Employee Benefits News examines legal developments that impact the employee benefits and executive compensation employers provide, including federal and state legislation, rules from federal...
AT&T’s welfare benefit plan doesn’t owe disability benefits to a worker who said the company violated federal regulations by consulting the same doctor when considering her initial claim and her subsequent appeal.
The worker accused AT&T of violating the Labor Department’s standards for evaluating disability benefit claims, including a provision prohibiting plan administrators from using the same doctor to evaluate both the initial and appeal phases of a worker’s claim for benefits. AT&T and its claims administrator didn’t run afoul of this requirement by consulting with the same cardiologist at both stages of the worker’s claim, a three-judge panel of the U.S. Court of Appeals for the Sixth Circuit ruled March 26. That’s because the worker “shifted her focus” on appeal by claiming benefits based on psychiatric disability as opposed to physical disability, the panel said.
Judge Karen Nelson Moore dissented, saying that AT&T should have consulted a “new, independent cardiologist” to consider the worker’s cardiac complaints on appeal. It wasn’t enough that AT&T used a different internist for the worker’s appeal, because the internist specifically said that cardiac issues were outside his area of expertise, Moore said.
The judges’ disagreement comes less than a week before new rules governing claims procedures under the Employee Retirement Income Security Act are scheduled to take effect. The Obama-era rules, which become effective April 1, adopt certain procedural protections and safeguards for disability benefit claims by borrowing from those applicable to group health plans under the Affordable Care Act. The new rules don’t change the requirement that different doctors must be used at different stages of a benefits claim.
The judges in this case also disagreed over whether AT&T properly considered the worker’s job duties in the course of denying her claim. The majority said AT&T’s “shorthand description” of the worker’s job as “sit, talk, type” was an adequate description of the “physical rigors” of her job. Moore said this description didn’t account for the potential “cardiac demands” of the worker’s job, which included visits to other job site locations and substantial interaction with customers.
This isn’t the first time Moore has broken from her colleagues in an ERISA case raising questions about an individual’s ability to do sedentary work. In 2015, Moore dissented from a decision upholding Unum’s denial of benefits to a registered nurse after finding the insurer conflated “sedentary work,” which she said involves brief periods of standing or walking, with “sit down duty only,” which she said is more restrictive.
Judge Joan L. Larsen wrote the majority opinion, which was joined by Judge Amul R. Thapar. Both are among the 14 judges appointed and confirmed to the federal appellate bench by President Donald Trump since 2017.
McDonald & McDonald represented the worker. Ogletree Deakins Nash Smoak & Stewart represented the AT&T plan.
The case is Castor v. AT&T Umbrella Benefit Plan No. 3, 2018 BL 102005, 6th Cir., No. 17-3400, unpublished 3/26/18.
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