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Treating Physician Rule in LTD and ERISA Disability Benefits

The Treating Physician Rule Under ERISA

What Weight Should Be Given to a Treating Physician's Disability Opinion?

While a plan administrator is not necessarily required to defer to the opinion of a treating physician, at least in cases in which the administrator has reviewed, considered, and distinguished medical reports that are conflicting, a plan administrator may not totally disregard a treating physician's opinion in the absence of conflicting medical opinions. On the contrary, a plan administrator abuses its discretion if it disregards the opinion of a treating physician, without providing a reasonable explanation why that opinion was not credited. Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003).

An administrator is not excused from explaining why it has refused to credit reliable evidence that is not contradicted by other evidence in the record. Taylor v. Reliance Standard Life Ins. Co., 837 F. Supp. 2d 1194, 1206-1207 (W.D. Wash. 2011).

While a treating doctor's opinion is not controlling, the court may choose to give "significant weight" to the opinion of a claimant's treating physician based on the compatibility of his respective opinion to all of the other evidence, his special expertise, and the length of the doctor-patient relationship with the plaintiff. Perryman v. Provident Life & Accident Ins. Co., 690 F. Supp. 2d 917, 943, 944 (D. Ariz. 2010).

ERISA law is complicated. At Law Med, we are ERISA knowledgeable and experienced.

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