Benefits Determination That Does Not Address Claimant's Key Medical Evidence Is Unreasonable

MAJESKI v. METROPOLITAN LIFE INSURANCE CO. (December 29, 2009)

Kirsten Majeski was a nurse consultant for Metropolitan Life Insurance Co. ("MetLife"). Her typical workday involved sitting at a desk, using a phone and computer. In 2006, she was diagnosed with cervical radiculitis, a compression in the upper spinal. MetLife originally approved short-term disability benefits. It later determined that Majeski was not entitled to benefits, concluding that her impairment did not prevent her from performing her job. Majeski appealed and submitted medical evidence from her doctor and physical therapist. The conclusion of the medical evidence was that she had difficulty sitting and using her hands -- and was thus unable to perform her job. MetLife had a physician review the records. He concluded that there were "minimal objective findings" to support the suggested limitations. MetLife rejected the appeal. Majeski brought suit under ERISA. The district court granted summary judgment to MetLife. Majeski appeals.

In their opinion, Judges Wood, Evans and Tinder vacated and remanded. The Court first rejected Majeski's argument that the Supreme Court's decision in Glenn required a heightened standard of review. The Court admitted that it was still undecided on how to weigh a Plan administrator's conflict of interest. In Marrs, the Court concluded that the circumstances of the case should determine the impact of the conflict. The Court also rejected Majeski's argument that the district court should have considered evidence outside of the administrative record. On the merits, however, the Court agreed with Majeski. The physician's report on which MetLife solely relies did not address key findings presented by Majeski's medical evidence. Although the report concludes that there were "minimal objective findings," the Court cited several objective findings contained in Majeski's material that MetLife physician failed to mention or rebut. The failure to address this significant medical evidence amounts to an absence of reasoning and lack of fair review. The Court declined to rule directly in Majeski's favor, concluding that the typical and proper course is to remand to the plan administrator.

Statutory Award Of Attorneys' Fees Need Not Be Proportional To The Recovery

ANDERSON v. AB PAINTING AND SANDBLASTING (August 20, 2009)

Under its collective bargaining agreement, AB Painting and Sandblasting was required to make contributions to several union benefit plans. The trustee of the plans brought an action under ERISA to collect overdue contributions. The court granted summary judgment to the fund for the entire amount claimed ($6,500). The court awarded attorneys’ fees of only $10,000, however, on a request in excess of $50,000. The amount claimed, stated the district court, was “disproportionate” to the amount at stake. The trustee appealed.

In their opinion, Judges Bauer, Manion and Sykes reversed and remanded. The Court noted that ERISA requires an award of “reasonable” attorneys’ fees in a successful action to recover overdue contributions. The district court should begin with the “lodestar” (hours times a reasonable rate)and adjust it upon consideration of a number of factors, including the amount at stake and the results obtained. The Court cited its own jurisprudence, however, where it has rejected any requirement of proportionality between the result and the fee award. In fact, one of the policy reasons behind fee-shifting statutes is the promotion of meritorious claims that would not be brought otherwise. In a situation where Congress has spoken by including a fee-shifting provision in a statute, a court should only look at whether the time expended was a reasonable approach to the desired end. Here, the lower court did not opine on the reasonableness of the hours spent achieving the outcome. The Court remanded for such a recalculation.