Opinion ID: 1359690
Heading Depth: 3
Heading Rank: 6

Heading: Consideration of the SSA's Finding of Disability

Text: MetLife required Hobson to apply for social security disability benefits, and in May 2003, the SSA awarded Hobson such benefits on the basis that she suffered from colitis and fibromyalgia. Hobson alleges that both the district court and MetLife failed to consider her social security disability benefits award in making their LTD determinations. Where the administrator requires a claimant to pursue social security disability to reduce the amount of benefits due under the plan, Leffew v. Ford Motor Co., 258 Fed.Appx. 772, 778-779 (6th Cir.2007), and subsequently determines that the claimant is not entitled to ERISA benefits, the Sixth Circuit has counsel[led] a certain skepticism of a plan administrator's decision-making, Calvert, 409 F.3d at 295; see also Leffew, 258 Fed.Appx. at 779. Although the SSA's definition of the term disability is not necessarily coextensive with an ERISA plan's definition of that term, see Kunstenaar v. Conn. Gen. Life Ins. Co., 902 F.2d 181, 184 (2d Cir.1990), the Sixth Circuit nevertheless considers an award of social security disability benefits to be a relevant factor in determining whether a claimant is disabled under an ERISA plan, see Calvert, 409 F.3d at 295. Here, it does not appear that either MetLife or the district court considered the SSA's conclusion that Hobson was disabled, as that term is defined by the SSA; neither MetLife's letters denying Hobson's claim for LTD benefits nor the district court's decision discuss that conclusion. Still, between the time that Hobson submitted the diagnoses upon which the SSA awarded her disability benefits and August 2004, when MetLife sent her its next letter terminating her LTD ERISA benefits, she had undergone surgery for her colitis. MetLife terminated Hobson's benefits on the basis that she had successfully recovered from this surgery; thus, the SSA's determination as to her pre-surgical condition was no longer relevant when Metlife denied her benefits claim. Compare with Ladd v. ITT Corp., 148 F.3d 753, 755-56 (7th Cir.1998) (determining that the claim denial was irrational where the claimant's medical condition worsened after the SSA awarded her benefits but before the plan administrator denied her ERISA benefits). As for Hobson's fibromyalgia diagnosis, substantial evidence supported MetLife's determination that the condition did not render her disabled, as explained above. Supra Part II.A; see also Suren, 2008 WL 4104461, at  (In light of all the medical evidence in the record, ... [the court] cannot responsibly find [the administrator's] decision to be without reason....). We encourage plan administrators, in denying benefits claims, to explain their reasons for determining that claimants are not disabled where the SSA arrived at the opposite conclusion: Doing so furthers ERISA's goal of providing claimants with additional information to help them perfect their claims for subsequent appeals. See 29 U.S.C. § 1133; 29 C.F.R. § 2560.503-1(g)(1)(iii). Nonetheless, especially in light of the substantial evidence supporting its determination, we decline to hold that MetLife's failure to do so in this case renders its denial of Hobson's LTD benefits claim arbitrary and capricious.