"Treating Physician Rule" for Making Disability Benefit Determinations Under Employee Benefit Plans Rejected

Black & Decker Disability Plan v. Nord, 123 S. Ct. 1965 (2003); 71(45) U.S. Law Week  1720 (May 27, 2003)

The Supreme Court unanimously held that although special weight is given to a claimant's treating physician (the "treating physician rule") in determining whether a claimant is entitled to Social Security disability benefits, an administrator of an employee benefit plan is not required to similarly give preferential weight to the opinion of an employees' treating physician.  Such benefit plans are governed by the federal Employee Retirement Income Security Act (ERISA).  The Ninth Circuit had ruled that ERISA, like the Social Security Act, imposed the "treating physician rule."  The Supreme Court rejected this position and determined a plan administrator was free to give greater weight to the conclusions of a physician who conducted an independent assessment at the behest of the plan administrator than to the employee's treating physician.  The Court concluded employee benefit plans were best served by preserving for them the greatest flexibility possible in their processing of employee health benefit claims....

Found in DMHL Volume 23 Issue 1