Today’s U.S. Supreme Court delivered a unanimous opinion written by Justice Ginsburg on the “treating physician rule” in No. 02-469, Black & Decker Disability Plan v. Nord and settled a division among the Circuits on the propriety of the “treating physician rule.” The case involved an ERISA disability plan which provided benefits for eligible disabled employees of Black and Decker. Employee Nord submitted a claim for disability benefits and at the plan administrator’s review stage, submitted letters and supporting documentation from his physicians who had concluded that he suffered from a degenerative disc disease and chronic pain that rendered him unable to work. Black & Decker then referred Nord to their neurologist who determined that Nord was not “disabled” under the plan and therefore his claim was denied. Seeking to overturn the determination, Nord filed an action under ERISA. The District Court granted summary judgment for the plan, concluding that the company’s denial of Nord’s claim was not an abuse of the plan administrator’s discretion. The Ninth Circuit reversed and itself granted summary judgment for Nord. They based their decision on another Ninth Circuit decision holding that, when making benefit determinations, ERISA plan administrators must follow a “treating physician rule.” This rule required a plan administrator who rejects the opinions of a claimant’s treating physician to come forward with specific reasons for the decision, based on substantial evidence in the record.

The U.S. Supreme Court vacated and remanded the Ninth Circuit decision and held that ERISA does not require plan administrators to accord special deference to the opinions of treating physicians. The Court stated: “Nothing in ERISA or the Secretary of Labor’s ERISA regulations suggests that plan administrators must accord special deference to the opinions of treating physicians, or imposes a heightened burden of explanation on administrators when they reject a treating physician’s opinion.” (The DOL had filed an amicus brief opposing the adoption of such a rule for disability determinations under plans covered by ERISA.) The Court stated further: “Plan administrators may not arbitarily refuse to credit a claimant’s reliable evidence, including the opinions of a treating physician. But courts have no warrant to require administrators automatically to accord special weight to the opinion of a claimant’s physician; nor may courts impose on administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician’s evaluation.“