather than inflammatory bowel disease, which he deemed unlikely. He indicated that there are no gastrointestinal-related physical restrictions or limitations from October 30, 2011, onward, and that she can perform various physical activities without restrictions. However, he expressed doubt about her ability to return to full-time work due to the intensity of her symptoms and her reliance on narcotics. Surveillance footage was deemed unhelpful. An addendum from May 13, 2013, confirmed no new gastrointestinal restrictions or limitations. Dr. Wadhwa, Prudential’s Medical Director, reviewed Ms. Cowern’s medical records and noted inconsistencies in her reported abdominal pain, stating there is no clear pattern or consistent objective documentation of her symptoms. He concluded that her pain symptoms lack corroboration by consistent medical findings.
The claimant has been using narcotics long-term, leading to dependence, which may complicate her clinical picture. There is no evidence in the records that this issue has been addressed. Medical opinions indicate that the abdominal pain reported lacks a concrete physical cause and that narcotic use is voluntary. Consequently, the records do not demonstrate a medical basis for work restrictions related to these symptoms. The medical documentation fails to consistently show how the claimant is impaired from performing a sedentary job. The symptoms described, including abdominal pain, joint pain, and skin rashes, lack clear and consistent documentation, and no unifying diagnosis has been established. As such, there are no documented impairments that necessitate work restrictions.
Prudential engaged Frances Grunden, a vocational consultant, to assess the claimant's medical records for the second appeal. Based on her analysis, she concluded that the physical demands of the claimant's occupation fall within her capabilities as indicated by the second multidisciplinary panel.
The discussion section outlines the standard of review for benefit denials under ERISA, highlighting that a de novo standard applies unless the plan grants discretion to the administrator. In this case, Prudential's plan gives the insurance company sole discretion to interpret terms, making the standard for judicial review arbitrary and capricious. The court will assess whether Prudential's decision is plausible based on the overall record and supported by substantial evidence.
The First Circuit emphasizes that while there is a deferential standard of review for plan administrators' decisions, this does not equate to a lack of review. A plan administrator must provide reasoned determinations supported by substantial evidence to withstand scrutiny. Courts will consider various case-specific factors to assess whether there has been an abuse of discretion in benefit denials, employing a "combination-of-factors method of review" as established by Supreme Court precedent.
In the context of ERISA, summary judgment differs from typical civil cases, as the district court acts more like an appellate tribunal, evaluating the reasonableness of administrative decisions without taking new evidence. The court must determine if the evidence, viewed favorably for the non-moving party, could support a rational decision by the plan administrator. Ms. Cowern is challenging Prudential's termination of her long-term disability (LTD) benefits and its subsequent denials, claiming these actions were arbitrary and capricious, specifically alleging misinterpretation and improper application of the SRS limitation in the LTD plan.
Prudential's handling of Ms. Cowern's claim for long-term disability (LTD) benefits is contested on two main points: selective reliance on medical records and the interpretation of the Self-Reported Symptoms (SRS) limitation. Ms. Cowern contends that Prudential improperly ignored supportive medical evidence while emphasizing aspects that undermine her claim. The Court finds merit in her second claim but not the first.
Prudential asserts it correctly applied the SRS limitation, which restricts benefits for disabilities primarily based on self-reported symptoms to a 24-month period. These self-reported symptoms are defined as manifestations of a condition reported by the patient that cannot be objectively verified through standard medical procedures. Ms. Cowern argues that Prudential's application of the SRS limitation was inconsistent across the internal appeals process and litigation, citing four differing interpretations from Prudential and its medical reviewers. She highlights discrepancies in the language used in Prudential's termination and denial letters regarding her condition.
Despite her arguments, the Court concludes that Prudential did not abuse its discretion in interpreting and applying the SRS limitation, referencing its internal guidelines that prioritize the manifestations of symptoms over diagnoses. Ms. Cowern's claim of inconsistency draws on the precedent set in Caola v. Delta Air Lines, Inc., which states that consistency in interpretation is key to determining reasonableness.
Prudential contends that the plaintiff's argument is flawed as it emphasizes form over substance, maintaining that it denied her claim for benefits based on the self-reported nature of her symptoms. The Court reviewed discrepancies in the wording of denial letters and medical evaluations but found these did not constitute an abuse of discretion. Ms. Cowern asserts that Prudential and its physicians unduly emphasized the absence of a definitive diagnosis, contrary to the LTD Plan's language and Prudential’s guidelines. Courts assess whether an interpretation of a plan is reasonable, particularly considering if it contradicts the plan's clear language. Administrators cannot deny benefits solely due to the lack of a definitive diagnosis; any inconsistent interpretation by trustees may be deemed arbitrary and capricious.
