In ERISA Claims, the Support of a Treating Physician Can Be Critical

Having the support of a treating Physician can be Critical for an insured’s’ ability to receive Disability benefits.  We often write how ERISA often provides a claims administrator with much discretion when it comes to approving or denying benefit claims.  The recent case from the Sixth Circuit, styled McClain v. Eaton Corp. Disability Plan, decided January 25, 2014, highlights the fact that an insured should have the support of her treating physician regarding her inability to work in order to be successful on her claim.  In this action, the plan administrator paid the claim for 24 months under an “own occupation” definition of disabled. At the end of 24 months, the administrator stopped paying benefits when the definition of disabled changed to any occupation.  Unfortunately for Ms. McClain her treating physician specifically found that she could perform some part time work.  The claims administrator cited to this piece of evidence as support for its assertion that the insured could work.  The Sixth Circuit affirmed the trial courts grant of summary judgment finding that this decision was not “arbitrary or capricious.”  If you are applying for long term disability benefits, or even for social security disability benefits, having a physician support your claim is critical.

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