Legal Document

538 U.S. 822 BLACK & DECKER DISABILITY PLANv.NORD. No. 02-469. Supreme Court of United States. Argued April 28, 2003. Decided May 27, Petitioner Black Decker Disability Plan (Plan), an employee welfare benefit plan governed by the Employee Retirement Income Security Act 1974 (ERISA), provides benefits for eligible disabled employees Corporation (Black Decker) and certain its subsidiaries. is administrator but has delegated authority to Metropolitan Life Insurance Company (MetLife) render initial recommendations on claims. Respondent Nord, a subsidiary, submitted claim disability under Plan, which MetLife denied. At MetLife's review stage, Nord letters supporting documentation from his physician, Dr. Hartman, treating orthopedist whom Hartman had referred Nord. These physicians stated that suffered degenerative disc disease chronic pain rendered him unable work. neurologist independent examination. The concluded that, aided medication, could perform sedentary thereafter made final recommendation deny Nord's claim, accepted. Seeking overturn determination, filed this action ERISA. District granted summary judgment concluding Decker's denial was not abuse administrator's discretion. Ninth Circuit reversed itself Appeals explained case controlled recent decision holding when making determinations, ERISA administrators must follow "treating physician rule." As described appeals court, rule required who rejects opinions claimant's come forward with specific reasons decision, based substantial evidence in record. found rule, provided adequate justification rejecting physicians. Held: does require accord special deference rule" imposed originally developed Courts as means control determinations administrative law judges Social Act. In 1991, Commissioner adopted regulations approving formalizing use program. Nothing or Secretary Labor's regulations, however, suggests physicians, imposes heightened burden explanation they reject physician's opinion. If it meet adopt regulation, courts would examine determination appropriate deference. See Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc., 467 837. But chosen course amicus brief reflecting Department position opposes adoption such plans covered Whether increase accuracy believed would, question Legislature superintending agency best positioned address. Finally, prime importance, critical differences between program caution against importing former area into latter. By accepting codifying sought serve need efficient administration obligatory nationwide contrast, nothing requires employers establish mandates what kind provide if choose have plan. Lockheed Corp. Spink, 517 882, 887. Rather, large leeway design other see fit. determining entitlement benefits, adjudicator measures condition uniform set federal criteria. validity plan, hand, likely turn, part, interpretation terms at issue. Firestone Tire Rubber Co. Bruch, 489 101, 115. Deference due Labor Secretary's view served preserving greatest flexibility possible operating claims processing systems consistent plan's prudent administration. may arbitrarily refuse credit reliable evidence, including physician. no warrant automatically weight physician; nor impose discrete conflicts evaluation. Pp. 829-834. 296 F. 3d 823, vacated remanded. GINSBURG, J., delivered opinion unanimous Court. 1 CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR NINTH CIRCUIT. 2 Lee T. Paterson argued cause petitioner. With briefs were John R. Ates, Amanda C. Sommerfeld, William G. Bruner III. 3 Lisa Schiavo Blatt States curiae urging reversal. her Solicitor General Olson, Deputy Kneedler, Howard M. Radzely, Allen H. Feldman, Nathaniel I. Spiller, Mark Flynn. 4 Lawrence D. Rohlfing respondent. Eric Schnapper.* 5 JUSTICE GINSBURG 6 Under Security, whether claimant entitled accorded 20 CFR §§ 404.1527(d)(2), 416.927(d)(2) (2002). This presents similar applies (ERISA Act), 88 Stat. 832, amended, 29 § 1001 et seq. We hold are obliged 7 "full fair" assessment clear communication "specific reasons" denials. 1133; 2560.503-1 these do command over relevant medical condition. Because erroneously applied ERISA, we vacate court's remand further proceedings. 8 * ERISA-governed covers "disability." here, defines "disability" mean "the complete inability ... Participant engage regular occupation Employer."1 826, n. (CA9 2002). both funds acts administrator, provides, "[are to] be [plan administrator] suitable Participant's employment history deems satisfactory sole absolute discretion." Id., 1. 9 Kenneth L. formerly employed subsidiary material planner. His job, classed "sedentary," up six hours sitting two standing walking per day. 826. 10 1997, consulted Leo about hip back pain. determined suffers mild disease, diagnosis confirmed Magnetic Resonance Imaging scan. After week's trial medication prescribed remained unimproved. told cease work temporarily, recommended he consult while continuing take medication. 11 denied February 1998. next exercised right seek consideration "Group Claims Review." 827. also questionnaire form, drafted counsel, headed "Work Capacity Evaluation." human resources representative Janmarie Forward answered questions, form instructed, single word "yes" "no." One items composing Evaluation" directed "[a]ssume moderate interfere ability intense interpersonal communications act appropriately stress occasionally (up one-third) during day." Lodging Pet. Cert. L-37. associated asked "individual those limitations [could] planner." Ibid. marked space labeled 12 During process, Antoine Mitri agreed doctors concluded, "sedentary some interruption between." L-45. claim. 13 accepted and, October 1998, so informed notification letter summarized conclusions doctors, results diagnostic tests, Mitri. id., L-155 L-156. It recounted forwarded Mitri's report counsel request comment attending Although additional information, continued, "provided new different information change [MetLife's] original decision." Work Evaluation completed "not sufficient reverse [the Plan's] 14 Federal "to recover plan." 1132(a)(1)(B). On cross-motions judgment, 15 roundly "grant[ed] motion judgment." 