Palmer v. Prudential Insur. Co., 2000 U.S. App. LEXIS 11341 (4th Cir. May 12, 2000) (unpublished)-This court affirmed the summary judgment against Palmer's claim that the plan wrongfully terminated her long-term disability benefits after almost two years.  Prudential retained an independent physician, Dr. Edward Doyle, to evaluate Palmer's condition.  Dr. Doyle determined that Palmer was no longer totally disabled.

            Applying the modified abuse of discretion standard applicable to the benefits decisions of plan administrators who act also as plan insurers, the district court properly concluded that it could reply upon Dr. Doyle's assessment if there was "nothing more than a difference of opinion" between her physician and the one Prudential hired.  In this case, Palmer's doctor testified that although he did not agree with Dr. Doyle's conclusions, he did agree that they were not unreasonable or outrageous.

            As for Palmer's claim that the plan did not give her a full and fair review, the district court properly held that the Palmers waived their right to administrative review by filing suit before the expiration of the 60-day review period.

 

Click Here!