Court Opinion

ID: 9483001
Source: CourtListenerOpinion
Date Created: 2023-08-05 09:07:30.526844+00
Date Added: 2024-06-11T17:49:21.050331
License: Public Domain

JOHN R. GIBSON, Circuit Judge,
dissenting.
I respectfully dissent. I would affirm the judgment of the district court holding that the denial of disability benefits was an abuse of discretion.
In my view, the issue in this case was very narrow. Section 2.49 of the Plan provides: “The determination as to whether a Member is Totally and Permanently Disabled shall be made on evidence that the Member is eligible for disability benefits under the Social Security Act in effect at the date of disability.”
The evidence was undisputed that Cox was eligible for disability benefits under the Social Security Act. The court today avoids application of this provision of the Plan by comparing the definition of disability in the Social Security Act with the definition of disability in the Plan. The chain of reasoning is ingenious, but it simply ignores the plain language of Section 2.49. Similarly, the committee’s reliance on the report of the nonexamining physician and rejection of the opinion of Cox’ treating doctor raise serious questions. Actually the report before the committee was written by a nurse with the title “Auditing Specialist,” and simply quoted the opinion of an unnamed but board-certified physician advisor and closed by thanking the appellant’s lawyer “for the opportunity to assist you in your cost containment efforts.” On the basis of these facts, the district court concluded:
This Court finds that the committee’s decision to deny plaintiff disability benefits was not supported by substantial evidence and constitutes an abuse of discretion. To rely chiefly on the opinion of a medical doctor who did not examine the plaintiff, and to totally disregard credible contradictory evidence from the plaintiff’s own treating physician, as well as the extensive examination of plaintiff done by the ALJ, is irrational and is an abuse of the discretion granted the committee by the Plan. Therefore, the committee’s decision is reversed.
The district court did not err in its application of the correct standard of review'. What the court today has done is to decide the issue de novo based upon its interpretation of several provisions of the Plan. In my view the court errs in doing so. We should conclude that the district court did not err in its determination that the denial was not supported by substantial evidence and was an abuse of discretion. I would affirm the judgment of the district court.