holding that “the treating physician rule should apply in ERISA cases, requiring courts to defer to the opinions of a claimant’s treating physician unless there is substantial evidence contradicting them”
How later courts described this case
- holding that “the treating physician rule should apply in ERISA cases, requiring courts to defer to the opinions of a claimant’s treating physician unless there is substantial evidence contradicting them”
- noting that “ ‘there is an actual, readily apparent conflict not a mere potential for one’ when the insurance company/plan administrator is the insurer that ultimately pays the benefits.”
- noting that denial of benefits is subject to reversal where plan administrator ignored evidence of treating physicians supporting disability
- “Though not directly applicable in this ease, the principles of judicial estoppel certainly weigh against [the defendant] taking such inconsistent positions.”
Written by the judges who cited it.
Later courts went against this
Overruled on other grounds by Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003)
Co., 317 F.3d 516, 527-28 (6th Cir.2003), overruled on other grounds, Black & Decker Disability Plan v. Nord, 538 U.S. 822, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003).
The opinion
SILER, Circuit Judge,
concurring.
Although I concur in the resolution of this case, I write separately because I do not think that we need to adopt the “treating physician rule” in this case. I would be inclined to adopt the decision of the Eighth Circuit in Conley v. Pitney Bowes, 176 F.3d 1044 (8th Cir.1999), when it held that the “treating physician’s opinion [does not trump] all other evidence but that a court must give it appropriate weight.” Id. at 1049. However, I think that Fortis acted arbitrarily and capriciously under all the circumstances in denying benefits to Darland, even without giving any special deference to the opinions of the treating physicians.