Strickland v. Merck & Co., Inc., 3:13-cv-01085

Christopher Strickland, a former Merck pharmaceutical salesman, received LTD benefits beginning October 2, 2008; after 24 months the Plan requires inability to perform any "Gainful Employment." Benefits were terminated effective October 2, 2010 and then through February 28, 2011 by settlement; Merck denied benefits after February 28, 2011 and Strickland exhausted administrative appeals.
Treating pain specialist Dr. T. Scott Baker treated Strickland from at least March 2010, documented chronic multi-site pain (often 5–8/10, pain 90% of waking hours), and provided functional restrictions in medical forms (including an opinion that pain/medication could cause concentration lapses).
Merck obtained two non‑examining peer reviews: Dr. Donald Minteer (file review) concluded no objective findings precluded sedentary work; Dr. Siva Ayyar (independent peer reviewer) found functional limitations but not total inability to work.
Merck denied continued LTD benefits, relying on the file reviews and medical records; Strickland challenged the denial under ERISA §502(a)(1)(B).
The Plan grants the administrator discretionary authority to determine eligibility; the court therefore applied the arbitrary-and-capricious standard of review and considered the administrator/insurer conflict as a factor.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Standard of review	Strickland implicitly argued denial should be reviewed with scrutiny given insurer role	Merck relied on Plan language granting discretionary authority	Court: discretionary language applies; arbitrary-and-capricious review governs
Weight of treating physician's opinions	Baker's records and restrictions establish total disability; reviewers’ file reviews insufficient	Peer reviewers’ file reviews reasonably interpreted records and could outweigh Baker where evidence conflicts	Court: Merck reasonably credited peer reviews; not arbitrary to give less weight to treating opinions here
Use of non‑examining reviewers	File reviews by non‑examining doctors do not provide reasoned basis to deny benefits	File reviews are permissible and were based on the record; physical exam not required though relevant	Court: File reviews were acceptable and considered pain and exam findings; not arbitrary or capricious
Consideration of pain and medication effects	Merck failed to account for chronic pain and medication side effects affecting work capacity	Reviewers and records addressed chronic pain; no treating physician tied medication side effects to total inability to work	Court: Decision accounted for chronic pain; no reliable evidence showed medication rendered claimant totally unable to work

Firestone Tire Rubber Co. v. Bruch, 489 U.S. 101 (plan discretion governs standard of review)
Black & Decker Disability Plan v. Nord, 538 U.S. 822 (administrators may not arbitrarily refuse to credit reliable treating‑physician evidence)
Evans v. UnumProvident Corp., 434 F.3d 866 (6th Cir.) (conflict of interest is a factor in abuse‑of‑discretion review)
Calvert v. Firstar Fin., Inc., 409 F.3d 286 (6th Cir.) (file reviews by qualified physicians are permissible)
McDonald v. Western‑Southern Life Ins. Co., 347 F.3d 161 (6th Cir.) (administrator can rationally favor one medical opinion over another)
Smith v. Continental Cas. Co., 450 F.3d 253 (6th Cir.) (describing arbitrary‑and‑capricious as deferential standard)
Kalish v. Liberty Mutual, 419 F.3d 501 (6th Cir.) (whether a doctor examined claimant is a relevant factor)
Gismondi v. United Technologies Corp., 408 F.3d 295 (6th Cir.) (administrator insurer dual role creates an apparent conflict)