In the Eleventh Circuit, the plan administrator's decision is analyzed under one of three standards of review. Williams v. BellSouth Telecomms., Inc., 373 F.3d 1132, 1134 (11th Cir. 2004)); Crume v. Metro. Life Ins. Co., 417 F. Supp. 2d 1258, 1272 (M.D. Fla. 2006); Smorto v. 3DI Techs., Inc., 393 F. Supp. 2d 1304, 1313 (M.D. Fla. 2005)). The Court adopts a "de novo" standard when the pension plan does not grant discretion to the administrators to make claims decisions.
The court's final adjudication of Plaintiffs LTD claim should be pursuant to a Motion for Final Judgment under Rule 52, Federal Rules of Civil Procedure, based on review of the administrative record, rather than a Rule 56 Motion for Summary Judgment. Smorto v. 3DI Techs., Inc., 393 F.Supp.2d 1304, 1313 (M.D.Fla.2005). The district court reviews ERISA benefit determinations more as an appellate tribunal reviewing an administrative decision than a trial court, and the usual rules of summary judgment do not apply.
Smorto v. 3DI Techs. Inc., 393 F.Supp.2d 1304, 1306 n.5 (M.D. Fla. 2005).
It is also described as "the conversion of an emotional, mental or psychosocial problem to a physical complaint." Smorto v. 3DI Techs. Inc., 393 F. Supp. 2d 1304, 1306 n.5 (M.D. Fla. 2005). In this context, "somatization" and "conversion" appear to be synonymous terms.
Malingering is pretending or exaggerating an incapacity or illness so as to avoid duty or work. Smorto v. 3DI Technologies, Inc., 393 F.Supp.2d 1304, 1306 n. 5 (M.D.Fla.2005) (citations omitted); see also Diagnostic and Statistical Manual of Mental Disorders 739 (4th ed. 2000) (defining malingering as “the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs”). On November 18, Dr. Thaggard agreed, stating, “I'm not really clear why he is having that sort of pain.... [W]ill try to wean down his pain medications.”
Dr. Mittenberg's evaluation found that Plaintiff was malingering, and Dr. McCarthy's evaluation found that she was not. Malingering is "pretending or exaggerating an incapacity or illness so as to avoid duty of work." Smorto v. 3DI Technologies, Inc., 393 F. Supp. 2d 1304, 1307 n. 5 (M.D. Fla. 2005). To resolve this discrepancy, Defendant had both evaluations analyzed by an independent consulting neuropsychologist, Dr. Jay. Dr. Jay found that Dr. Mittenberg's evaluation was "consistent with the usual expectations for a comprehensive neuropsychological evaluation of disability determination quality."
See Providence v. Hartford Life Acc. Ins. Co., 357 F. Supp. 2d 1341, 1342 n. 1 (M.D. Fla. 2005) (citing Bendixen) (Whittemore, J.); Smorto v. 3DI Techs., Inc., 393 F. Supp. 2d 1304, 1313 (M.D. Fla. 2005) (citing Providence and Bendixen) (Presnell, J.); Stenner-Muzyka v. Unum Life Ins. Co. of Am., No. 8:04-cv-984-T-17TBM, 2005 WL 1610708 *3 (M.D. Fla. Jul. 7, 2005) (citing Providence and Bendixen) (Kovachevich, J.). Although the First Circuit did not qualify the foregoing quote, this Court interprets the appellate court's statements as applying to those cases where a plan administrator has been granted discretion, rather than to those subject to de novo review.
See Providence v. Hartford Life Acc. Ins. Co., 357 F. Supp. 2d 1341, 1342 n. 1 (M.D. Fla. 2005) (citing Bendixen) (Whittemore, J.); Smorto v. 3DI Techs., Inc., 393 F. Supp. 2d 1304, 1313 (M.D. Fla. 2005) (citing Providence and Bendixen) (Presnell, J.); Stenner-Muzyka v. Unum Life Ins. Co. of Am., No. 8:04-cv-984-T-17TBM, 2005 WL 1610708 *3 (M.D. Fla. Jul. 7, 2005) (citing Providence and Bendixen) (Kovachevich, J.). Although the First Circuit did not qualify the foregoing quote, this Court interprets the appellate court's statements as applying to those cases where a plan administrator has been granted discretion, rather than to those subject to de novo review.
The Court's independent research has revealed cases in which a Prudential policy with language similar to the limitation of benefits section has been at issue. In Smorto v. 3DI Technologies, Inc., No. 6:04cv315ORL31JGG, 2005 WL 1227713 (M.D. Fla. May 23, 2005), however, the plaintiff did not contest the application of the arbitrary and capricious standard of review of what looks to be a Prudential plan with similar language in the limitation of benefits section for mental disorders. In Luton v. Prudential Ins. Co. of Amer., 88 F.Supp.2d 1364 (S.D. Fla. Mar. 23, 2000), the Prudential policy at issue contained the identical provision with respect to limiting LTD benefits for mental disorders.