192 F. Supp. 3d 601
D. Md.2016Background
- Weisner, a former CareFirst auditor, claimed long-term disability (LTD) benefits under an ERISA-governed policy issued by Liberty Life for alleged headaches, cognitive deficits, mood disorder, and a possible movement disorder; he stopped working January 15, 2014 and filed for LTD with an elimination period ending July 14, 2014.
- The Policy defines “Disabled” as inability to perform Own Occupation for the elimination period + 24 months, then Any Occupation thereafter; Policy included a Maryland endorsement addressing insurer discretion.
- Medical record is mixed: treating providers diagnosed mood disorder, severe cannabis-use disorder, occipital neuralgia/nerve injury, possible early multiple system atrophy; neuropsychological testing showed reduced processing speed and subjective symptom reporting.
- Liberty Life denied the claim after internal paper-peer reviews (neuropsychologist and psychiatrist) concluded insufficient evidence of impairment; after administrative appeal and submission of additional reports (neurology, physio, vocational), Liberty again denied the appeal.
- Plaintiff sued under 29 U.S.C. § 1132(a)(1)(B). Both parties moved for summary judgment; the court denied both motions and ordered a bench trial on the administrative record.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standard of review — whether de novo or deferential | Maryland law (Ins. §12-211) forbids clauses reserving sole discretion; Weisner argued de novo review is required | Liberty argued Policy language and Maryland endorsement preserve insurer discretion and deferential review | Court held Maryland statute requires de novo review and applied that standard; endorsement did not save deferential review |
| Adequacy of administrative record for merits determination on summary judgment | Weisner argued record supports disability from neurological and cognitive impairments | Liberty argued peer-review reports and gaps in record justify denial; urged summary judgment | Court found factual disputes, credibility issues, and gaps (treatment, job-specific impact) preclude summary judgment; denied both motions |
| Weight due to treating physicians vs. insurer paper reviews | Weisner urged court to credit treating providers and additional specialists submitted on appeal | Liberty relied on independent paper peer reviews and urged rejection of treating opinions | Court declined to resolve credibility on summary judgment, noting insurer’s reliance on paper reviews and that treating opinions cannot be arbitrarily discounted; reserved resolution for bench trial |
| Effect of Plaintiff's cannabis use on entitlement | Weisner argued his impairments (including dependence) are part of the medical picture and covered under Policy (subject to limits) | Liberty argued cannabis use and refusal of therapy undercut credibility and causation; urged denial or limitation | Court recognized cannabis-use disorder in record and that Policy contemplates substance-related limits; declined to decide effect now and left issue for de novo bench trial |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (establishes de novo default review for ERISA benefits denials absent plan-granted discretion)
- Quesinberry v. Life Ins. Co. of N. Am., 987 F.2d 1017 (4th Cir. en banc) (scope of review generally limited to the administrative record)
- Black & Decker Disability Plan v. Nord, 538 U.S. 822 (plan administrators may not arbitrarily refuse to credit reliable treating-physician evidence)
- Johnson v. Am. United Life Ins. Co., 716 F.3d 813 (4th Cir.) (describing correctness standard under de novo review)
- Cosey v. Prudential Ins. Co. of Am., 735 F.3d 161 (4th Cir.) (subjective pain reports may be relevant where plan does not require objective evidence)
- Rossignol v. Voorhaar, 316 F.3d 516 (summary-judgment motions by both parties considered separately)
- Anderson v. Liberty Lobby, 477 U.S. 242 (summary-judgment standard; mere scintilla insufficient)