Opinion ID: 2976248
Heading Depth: 2
Heading Rank: 3

Heading: SSA’s Disability Determination

Text: Bennett argues that the district court gave inadequate consideration to the fact that Broadspire, in its final benefits determination, failed to discuss the SSA’s determination that Bennett was “disabled” under the Social Security Act. Recently, we addressed a situation where the administrator assisted the plaintiff in obtaining Social Security disability benefits, and then, without explanation, determined that for purposes of LTD benefits, the plaintiff was not disabled. This sequence of events raised two overarching concerns: [T]he fact that MetLife and the Social Security Administration reached contrary conclusions regarding Glenn’s disability status has two ramifications for this appeal. The first stems from the fact that MetLife assisted Glenn in obtaining Social Security benefits and reaped a financial benefit of its own when that assistance was successful. The second issue relates to the fact that, in denying Glenn continuation of her long-term benefits, MetLife failed to address Social Security’s contrary determination of Glenn’s status. Glenn, 461 F.3d at 667. We further explained in Glenn that “an ERISA plan administrator’s failure to address the Social Security Administration’s finding that the claimant was ‘totally disabled’ is yet another factor that can render the denial of further long-term disability benefits arbitrary and capricious.” Id. at 669. We concluded that “[h]aving benefitted financially from the government’s determination that Glenn was totally disabled, [the plan administrator] obviously should have given appropriate weight to that determination.” Id. Similarly, in the case at bar, Kemper provided Bennett with assistance in obtaining Social Security disability benefits, and under the Plan, was entitled to reduce the amount of benefits it paid to Bennett by the amount Bennett received from Social Security. When Broadspire issued its No. 06-2326 Bennett v. Kemper Nat’l Servs., Inc. et al. Page 6 decision 2denying LTD benefits, it failed to explain why it reached a conclusion contrary to that of the SSA. Conspicuously absent from the district court’s discussion on this point is any reference to our Glenn decision decided four weeks earlier. Rather, citing an unpublished case, the district court stated that a plan administrator is not required to refer to an SSA disability decision in its own decision denying LTD benefits. The district court also stated that “silence by a plan administrator with regard to a decision by the Social Security Administration does not necessarily mean that it was not considered and evaluated. Furthermore, a plan administrator’s decision cannot be considered arbitrary and capricious solely because the Social Security Administration rendered a different decision.” J.A. at 64 (Order at 7) (citing Hurse v. Hartford Life & Accident Ins. Co., 77 F. App’x 310, 318 (6th Cir. 2003)). While technically correct, the district court fails to explain further that if the plan administrator (1) encourages the applicant to apply for Social Security disability payments; (2) financially benefits from the applicant’s receipt of Social Security; and then (3) fails to explain why it is taking a position different from the SSA on the question of disability, the reviewing court should weigh this in favor of a finding that the decision was arbitrary or capricious. Glenn, 461 F.3d at 669. More importantly, the district court failed to demonstrate, through its application of law to the facts, that it appreciated the gravity of Broadspire’s failure to discuss the SSA’s disability determination. Instead the district court inquired into whether the defendants “act[ed] maliciously in helping [Bennett] to obtain Social Security disability benefits.” J.A. at 69 (Order at 12). This question is irrelevant and demonstrates that the district court did not properly synthesize Broadspire’s failure to discuss the SSA disability determination into the arbitrary-or-capricious analysis. We conclude that Broadspire’s silence as to the SSA’s disability determination weighs in3 favor of finding that Broadspire failed to engage in a “deliberate, principled reasoning process.” Glenn, 461 F.3d at 666.