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12, 2000) (unpublished)-This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.