How do you respond to typical arguments by those seeking ERISA-governed disability benefits that the claim administrator:
-“cherry-picked the record”;
-ignored the social security disability determination;
-improperly considered claimant’s vacation travel;
-made inconsistent determinations?
Here’s the case of Chen v. CenturyLink, 2017 WL 219008 (D. Colo. May 18, 2017)(attached), with quick rebuttals to those arguments.
FACTS: Chen, an accounting analyst, sought ERISA-governed disability benefits for extreme fatigue following a kidney transplant. Standard Insurance, the claims administrator, determined Chen could perform a sedentary job and terminated benefits after 19 years. The plan vested discretion, and the court reviewed the claim denial under the abuse of discretion standard.
DISTRICT COURT HELD: Affirmed the Denial of Benefits.
- The Court rejected Plaintiff’s argument that Standard had made inconsistent prior decisions. “ERISA does not prevent a plan administrator from reversing course and finding a claimant no longer entitled to disability benefits…[so long as the changed decision] is supported by new medical or other information.” Op. at 12.
- The Court rejected Plaintiff’s argument that Standard had failed to consider the Social Security determination. “[A] plan administrator should not ignore a claimant’s eligibility for social security disability benefits….[But] the validity of a claim for benefits under an ERISA plan turns on the interpretation of the plan at issue, not on whether the claimant is eligible for social security benefits.” Plaintiff’s condition when Social Security determined eligibility in 1996 was significantly different from the benefit denial 20 years later. Op. at 14.
- The Court rejected Plaintiff’s argument that Standard “cherry-picked” the record. “[A] plan administrator is not required to ‘pore over the record’ picking out and addressing all evidence supporting payment or denial of a claim [but] …cannot shut her eyes to readily available evidence that suggests the claimant is entitled to benefits.” Op. at 15.
- It is OK to consider Claimant’s vacation travel to Europe, Hawaii in determining whether she is disabled. Plaintiff’s “inclination to travel [to Europe, Hawaii, Miami] was considered by medical experts in the context of her medical symptoms, particularly her persistent fatigue. Standard relied upon the medical opinions that Ms. Chen’s travel was inconsistent with her claims of debilitating fatigue.” Op. at 17.