While the Court noted that certain statements from Prudential suggested an undue focus on the absence of a diagnosis, it ultimately concluded that Prudential did not improperly prioritize this absence in its decision-making. Neither Prudential nor its physicians claimed that the absence of a diagnosis was the primary reason for denying benefits. The Court will not restrict Prudential from considering the lack of a diagnosis, especially when it accurately reflects Ms. Cowern’s medical records. However, the Court remands the case to Prudential for other errors deemed an abuse of discretion, instructing Prudential to interpret the SRS limitation consistently with the LTD Plan and its internal guidelines.
Additionally, Prudential's reliance on surveillance footage of Ms. Cowern is mentioned as part of its evidence evaluation process.
FactualPhoto conducted surveillance on Ms. Cowern over nine days across two periods: January 6-9, 2010, and March 11-15, 2010. The surveillance produced less than seven minutes of footage, primarily showing the exterior of her residence, with Ms. Cowern observed leaving her house on only four occasions. On those days, she was seen engaging in minimal activities such as driving to a Dunkin Donuts, visiting a medical office, and making brief stops at a bank and auto services center. On five days, she was not seen leaving her home at all. Prudential acknowledged that it relied on this surveillance in reviewing Ms. Cowern’s claim and noted in its termination letter that the footage depicted her driving and walking without difficulty. Ms. Cowern argues that Prudential's reliance on the footage was unreasonable, as it neither contradicted her self-reported symptoms nor demonstrated her capacity to perform substantial work tasks. Prudential defends its position by referencing the First Circuit's decision in Cusson v. Liberty Life Assurance Company of Boston, where the court allowed consideration of surveillance footage that contradicted the claimant's reported limitations. However, the activities observed in Ms. Cowern's case differed from Cusson's, as she did not claim an inability to perform the actions seen in the surveillance.
Ms. Cowern's activities, including leaving her house, getting in and out of a car, and walking short distances, confirm her generally housebound lifestyle rather than contradicting her disability claim. The surveillance footage reviewed does not conclusively disprove her claims of extreme pain and abdominal symptoms, which impede her ability to perform sedentary work. Prudential's reliance on this footage was deemed arbitrary and capricious.
Furthermore, Prudential was criticized for selectively interpreting Dr. Liebermann’s opinions, ignoring evidence that supported Ms. Cowern's disability claim while highlighting only those parts that justified terminating her coverage. Dr. Liebermann expressed doubts about Ms. Cowern's ability to work full-time due to severe symptoms and her use of narcotics, indicating a diagnosis of pain-predominant irritable bowel syndrome and narcotic bowel syndrome. His reports contained significant statements indicating functional gastrointestinal disorders, all of which were omitted in Prudential's final denial letter dated August 29, 2013. This selective reliance on Dr. Liebermann's opinion was improper and failed to consider the totality of evidence regarding Ms. Cowern’s claim for long-term disability benefits.
An administrator must weigh competing evidence without selectively choosing only favorable evidence while disregarding significant contrary evidence. Prudential's failure to consider Dr. Liebermann's statements supporting Ms. Cowern's claim was deemed arbitrary and capricious. Ms. Cowern argues that Ms. Grunden's vocational assessment was flawed due to its reliance on an incomplete record, primarily based on external medical reviews conducted by Prudential's physicians. The Court notes ambiguity regarding the records provided to Ms. Grunden but proceeds with the understanding that only external reviews were available to her. Ms. Grunden concluded that the physical demands of Ms. Cowern's occupation were within the capacity indicated by a multidisciplinary panel. Prudential's final denial letter referenced Ms. Grunden’s conclusions but failed to provide her with a complete record, which constitutes an abuse of discretion. The Court highlights that not providing all relevant evidence to independent experts reflects arbitrary and capricious decision-making. Discrepancies in the medical records available for review raise concerns about whether the administrator manipulated the record to influence the outcome. Without justification for the incomplete record provided to Ms. Grunden, the possibility that Prudential selectively presented documents to support a conclusion that favored its position cannot be dismissed. Furthermore, Prudential rejected Mr. Parker's vocational reports, which were based on a comprehensive review of Ms. Cowern's medical records, indicating further abuse of discretion.
