Opinion ID: 2974356
Heading Depth: 2
Heading Rank: 1

Heading: Proper Weight to Be Given to the SSA Decision

Text: As a preliminary matter we must determine the proper amount of weight, if any, to give to the SSA’s finding that Tracy is disabled. At the outset, we note that the SPD states that, “[d]eterminations made by the [SSA], [etc.] are not relevant to determining a disability under [the Plan].” J.A. at 667. Nevertheless, Tracy received a fully favorable Notice of Decision of the ALJ as a result of the evidentiary hearing held to determine Tracy’s disability status under the Social Security rules, J.A. at 298-306, and he contends that that decision should not be ignored because there was an evidentiary basis for the ALJ’s conclusion, there is no contradictory evidence, and the evidentiary hearing represents the only independent evaluation of the evidence in this case. 5 As previously mentioned, the Plan states that “[b]enefit determinations will be based on the existence or non-existence of a qualifying disability and will not depend on the availability of actual employment at Upjohn or elsewhere (i.e. an employee will not have a qualifiying disability if physically and mentally able to perform in his customary or reasonable substitute employment at Upjohn...),” J.A. at 428, which quite reasonably leads to the inference that the phrase, “gainfully employed at Upjohn” refers to “customary or reasonable substitute employment” at Upjohn. 10 Defendants point out that the standards for qualifying for SSA disability and for benefits under Upjohn’s plan differ. Defendants claim that under the “treating physician rule,” the ALJ must accord special weight to the treating physician. Defendants argue that neither conclusion at the SSA hearing (that Tracy is disabled and that jobs did not exist, which someone with his characteristics could perform) “bear[s] upon the Plan’s standard for disability,” (Def. Br. at 24) as the Plan’s language requires a finding that Tracy cannot work “anywhere” and the disability standard requires that there is not a significant number of jobs in the economy that he could perform, Jones v. Commissioner of Social Security, 336 F.3d 469, 474 (6th Cir. 2003). We also reiterate that the burden of proof is differently allocated. In the SSA proceeding, the government was obligated to show that Tracy could work, whereas here, Tracy must prove that he cannot. This circuit has previously addressed the weight to be given to an SSA decision in Calvert v. Firstar Finance, Inc., 409 F.3d 286, 294 (6th Cir. 2005). We rejected the suggestion that an SSA determination is “meaningless,” but found that it is “not binding.” Id. at 295. We further stated: While it is true that the SSA must apply the ‘treating physician rule’ in its determinations, that rule provides that deference is to be given to the opinions of treating physicians (over those of non-treating or reviewing physicians) where, and only where, there is objective support for those opinions in the record.... Hence, the SSA determination, though certainly not binding, is far from meaningless. As the Court said in Black & Decker, a plan administrator may not arbitrarily disregard the medical evidence proffered by the claimant, including the opinions of her treating physicians. Here, the SSA determination, at a minimum, provides support for the conclusion that an administrative agency charged with examining Calvert’s medical records found, as it expressly said it did, objective support for Dr. Hester’s opinion in those records. Calvert, 409 F.3d at 294 (emphasis added) (citations omitted). Therefore, we agree that, despite the Plan language, the decision of the ALJ provides evidentiary insight. However, in line with the Plan 11 language and our earlier discussion, we review ALJ conclusions de novo. In sum, while the SSA determination is not binding, some weight is to be given to the SSA determination that Tracy is disabled and unable to work.