Kevin McCann v. Unum Provident
907 F.3d 130
3rd Cir.2018Background
- Dr. Kevin McCann, a board‑certified interventional radiologist, purchased a supplemental long‑term disability (LTD) policy issued by Provident through a Henry Ford Hospital residents’ program (RSDP); premiums were paid by participants but Henry Ford selected Provident as the plan provider and limited eligibility.
- McCann stopped working in March 2008 after diagnoses including a mildly dilated ascending aortic aneurysm, hypertension, obesity, and obstructive sleep apnea; physicians imposed restrictions (e.g., avoid heavy lifting, reduce stress, tight BP control). Provident initially paid benefits, then reassessed and terminated total disability payments in December 2009.
- Provident’s reassessment relied on medical reviews and CPT code analysis suggesting McCann performed mostly diagnostic radiology (sitting/reading films) before disability; Provident concluded he could work up to 50 hours/week with restrictions and thus was not totally disabled.
- McCann sued under ERISA seeking past due and reinstated LTD benefits; the district court held the policy was governed by ERISA (safe harbor inapplicable) and granted summary judgment for Provident after de novo review.
- On appeal, the Third Circuit affirmed ERISA’s applicability (finding employer endorsement of the RSDP) but vacated the merits decision: it held McCann’s occupation must be treated as his recognized specialty (interventional radiology), found the record disputed whether his conditions prevented him from performing the specialty’s substantial and material duties (including on‑call/nights and procedures), and remanded for further proceedings, including consideration of residual disability.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the RSDP policy is governed by ERISA (safe harbor applies) | McCann: safe harbor applies because program was voluntary, no employer contributions, and employer merely allowed publicity/payroll deduction | Provident: Henry Ford endorsed the program, selected insurer, and set eligibility—so safe harbor fails | Held: Safe harbor inapplicable; Henry Ford’s selection/encouragement constituted endorsement, so ERISA governs |
| Proper definition of "occupation" under the policy | McCann: policy limits occupation to recognized specialty—interventional radiology—so evaluation must be against that specialty | Provident: occupation is what he actually performed pre‑disability (primarily diagnostic radiology per CPTs) | Held: Occupation is interventional radiology (specialty controls); interventional duties cannot be disregarded merely by billing/unit counts |
| What are the "substantial and material duties" of that occupation | McCann: include performing interventional procedures and night/weekend on‑call duties | Provident: material duties are primarily diagnostic reading; interventional work was a small part and not material | Held: Substantial and material duties include interventional procedures and on‑call/night work; billing percentages are not dispositive |
| Whether McCann’s medical conditions prevented performance of those duties (entitling him to Total or Residual Disability) | McCann: treating physicians state he is permanently/fully disabled from interventional duties and on‑call work | Provident: independent/consulting reviewers concluded his aneurysm and BP were stable and he could perform modified/light/interventional duties or non‑interventional radiology | Held: Disputed material facts exist about functional limitations; remanded to determine if conditions preclude performing substantial and material duties; remanded also to consider residual disability (exhaustion excused) |
Key Cases Cited
- Menkes v. Prudential Ins. Co. of Am., 762 F.3d 285 (3d Cir. 2014) (analyzing when related policies form an ERISA plan and the safe harbor’s limits)
- Lasser v. Reliance Standard Life Ins. Co., 344 F.3d 381 (3d Cir. 2003) (defining "regular occupation" by the insured’s actual pre‑disability work)
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) (standard of review for ERISA plan benefit denials: arbitrary and capricious vs. de novo)
- Johnson v. Watts Regulator Co., 63 F.3d 1129 (1st Cir. 1995) (discussing employer involvement and safe harbor endorsement analysis)