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Black & Decker Disability Plan v. Nord

Supreme Court of the United States

April 28, 2003, Argued ; May 27, 2003, Decided

No. 02-469

Opinion

 [*825]  [**1967]   Justice Ginsburg delivered the opinion of the Court.

LEdHN[1A][] [1A] HN1[] Under HN2[] a rule adopted by the Commissioner of Social Security, in determining whether a claimant is entitled to Social Security disability benefits, special weight is accorded opinions of the claimant's treating physician. See 20 CFR §§ 404.1527(d)(2), 416.927(d)(2) (2002). This case presents the question whether a similar "treating physician rule" applies to disability determinations under employee benefits plans covered by the Employee Retirement Income Security Act of 1974 (ERISA or Act), 88 Stat 832, as amended, 29 U.S.C. § 1001 et seq [29 USCS §§ 1001 et seq.] We hold that HN3[] plan administrators are not obliged to accord special deference to the opinions of treating physicians.

HN4[] ERISA and the Secretary of Labor's regulations under the Act require "full and fair" assessment of claims and clear communication to the claimant of the "specific reasons" for benefit denials. See 29 USC § 1133 [29 USCS § 1133]; 29 CFR § 2560.503-1 (2002). But these measures do not command plan administrators to credit the opinions of treating physicians over other evidence [****7]  relevant to the claimant's medical condition. Because the Court of Appeals for the Ninth Circuit erroneously applied a "treating physician rule" to a disability plan governed by ERISA, we vacate that court's judgment and remand for further proceedings.

Petitioner Black & Decker Disability Plan (Plan), an ERISA-governed employee welfare benefit plan, covers employees of Black and Decker Corporation (Black & Decker) and certain of its subsidiaries. The Plan provides benefits for eligible employees with a "disability." As relevant here, the Plan defines "disability" to mean "the complete inability . . . of a Participant to engage in his regular occupation with  [*826]  the Employer." 1  296 F.3d 823, 826, n. 2 (CA9 2002). Black & Decker both funds the Plan and acts as plan administrator, but it has delegated authority to Metropolitan Life Insurance Company (MetLife) to render initial recommendations on benefit claims.  Disability determinations, the Black & Decker Plan provides, "[are to] be made by the [plan administrator] based on suitable medical evidence and a review of the Participant's  [**1968]  employment history that the [plan administrator] deems satisfactory in its sole and [****8]  absolute discretion."  Id., at 826, n. 1.

Respondent Kenneth L. Nord was formerly employed by a Black & Decker subsidiary as a material planner. His job, classed "sedentary," required up to six hours of sitting  [***1040]  and two hours of standing or walking per day.  Id., at 826.

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538 U.S. 822 *; 123 S. Ct. 1965 **; 155 L. Ed. 2d 1034 ***; 2003 U.S. LEXIS 4061 ****; 71 U.S.L.W. 4405; 2003 Cal. Daily Op. Service 4369; 2003 Daily Journal DAR 5586; 30 Employee Benefits Cas. (BNA) 1577; 61 Fed. R. Evid. Serv. (Callaghan) 1642; 16 Fla. L. Weekly Fed. S 314

THE BLACK & DECKER DISABILITY PLAN, Petitioner v. KENNETH L. NORD

Subsequent History: On remand at Nord v. Black & Decker Disability Plan, 356 F.3d 1008, 2004 U.S. App. LEXIS 996 (9th Cir. Cal., Jan. 23, 2004)

Prior History:  [****1] ON WRIT OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT.

Nord v. Black & Decker Disability Plan, 296 F.3d 823, 2002 U.S. App. LEXIS 14159 (9th Cir. Cal., 2002)

Disposition: Vacated and remanded.

treating physician, disability, benefits, regulations, determinations, plans, claimant's, plan administrator, court of appeals, treating, courts, reasons, pain, employee benefits, recommendation, consultants, deference

Business & Corporate Compliance, ERISA, Funding Requirements, Pension Plan Funding, Public Health & Welfare Law, Eligibility, Disability Determinations, Treating Physicians & Sources, Workers' Compensation & SSDI, Evidence, Admissibility of Evidence, Medical Evidence, Pensions & Benefits Law, General Overview, Disability Insurance & SSI Benefits, Administrative Proceedings, Witnesses, Five-Step Evaluation Process, Severe Impairments, Claim Procedures, Judicial Review, Civil Procedure, Federal & State Interrelationships, Federal Common Law, Civil Litigation, Federal Common Law, Preliminary Considerations, Burdens of Proof, Claimants