Newport v. Prudential Ins. Co. of Am.

In this 2004 ERISA case, the Appellant employee brought a suit in the United States District Court for the Eastern District of Michigan, Southern Division, against appellee benefit plan administrator afte rthe plan terminated the long term disability benefits, which the employee received under a benefit plan goverened by ERISA.

The employee claimed that the administrator did not give enough weight to her treating physicians’ opinions that she should not work. The appellate court could not conclude that the administrator acted arbitrarily and capriciously when it terminated the employee’s benefits. The treating surgeon’s opinion that the employee could not work in one letter contradicted his work restrictions in which he restricted her only in ways consistent with sedentary work. Moreover, he did not apply the definition of “disabled” as defined by the plan. The other physician did not apply the plan’s standard for “disabled.” She simply supported the Social Security Administration’s determination. ERISA plan administrators were not bound by SSA findings of disability because the SSA had to use the treating physician rule while ERISA plan administrators did not. Rather than disregarding the surgeon’s opinion entirely, the administrator submitted his opinion of the employee’s work restrictions to its vocational rehabilitation counselor. Using the restrictions issued by the surgeon, the counselor determined sedentary jobs were suitable for the employee considering her physical restrictions.

The plan administrator’s termination of the employee’s benefits was affirmed and the case was dismissed.

If you need assistance navigating your claim for short term or long term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com.  We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee.  We offer a free consultation and would love to speak with you.