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Documents Reviewed by Independent Medical Examiner Sufficient to Satisfy Plan Obligation to Consider All Relevant Documents

The United States Court of Appeals for the Ninth Circuit, in an unpublished decision, addressed the question of whether documents reviewed by an independent medical examiner, but not by the plan administrator, was sufficient to satisfy the Plan’s obligation to consider all relevant documents. Sun Sun Lin v. Mellon Long Term Disability Plan, 2010 WL 1917305 (Decided May 13, 2010).

In Sun Sun Lin, the Mellon Long Term Disability Plan was administered by a Corporate Benefits Committee (“CBC”). The plaintiff, Sun Sun Lin (“Lin”), challenged the district court’s grant of summary judgment by arguing that CBC failed to give her a full and fair review of the denial of her claim for long term disability benefits. In making this argument, she relied on a statement from the Plan’s attorney “that the CBC did not directly consider those documents in making its determination to deny [Lin’s] claim,” but did “‘indirectly’ consider[ ] these documents to the extent they were reviewed and considered by” an independent medical examiner retained by the CBC in its review of Lin’s appeal. The question before the court was whether the review by the independent examiner was sufficient.

 

On appeal, the Ninth Circuit focused on the language of the Plan which did not contain any “direct consideration” requirement. Instead, the terms of the Plan required CBC to “take into account all comments, documents, records, and other information submitted by the participant relating to the Claim.” This language did not impose a requirement upon CBC to directly review each and every document. Instead, it was sufficient that the documents were reviewed and considered by the independent medical expert. The Court explained:

In light of the plain language of the Plan, which provides that the CBC need only “take into account,” not “directly consider,” all documentation, and which actually requires that the CBC consult an independent expert on questions of medical judgment, the CBC did not abuse its discretion in “indirectly consider[ing]” certain medical documents relating to an earlier benefits determination under a different disability standard.

As a result, the Court affirmed the district court’s grant of summary judgment. This result is not surprising given the plan language and the fact that the plan did consider an opinion by an independent medical expert.

The California Insurance and Life, Health, Disability Blog at californiainsurancelitigation.com and at mslawllp.com
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