The report evaluates vocational assessments that Prudential deems unsupported by medical data, specifically regarding Ms. Cowern's claim. Prudential's denial letters reiterate that Mr. Parker's conclusions lack medical backing and are irrelevant to the self-reported conditions limitation. Ms. Cowern contends that Prudential's selective acceptance of Ms. Grunden’s report over Mr. Parker’s indicates bias in the review process. The court clarifies that Prudential is not obligated to favor a claimant's vocational consultant's opinion based solely on the acceptance of its own consultant’s report. Under ERISA, benefit plan administrators must provide clear and specific reasons for denying disability benefits, which Prudential failed to do regarding Mr. Parker's conclusions, rendering its rejection arbitrary and capricious. Additionally, Ms. Cowern argues that Prudential's disregard for her awarded Social Security Disability Income (SSDI) benefits was similarly arbitrary. The only references to her SSDI status in the record came from Mr. Parker’s assessments, which acknowledged her total disability status as determined by the SSA.
The consultant has extensive experience with Social Security hearings and indicates that to qualify for Social Security Disability Insurance (SSDI) benefits, an individual must be considered totally disabled from all work above the sedentary level. Ms. Cowern was awarded SSDI benefits effective August 2010, according to an SSA decision. Although Mr. Parker reviewed a notice of award dated September 15, 2012, that document is missing from the record. The court notes that while the SSDI award decision is not binding on a claims administrator, it remains relevant evidence of disability that cannot be disregarded. Prudential argued it could not consider Ms. Cowern's SSDI award due to the absence of the formal award letter in the administrative record. The court disagreed, stating that the mere fact of her SSDI award is sufficient for consideration, and Prudential was obligated to inform Ms. Cowern of the missing letter and allow her to provide it and any other relevant information. Prudential’s failure to address the SSDI award in its final decision and to give Ms. Cowern an opportunity to submit the award letter was deemed arbitrary and capricious. Ultimately, the court found that while evidence of Ms. Cowern's disability is not overwhelming enough to grant summary judgment in her favor, significant flaws exist in Prudential’s decision-making process, resulting in a denial of summary judgment for Prudential as well. Both motions for summary judgment were denied, and the case was remanded to Prudential for further proceedings.
Pages are numbered from PRU-77212-000413-000001 to PRU-77212-000413-002294, with citations in this opinion formatted as "R." followed by the page number. Key definitions related to the LTD Plan are provided but are not material to the cross-motions for summary judgment. A 24-month limitation applies to disabilities from mental illness. Internal guidelines emphasize the goal of a fair review of claims while allowing for discretion in their application. Dr. Robert Canning found no significant medical issues in Ms. Cowern's case, and vocational consultant James Parker deemed surveillance footage irrelevant to her claim. Various doctors, including Dr. Day and Dr. Antonelli, consistently concluded that new information did not change their assessments of Ms. Cowern’s impairments. The case also highlights the conflict of interest inherent in Prudential's dual role as both claims administrator and underwriter, a concern previously denied by Judge Stearns due to lack of evidence of bias or procedural irregularities. Prudential's conflict of interest is not further examined in this opinion. Dr. Antonelli noted that surveillance footage indicated Ms. Cowern was highly functional, capable of driving and walking.
Surveillance footage revealed Ms. Cowern engaging in activities such as driving and walking without difficulties, as noted by Dr. Day and Dr. Vuppalanchi, who concluded that she faced no restrictions based on the videos. Dr. Liebermann found the investigation agent's observations to lack significant detail. The Court indicated that it would have remanded the case even if Prudential had provided complete medical records due to other identified errors. Ms. Cowern alleged that Prudential improperly rejected a Functional Capacity Evaluation (FCE) by Ms. Breeze from April 2013; however, the Court disagreed. Unlike Prudential's inadequate rationale for dismissing Mr. Parker's vocational reports, Prudential and its physicians presented valid reasons for doubting Ms. Breeze's evaluation. In its denial letter, Prudential cited Dr. Wadhwa's assessment that the FCE lacked validity and reliability, relying on self-reported symptoms and failing to document impairments objectively, aside from grip strength. Dr. Antonelli corroborated this by stating the FCE primarily reflected self-reported limitations without clear objective measurements. Both Prudential and its reviewers provided sufficient justification for discrediting the FCE. Given the deferential standard of review, the Court upheld Prudential's decision and found no abuse of discretion regarding the weight assigned to the FCE.
