Stanley Rothe v. Duke Energy Long Term Disability, 688 F. App'x 316

Stanley Rothe, a gas controller for Duke Energy, applied for long-term disability (LTD) benefits under Duke’s Group Disability Income Policy with Liberty Life as the claims administrator and payor.
Rothe claimed disability beginning January 3, 2013, due to chronic degenerative conditions and spine/back problems.
Policy defines “Disability” by inability to perform the Material and Substantial Duties of one’s “Own Occupation,” which Liberty interprets as the occupation as normally performed in the national economy.
Liberty’s vocational analyst matched Rothe’s role to the DOT occupation “Gas Dispatcher” (generally sedentary). Liberty obtained multiple medical reviews (attending physicians and independent/peer reviewers) and concluded Rothe could perform sedentary work.
Liberty denied benefits administratively; the denial was upheld on appeal. Rothe sued under ERISA claiming Liberty’s denial was arbitrary and capricious. The district court granted summary judgment to Liberty; Rothe appealed.

Issue	Rothe’s Argument	Liberty’s Argument	Held
Whether Liberty properly construed “own occupation”	Liberty ignored Rothe’s actual Duke job duties; should use his specific job requirements	Policy defines own occupation by national-economy standard; comparing to DOT is proper	Court: Liberty reasonably used DOT to define own occupation; not arbitrary
Whether Liberty failed to consider medication side effects and federal regulation implications	Side effects of Norco/Ultram would prevent safe performance and cause failure of required drug tests	Medical reviewers found side effects did not preclude performance; gas dispatcher is not a federally regulated position	Court: Liberty relied on substantial medical evidence; argument fails
Whether Liberty disregarded substantial medical testimony from treating physicians	Treating docs show Rothe permanently disabled; Liberty ignored their history/findings	Liberty considered treating opinions but weighed them against other medical reviews and independent exams	Court: Conflict in reports permits administrator to weigh evidence; Liberty’s decision was reasoned and supported
Whether administrator’s conflict of interest (claims + payor) taints decision	Liberty’s dual role created a problematic conflict that should alter review	Conflict exists but was weighed; decision still supported by substantial evidence and principled reasoning	Court: Conflict considered but did not render denial arbitrary or capricious

Glenn v. MetLife, 461 F.3d 660 (6th Cir.) (standard for reviewing administrator with discretion under ERISA)
Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (U.S.) (discretionary-plan review framework)
Evans v. UnumProvident Corp., 434 F.3d 866 (6th Cir.) (arbitrary-and-capricious decision must have a reasoned explanation)
Killian v. Healthsource Provident Adm’rs, Inc., 152 F.3d 514 (6th Cir.) (same)
Watson v. Solis, 693 F.3d 620 (6th Cir.) (least-demanding judicial review for ERISA discretion)
Farhner v. United Transp. Union Discipline Income Prot. Program, 645 F.3d 338 (6th Cir.) (characterization of review standard)
Baker v. United Mine Workers of Am. Health & Ret. Funds, 929 F.2d 1140 (6th Cir.) (decision upheld if principled reasoning and substantial evidence)
DeLisle v. Sun Life Assurance Co. of Canada, 558 F.3d 440 (6th Cir.) (conflict of interest when insurer both evaluates and pays claims)
Peruzzi v. Summa Med. Plan, 137 F.3d 431 (6th Cir.) (weigh conflict of interest in arbitrary-and-capricious review)
Helfman v. GE Group Life Assur. Co., 573 F.3d 383 (6th Cir.) (use of in-house consultants relevant to weighing conflict)
Osborne v. Hartford Life & Accident Ins. Co., 465 F.3d 296 (6th Cir.) (own-occupation may be defined by occupational categories and DOT)
Cox v. Standard Ins. Co., 585 F.3d 295 (6th Cir.) (administrator may deny benefits when treating physician’s opinion conflicts with other medical evidence)