ERISA -- 2003



Black and Decker Disability Plan v. Nord   (U.S. Supreme Court)

Treating physician rule does not apply to ERISA plans

The Supreme Court unanimously held 5/27/03 that an employer-sponsored disability plan need not defer to the determination of a patient’s treating physician as to whether benefits should be extended. Petitioner, the Black and Decker Disability Plan, denied an employee’s request for long-term disability benefits after it determined that the employee's back injury did not prevent him from doing his job. The employee’s physician, however, had a contrary view, and the employee sued petitioner. Justice Ginsburg’s opinion for the Court explained that while the Secretary of Labor has imposed the “treating physician rule” in regulations governing the Social Security disability program, the Secretary has expressly disavowed imposing the same requirement on ERISA plan administrators. Indeed, the Court stressed that deference was due to the Secretary’s view that the purposes of ERISA are best served by preserving employers’ flexibility to design procedures for processing claims under disability plans. This case is significant to all businesses that offer disability plans governed by ERISA to their employees.

The NAM and the Michigan Manufacturers Association filed an amicus brief 2/24/03 opposing the treating physician's rule. We argued that the lower court wrongly assumed that a company cannot administer its own benefit plan without an inherent conflict of interest, even though ERISA allows for company administration. Second, the court confused an administrator’s ERISA-defined fiduciary duty to all company employees with a duty to individual employees. And third, it interfered with ERISA’s "freedom of contract" by erroneously applying Social Security’s "treating physician rule."