3d, 832. appeal, explained, Regula Delta Family-Care Survivorship 266 1130 (2001). 829. held 1139-1144. "who [the] [of physician] record." 1139. Declaring matter law, emphasized fell short rule: justification, said, others Hartman's recommendation. 830-832. 16 certiorari, 537 1098 (2002), division among Circuits propriety judicial installation within ERISA's domain. Compare Regula, 1139; Donaho FMC Corp., 74 894, 901 (CA8 1996), Elliott Sara 190 601, 607-608 (CA4 1999); Marshall, 258 834, 842-843 2001); Turner 291 1270, 1274 (CA11 Salley E. DuPont de Nemours Co., 966 2d 1011, 1016 (CA5 1992) (expressing "considerable doubt" should govern cases). Concluding order application Circuit's proceedings.2 II 17 issue here Act, 49 620, 42 231 Maccaro, Treating Physician Rule Adjudication Benefits, 41 Soc. Sec. Rep. Serv. 833, 833-834 (1993). 56 Fed. Reg. 36961, 36968 (codified (2002)). Administration, inform, will generally "give more sources," "will always give good our notice your source's opinion." 416.927(d)(2). 18 similarly private said "reasons ha[d] common sense well consistency [judicial] where protected law." "Just context," court observed, disputed concerns facts beneficiary's entitle benefits." perceived "no reason why used test reasonableness [plan] positions." urges "erred equating [statutory regimes]." Brief Amicus Curiae 23. agree.3 19 "ERISA enacted promote interests their beneficiaries plans, protect contractually defined 113 (1989) (internal quotation marks citations omitted). furthers aims part regulating manner process Plans "provide writing any participant beneficiary whose been denied, setting forth denial, written calculated understood participant." 1133(1). procedures "afford reasonable opportunity full fair review" dispositions adverse claimant. 1133(2). itself, Nor empowers "prescribe finds necessary carry out" statutory provisions securing rights. 1135; 1133 (plans shall "[i]n accordance Secretary"). instruct extra respect physicians' opinions. (1997) (regulations effect claim); (2002) (current regulations). Notably, most version installs issued than nine years after Administration codified agency's regulations. 36932, 36961 (1991), 65 70265 (2000). 21 837 (1984). course, 7-27. Congress "expect[ed]" develop "a rights obligations ERISA-regulated plans," Pilot Ins. Dedeaux, 481 41, (1987), scope permissible innovation narrower areas actors engaged, cf. Milwaukee Illinois, 451 304, 317-332 (1981) (because comprehensive regulatory dealing discharge pollutants Nation's waters, State maintain common-law nuisance city latter's pollution Lake Michigan). 22 "increas[e] determinations" 1139, moreover, seems us one compared consultants retained true "ha[ve] greater know observe patient individual." citation Appeals' concern repeatedly "incentive make finding `not disabled' save money preserve own consulting arrangements." 1143. assumption scant when, example, relationship duration, specialist engaged expertise lacks. And consultant "incentive" disabled," close case, favor "disabled." Intelligent resolution routine yield accurate thus appears, might empirical investigation ill equipped conduct. 23 creates funded Contributions payments, 26 3101(a), 3111(a), superintended Security. To cope "more 2.5 million [filed] each year," Cleveland Policy Management Systems 526 795, 803 (1999), published detailed governing adjudications. See, e. g., 803-804. Presumptions Commissioner's "grow out administer system efficiently." 804. need. Along works foster uniformity regularity first instance corps judges. 24 contrast obligatory, program, "[n]othing plans. mandate 887 (1996). "[T]he plan," "is turn," "on issue." Tire, S., "preserv[ing] Labor, Benefits http://www.dol.gov/ebsa/faqs/faq_claims_proc_reg.html, Question B-4 (as visited 6, 2003) (available Clerk Court's file). view. 25 administrators, But, hold, evaluation.4 therefore erred lacking endorsement judgment. 27 For stated, vacated, remanded proceedings 28 ordered. Notes: Briefs ofamici reversal American Council Robert N. Eccles Jonathan Hacker; Insurers al. J. Kayatta, Jr., Schmidtke, Victoria Fimea; Bert Bell/Pete Rozelle NFL Player Douglas W. Ell, P. McAllister, Alvaro Anillo; Central States, Southeast Southwest Areas Health Welfare Fund Thomas Nyhan, James Condon, Franczyk, Jr.; Hunter Hughes; Industry Committee Caroline Brown Vine; National Association Manufacturers Frederick Damm, Lira Johnson, Jan Amundson, Quentin Riegel; Peabody Energy Solomons Laura Metcoff Klaus. amici affirmance AARP Mary Ellen Signorille Melvin Radowitz; Medical Joseph Guerra Jack Bierig; Employment Lawyers Jeffrey Lewis, Jenifer Bosco, Daniel Driesen, Ronald Dean; Organization Claimants' Representatives Nancy Shor, Schnaufer, Rains, Jon Holder. sets standard period longer 30 months. respondent "for months," 826 2002), term play only "that subject `treating rule.'" i. express issues attracted universal adherence outside context. Some approved Longshore Harbor Workers' Compensation 33 901et seq., see, Pietrunti Director, Office Programs, 119 1035, 1042 (CA2 1997), Lung 718.104(d)(5) Appeals, rejected veterans' service-connected disabilities, White Principi, 243 1378, 1381 (CA 2001), another Railroad 1974, 45 Dray Bd., 1306, 1311 (CA7 1993). Furthermore, there appears practice regarding state workers' compensation statutes. Conradt Mt. Carmel School, 197 Wis. 60, 69, 539 713, 717 (Ct. App. 1995) ("Conradt misrepresents she majority states rule.'"). asserts rules: "procedural" hearing officer explain "substantive" weight" given 12-13 contends, ruleId., 13. reading correct. 831 (faulting for, inter alia, having "[n]o considered inappropriate factors lacked requisite draw conclusions"). rate, opinion, conclude support imposition "substantive."

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