Jay Barry Harris teamed with Josh Horvitz of to obtain a successful verdict in an ERISA claim in favor of their client, Old Dominion Freight Lines (“Old Dominion”), in the United States District Court for the District of New Jersey.
In McLean v. Old Dominion Freight Line, Inc., the plaintiff challenged Old Dominion’s decision to discontinue his long term disability. Old Dominion determined that the plaintiff was no longer totally disabled as he was able to perform some type of sedentary work and, therefore, no longer entitled to receive benefits. The plaintiff challenged Old Dominion’s decision on two fronts. First, as the plan sponsor and administrator, the plaintiff contended that Old Dominion’s actions had to be examined under ERISA’s heightened standard of review. Second, the plaintiff contended that even without the heightened standard, Old Dominion’s actions were arbitrary and capricious and that the plaintiff was entitled to be reinstated and to continue to receive long term benefits.
After having the plaintiff’s counts seeking damages for breach of contract, bad faith and declaratory relief, and request for a jury trial dismissed, Old Dominion filed its motion for summary judgment, asserting that as a matter of law the heightened standard of care did not apply and that Old Dominion’s actions were not arbitrary and capricious. In granting Old Dominion’s motion for summary judgment, the court ruled that a heightened standard of review did not apply, as no conflict of interest existed since Old Dominion was both the plan sponsor and administrator.
It also rejected the plaintiff’s claim that the review process was tainted. The plaintiff contended that the process was tainted because Old Dominion did not consult with a qualified health care professional in the field of medicine involved and that Old Dominion failed to take into account all of the documents submitted by the plaintiff. The court rejected these arguments, finding that the evidence proffered by the plaintiff did not trigger the heightened scrutiny, but was precisely the evidence that should be considered applying the arbitrary and capricious standard.
With regard to the arbitrary and capricious standard, the court found particularly persuasive Old Dominion’s reliance on medical reports submitted by the plaintiff’s own physicians. Those physicians indicated that the plaintiff was cancer free, the original condition for which he had been receiving long term disability benefits. Although the plaintiff was still receiving treatment for diabetes and impairments from cancer surgery and radiation, the court found that these conditions were unrelated to the original medical condition for which he was disabled. The court also rejected the plaintiff’s contention that Old Dominion acted improperly when it decided to terminate the plaintiff’s benefits based upon an independent review of the plaintiff’s medical records review rather than an independent medical examination.