Rowe v. United of Omaha Life Insurance Company (TV1), 3:15-cv-00256

Background

Plaintiff Dawn Rowe (former commercial property manager) stopped working November 21, 2013 and applied for long‑term disability (LTD) benefits under an ERISA plan issued by United of Omaha Life Insurance Company.
The policy defines “disability” as inability to perform at least one material duty of the insured’s Regular Occupation (as performed in the national economy) and vests the insurer with discretionary authority to determine benefits.
Medical records (primary care and pain management) document chronic low‑back pain, prior lumbar fusion, ongoing narcotic and muscle‑relaxant use, limited range of motion, and nurse‑practitioner opinions restricting prolonged sitting/standing and requiring position changes.
The insurer obtained vocational and medical file reviews concluding the job maps to the DOT occupation “Property Manager” (light work) and that medical evidence did not support restrictions precluding performance; insurer denied benefits initially and on appeal, relying on peer review and vocational analysis.
Plaintiff appealed administratively and then filed this ERISA action challenging the denial and the administrative process; Magistrate Judge recommends remand for further reasoned explanation rather than an award of benefits.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether insurer’s denial was reasonable under the arbitrary-and-capricious standard	Rowe: she cannot perform at least one material duty of her Regular Occupation as performed in the national economy (needs sit/stand accommodations; medical restrictions prevent duties).	United: job is light and can accommodate restrictions; medical record and peer review do not support disabling limitations.	Remand recommended — record unclear whether insurer credited medical limitations or explained why those limitations do not preclude material duties; decision not shown to be the product of a sufficiently reasoned process.
Whether insurer properly relied on non‑examining peer reviewer and vocational reports	Rowe: reliance on non‑examining reviewer and vocational experts was arbitrary, and she lacked chance to address peer review.	United: reviews from consultants are proper and were part of the administrative record; requested additional records plaintiff did not provide.	Remand recommended — court did not find the use of consultants per se improper but required the insurer to state which opinions it credited and why.
Whether a conflict of interest (insurer is payor) altered the standard of review	Rowe: conflict of interest should be considered and may extend skepticism to hired reviewers.	United: conflict does not change the deferential standard.	Court acknowledged conflict exists and considered it as a factor but applied arbitrary-and-capricious review.
Appropriate remedy (award benefits v. remand)	Rowe: seeks benefits and continuing payments.	United: urges denial be upheld.	Remand to administrator ordered for a fuller, non‑arbitrary explanation of findings (not an immediate award).

Key Cases Cited

Metro. Life Ins. Co. v. Glenn, 554 U.S. 105 (U.S. 2008) (conflict of interest as a factor in arbitrary‑and‑capricious review)
Glenn v. MetLife, 461 F.3d 660 (6th Cir. 2006) (administrator’s decision must reflect deliberate, principled reasoning and be supported by substantial evidence)
McDonald v. Western–Southern Life Ins. Co., 347 F.3d 161 (6th Cir. 2003) (application of arbitrary‑and‑capricious standard where plan grants discretion)
Moon v. UnumProvident Corp., 405 F.3d 373 (6th Cir. 2005) (skepticism warranted when administrator’s medical reviewer relies on a narrow subset of evidence)
Helfman v. GE Group Life Assur. Co., 573 F.3d 383 (6th Cir. 2009) (remand is proper when decision‑making process is questionable but entitlement is not clear)
Elliott v. Metro. Life Ins. Co., 473 F.3d 613 (6th Cir. 2006) (remand appropriate where record does not show a full and fair inquiry)