Opinion ID: 1354269
Heading Depth: 3
Heading Rank: 2

Heading: Social Security Administration's Determination of Total Disability

Text: A determination that a person meets the Social Security Administration's uniform standards for disability benefits does not make her automatically entitled to benefits under an ERISA plan, since the plan's disability criteria may differ from the Social Security Administration's. Whitaker v. Hartford, 404 F.3d 947, 949 (6th Cir.2005). Nonetheless, the Social Security Administration's decision is far from meaningless. Calvert, 409 F.3d at 294. Although there is no technical requirement to explicitly distinguish a favorable Social Security determination in every case, [i]f 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 and capricious. Bennett v. Kemper Nat'l Servs., 514 F.3d 547, 554 (6th Cir.2008). Here, the terms of Sun Life's plan required that DeLisle apply for Social Security Disability benefits and to appeal the denial to all administrative levels Sun Life deems necessary. So, she was required, not merely encouraged to apply. Sun Life also received a financial offset from future liability based on DeLisle receiving Social Security Disability benefits. And none of the three denial letters Sun Life sent DeLisle mentions her Social Security determination as a factor that Sun Life considered in reaching its own determination. Only one of Sun Life's file reviewers even acknowledged in his report that he was aware of the Social Security determination. Even though Sun Life did not have the opinion accompanying the notice of award, it still was well aware of the uniform federal standard that applies to Social Security claims. Sun Life's silence here does not make its denial arbitrary per se, but is among those serious concerns that, taken with some degree of conflicting interests, provide a proper basis for concluding that the administrator abused its discretion. See Glenn, 128 S.Ct. at 2352.