Opinion ID: 794475
Heading Depth: 3
Heading Rank: 3

Heading: Eligibility under the own occupation standard

Text: 19 Hartford next argues that the district court erred in finding that Paese was eligible for benefits from March 8, 2000 to March 8, 2002 under the own occupation standard. Once again, we disagree. Where an ERISA plan does not accord an administrator `discretionary authority to determine eligibility for benefits or to construe the terms of the plan,' a district court reviews all aspects of an administrator's eligibility determination, including fact issues, de novo. Locher, 389 F.3d at 293 (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)); see also Krizek v. Cigna Group Ins., 345 F.3d 91, 98 (2d Cir.2003); Muller, 341 F.3d at 123-24. Neither party disputes that the Sequa Plan does not give Hartford full discretion to interpret and apply its terms. Thus, the district court correctly found that it could review Hartford's decision to terminate benefits de novo, instead of under a more restrictive arbitrary and capricious standard. See Paese, 2004 WL 764760, at . 20 Where the district court reviews an ERISA plan's eligibility determination de novo, we, in turn, review factual findings for clear error, and legal conclusions de novo. See Locher, 389 F.3d at 293. Under those standards, we conclude that there were sufficient facts in the record generated from a variety of sources—facts which the district court appropriately discussed and relied upon—to support the finding that Paese was totally disabled. See Paese, 2004 WL 764760, at -. The district court drew no impermissible inferences from the evidence, nor is it evident to us that the court was mistaken in its conclusion. 21 As for the specific issue of whether the district court gave undue weight to the conclusions of Paese's treating physicians, see id. at  & n. 6, the Supreme Court has explicitly stated that, unlike the SSA, ERISA Plan administrators need not give special deference to a claimant's treating physician. See Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003) ([C]ourts have no warrant to require administrators automatically to accord special weight to the opinions of a claimant's physician; nor may courts impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician's evaluation.). However, the Court in Black & Decker also observed that ERISA Plan administrators may not arbitrarily refuse to credit a claimant's reliable evidence, including the opinions of a treating physician. Id. Accordingly, while Black & Decker holds that no special deference is required, this does not mean that a district court, engaging in a de novo review, cannot evaluate and give appropriate weight to a treating physician's conclusions, if it finds these opinions reliable and probative. This is precisely what happened here. 22 As for the specific issue of whether the district court gave undue weight to the SSA's finding that Paese was totally disabled, we are not troubled. See Paese, 2004 WL 764760, at . The court acted well within its discretion when it considered the SSA's findings as some evidence of total disability, even though they were not binding on the ERISA Plan, and even though the SSA's definition of disability may differ from that in the Sequa Plan. See Billinger v. Bell Atlantic, 240 F.Supp.2d 274, 285 (S.D.N.Y.2003) (Plaintiff alleges that the Social Security Administration's decision to grant her social security disability benefits is evidence of a `complete disability' under the Plan. While I agree that it is `evidence,' it is but one piece of evidence ....) (internal citations omitted); Pagan v. Nynex Pension Plan, 846 F.Supp. 19, 21 (S.D.N.Y.1994) (Social Security determinations are [ ] not binding on ERISA plans ....); cf. Kunstenaar v. Conn. Gen. Life Ins. Co., 902 F.2d 181, 184 (2d Cir.1990) (statutory definitions of disability such as those governing the SSA are not binding on a district court engaged in de novo review of an ERISA Plan's denial of long-term disability benefits); cf. Muller, 341 F.3d at 125-26 (As to the SSA decision, it was made after First Unum's review had been completed and has little independent probative value.). True, the SSA's determination did not bind either the ERISA Plan or the district court. However, it does not follow that the district court was obligated to ignore the SSA's determination, especially if the district court found the determination probative, if not necessarily dispositive, as was the case here. 23