reviewing physician never “explained why he believed that the medical evidence did not support [the claimant]’s claim,” and instead, “baldly asserted that ‘the observed activities of daily living are inconsistent with the claimant’s self-reported limitations’”
How later courts described this case
- reviewing physician never “explained why he believed that the medical evidence did not support [the claimant]’s claim,” and instead, “baldly asserted that ‘the observed activities of daily living are inconsistent with the claimant’s self-reported limitations’”
- awarding benefits based on objective medical evidence that claimant was disabled
- “We have repeatedly found that ‘the failure to conduct a physical examination though the benefits plan explicitly reserves that right raises questions about the thoroughness and accuracy of the benefits determination.’”
- remanding for reinstatement of benefits
Written by the judges who cited it.
The opinion
ROGERS, Circuit Judge,
dissenting.
I would affirm for the reasons given in the district court’s thorough and balanced opinion.
Even assuming that the district court on balance abused its discretion in this close case, I would direct the district court to remand to LINA, so that LINA could more directly address the SSA award, and so that LINA could obtain a further file review by a physician who has physically examined Mr. Calhoun. Under our test for the proper remedy as described in Cooper v. Life Ins. Co. of N. Am., 486 F.3d 157, 171 (6th Cir. 2007), the primary reasons for the majority’s finding of an abuse of discretion go to “the integrity of the plan’s decision-making process,” and not to show that Mr. Calhoun was “clearly entitled” to benefits.