517 F. App'x 475
6th Cir.2013Background
- Neaton sought ERISA LTD benefits after ceasing work on Sep 6, 2007; benefits were awarded Dec 5, 2007 and terminated July 15, 2008.
- Neaton has Gorlin’s syndrome causing recurrent and increasingly aggressive skin cancers requiring Mohs surgeries and curettage/cautery procedures.
- Hartford relied on a non-examining consultant (Dr. Petronic-Rosic) for recovery-time and on an in-house vocational analyst for absenteeism assumptions.
- Hartford’s final decision rested on a v. expert’s assertion that Neaton could work from home with 3–4 days bi-monthly absenteeism; Neaton’s treating physician’s input on home-work recovery was not sought.
- District court granted judgment on the pleadings for Hartford; the Sixth Circuit reverses, reinstating benefits with retroactive adjustment.
- The court emphasizes that treating-physician input and complete, data-backed vocational analysis are required for a principled ERISA decision.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Recovery time basis for disability decision | Non-examining opinion underestimates recovery time | Non-examining opinion adequate, corroborated by file review | Reversal; reliance on non-examining opinion insufficient |
| Frequency of surgeries and missed work | Frequency increased in 2008; averaging over pre-disability period misstates impact | Employer could accommodate without detailed period-specific data | Reversal; incorrect averaging renders evidence unreliable |
| Level of absenteeism deemed tolerable | No evidence Navy Federal would tolerate 3–4 days bi-monthly | Common employer practice supports accommodation | Reversal; reliance on in-house opinion without data inadequate |
| Adequacy of vocational analysis | Vocational analysis lacked data and relied on speculative absences | Analysis based on job description and home-work feasibility | Reversal; need for complete, data-backed support for conclusions |
Key Cases Cited
- Kalish v. Liberty Mut. Grp., 419 F.3d 501 (6th Cir. 2005) (credibility and medical evidence quality in ERISA review)
- Cont’l Cas. Co. v. Hartford Life Ins. Co., 450 F.3d 263 (6th Cir. 2006) (reliance on non-examining physician requires caution)
- McDonald v. W.-S. Life Ins. Co., 347 F.3d 161 (6th Cir. 2003) (failure to provide reasoned explanation supports reversal)
- Moon v. UNUM Provident Corp., 405 F.3d 373 (6th Cir. 2005) (skepticism warranted when plan relies on employer-doctor)
- Killian v. Healthsource Prov’d Admin’rs, 152 F.3d 514 (6th Cir. 1998) (de novo review for certain ERISA determinations; emphasis on principled reasoning)
- Spangler v. Lockheed Martin Energy Sys., Inc., 313 F.3d 356 (6th Cir. 2002) (ultimate issue is whether denial was arbitrary and capricious)
- Glenn v. Metro. Life Ins. Co., 461 F.3d 660 (6th Cir. 2006) (retroactive reinstatement favored where improper termination)
- Elliott v. Metro. Life Ins. Co., 473 F.3d 613 (6th Cir. 2006) (remedy for arbitrary termination may be retroactive benefits)