Feb 132014

Since the dawn of ERISA disability litigation, claimants have been advancing the position that the opinions of their treating physicians should be credited over those of a file reviewing physician/consultant. The opinions of a treating physician, it has been argued, are ipso facto more reliable than those of a “consultative reviewer” who has never examined the claimant, and whose only “knowledge” as to the claimant’s condition is derivative of a cold file review. But in 2003, the United States Supreme Court dealt a blow to the position’s adherents, declaring in Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003), that the so-called “treating physician rule” — a rule developed in the context of Social Security Disability — is inapplicable to ERISA claims.

The Nord decision did not, however, put an end to the debate, and the issue continues to receive attention to this day, particularly in the area of “mental illness” disability.  A notable example is found within a pair of decisions from the Western District of New York: Westphal v. Eastman Kodak Co., 2006 WL 1720380 (W.D.N.Y. June 21, 2006) and Morse v. Corning Inc. Pension Plan for Hourly Employees, 2007 WL 610628 (W.D.N.Y. Feb. 23, 2007). Another is Kinser v. Plans Admin. Committee of Citigroup, Inc., 488 F.Supp.2d 1369, 1383 (M.D.Ga. 2007) (“There can be no serious doubt that a psychiatric opinion of a treating psychiatrist is more reliable than an opinion based on a one-time file review”). Still another is a very recent Sixth Circuit decision, wherein it was held that while there is “nothing inherently objectionable about a file review by a qualified physician,” such a review is “questionable as a basis for identifying whether an individual is disabled by mental illness,” and is likewise “inappropriate where a claims administrator disputes the credibility of a claimant’s complaints.”

Javery v. Lucent Technologies, Inc. Long Term Disability Plan for Management or LBA Employees, 741 F.3d 686 (6th Cir. 2014)

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