Plan Was Entitled To Rely On "Thorough And Reasonable" Opinions Of Consulting Physicians
BLACK v. LONG-TERM DISABILITY INSURANCE (September 18, 2009)
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Elizabeth Black was the executive director of the Milwaukee World Festival, Inc., the organization that operates an annual summer music festival in Milwaukee. In early 2001, she had surgery to repair two aneurysms. She returned to work after several weeks and was well enough to run the festival that summer. Although her contract was not scheduled to expire until the end of 2003, she sought a renewal after the 2001 festival. The organization deferred a decision until 2002. When that time came, many of her relationships with coworkers had deteriorated. She complained, and had several doctors support her complaints, that the stress and abuse of her job was harmful to her health. In July of 2003, the organization elected not to extend her contract. Within a month, Black claimed that she was disabled and could no longer work. She filed a disability claim with the organization's plan. The plan denied the claim, based on a review of the records she submitted. After an administrative appeal, the plan’s underwriter consulted four physicians and a psychiatrist, each of whom reviewed her records and concluded that she was not disabled. The underwriter denied the appeal. Black appealed to the district court, which granted summary judgment to the plan. Black appeals.
In their opinion, Judges Evans, Williams and Tinder affirmed. The Court reiterated that it’s standard of review, because of the plan’s discretion, is arbitrary and capricious. The Supreme Court's Glenn decision simply requires the court to consider a plan administrator's conflict of interest -- it does not result in a heightened standard of review. On the merits, the administrator's decision was well supported by the record. The plan's consulting physicians were unanimous in their belief that Black's condition was stable. The administrator also considered Black's treating physician's reports. The administrator found those reports to be slanted one way when she was seeking a contract extension and the other way when she was seeking disability benefits. The Court concluded that the administrator was allowed to rely on the thorough and reasonable explanations given by the consulting physicians. Finally, although Black's Social Security disability determination is a factor that should be considered in a benefits determination, the Court noted that the administrator did consider the determination and discounted it because the Social Security Administration did not have the same medical records available to it.
Alan and Patricia Bilthouse bought $500,000 worth of stock in S&E Contractors (“S&E”), a heavy construction contractor in Florida. S&E’s principal business was public works projects, for which it needed to be bonded. S&E came upon hard times beginning in early 1994. It suffered severe losses from cost overruns on a large project, eventually defaulting on the bonds in 1995. Without bonding, S&E had to discontinue its public works projects. It did file a lawsuit in late 1995 to recover its losses from the project. The lawsuit was settled in 1997 with S&E receiving no money. The confluence of the IRS regulations and the Bilthouse personal situation made the S&E losses much more valuable to them if their loss occurred in 1997 rather than 1995. The Bilthouses sought a refund from the IRS from their 1997 tax payment, asserting that their interest in S&E became worthless in 1997 and their shares were, therefore, “disposed of” in that year. The IRS denied their claim. The Bilthouses sued in district court. The court granted summary judgment to the United States. The Bilthouses appeal.