495 F. App'x 694
6th Cir.2012Background
- McCollum suffers from chronic lumbar pain with spinal stenosis and related conditions, and has been unable to work since 1996.
- LINA, issuing LTD and WOP policies, initially approved benefits but later reviewed and denied after a September 2006 PAA and subsequent TSAs identifying two light-work jobs.
- Dr. Kellman repeatedly opined McCollum could perform sedentary work; later PAAs and other doctors described more limited abilities but without new examinations.
- LINA relied on a May 2007 TSA and an independent medical reviewer, Dr. Popovich, who opined McCollum could work in a light-duty capacity.
- McCollum appealed, submitted additional medical evidence, and LINA reaffirmed denial in 2008 and 2009; McCollum sued under ERISA seeking LTD and WOP benefits and penalties for SPD non-production.
- The district court granted summary judgment to LINA on main disability issues but awarded nominal civil penalties for failure to provide the SPD; the court remanded for a full and fair review.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Did LINA correctly terminate LTD and WOP under ERISA de novo review? | McCollum contends treating physicians’ opinions show disability; de novo review should credit medical evidence supporting disability. | LINA argues evidence supports only light work; TSA identified two light-duty jobs; deference not due to treating physician rule in ERISA. | Remand for full and fair review; not a final entitlement determination. |
| Should the district court have given weight to treating physicians versus non-examining reviewers? | Treating physicians’ opinions are objective evidence of disability. | Nord allows no treating-physician rule; rely on reviewing doctors and VA/TSA. | Court notes concerns about lack of exam and reliance on non-examining reviewers; remand for thorough evaluation. |
| Is Doncasters liable for the statutory penalty as successor to Fabristeel? | Doncasters should bear penalties as a successor due to control/continuation. | Only plan administrator (Fabristeel) liable; Doncasters not a successor under ERISA here. | Doncasters not liable; Fabristeel alone liable for the penalty. |
| Was the nominal penalty for SPD non-production appropriate? | Penalty should reflect failure to provide SPD timely. | Delay was minor; limited prejudice; nominal penalty appropriate. | Nominal penalty affirmed as not an abuse of discretion. |
| What is the proper remedy given an improper denial and incomplete administrative record? | Remand to correct procedural defects and reassess disability evidence. | Maintain denial based on current evidence; no retroactive benefits required. | Remand to the plan administrator for a full and fair review. |
Key Cases Cited
- Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003) (treating-physician rule not extended to ERISA decisions)
- Kramer v. Paul Revere Life Ins. Co., 571 F.3d 499 (6th Cir. 2009) (behavior of plan in disability determinations; context for Kramer analysis)
- Calvert v. Firstar Fin., Inc., 409 F.3d 286 (6th Cir. 2005) (suspicious file-review when plan reserves right to exam)
- Helfman v. GE Group Life Assur. Co., 573 F.3d 383 (6th Cir. 2009) (concerns about lack of examination and thoroughness in benefits determinations)
- Kalish v. Liberty Mutual/Liberty Life Assur. Co., 419 F.3d 501 (6th Cir. 2005) (importance of physical examination in evaluating disability claims)