Wade Clark Mulcahy LLP

<p style="text-align: justify;">In <em><a href="https://www.wcmlaw.com/wp-content/uploads/2022/07/Canter-v.-ATT-Umbrella-Benefit-Plan.pdf">Canter v. AT&amp;T Umbrella Benefit Plan</a></em>, plaintiff, a premises technician, applied for and received short-term disability benefits under his employer’s umbrella benefit plan. He provided the plan administrator the requisite “objective medical evidence” in support of his disability claim after he experienced migraines and dizziness, making him unable to claim tall ladders.  The plan administrator granted benefits for about five months upon receipt of multiple unremarkable test results and medical reports of mixed improvement in plaintiff’s condition.</p>
<p style="text-align: justify;">When one of plaintiff’s medical providers reported that plaintiff’s “persistent dizziness has resolved” but he still experienced “dizziness with exertion,” the plan administrator referred plaintiff’s case to an independent medical reviewer.  That reviewer – and two subsequent ones on internal appeal – concluded that plaintiff did not provide the requisite evidence to continue his claim, so the administrator denied the claim, and later rejected the appeal.</p>
<p style="text-align: justify;">Plaintiff was ordered back to work early the following year, but was sent home because he did not have a doctor’s note releasing him for work.  His employer granted him unpaid time off as an accommodation, but at the end of that period, plaintiff was unluckily removed from payroll because there were no openings that accommodated his work restrictions.</p>
<p style="text-align: justify;">Plaintiff brought this ERISA claim for wrongful termination of benefits.  The district court granted defendant employer and plan summary judgment because the denial was not arbitrary and capricious in light of the many normal tests and despite some self-reported symptoms and the lack of communication between plaintiff’s treating providers and the independent medical reviewers.</p>
<p style="text-align: justify;">The Seventh Circuit affirmed, holding that while the plan administrator’s denial letter was not perfect – and that “improvement is almost always possible in the real world,” namely, by pointing out that no doctor in the weeks before the denial indicated that plaintiff should continue to refrain from working – it contained enough information to demonstrate the reasonableness of a denial and allow plaintiff an opportunity for a full and fair review.</p>
<p style="text-align: justify;">Thanks to Abed Bhuyan for his contribution to this article.  Should you have any questions, please contact <a href="mailto:haquino@wcmlaw.com">Heather Aquino</a>.</p>