Shaw v. AT&T Umbrella Ben. Plan No. 1, 795 F.3d 538 (6th Cir. 2015) concerned denial of plaintiff’s claim for disability due to chronic neck pain. The district court affirmed the denial, but the 6th Circuit reversed, finding the determination arbitrary and capricious.
The court took issue with much of the claim administration, criticizing the administrator for ignoring objective medical evidence and a functional capacity questionnaire, engaging in selective reviews and not obtaining an IME
Of particular note, the court held: “the Plan ignored favorable evidence from Shaw’s treating physicians by failing to make a reasonable effort to speak with them. Although the Plan’s physician advisors attempted to contact each of Shaw’s treating physicians, they gave the treating physicians only 24 hours to respond to their requests before they made their disability decisions ‘based on available medical information.’ None of the physicians was able to meet this unreasonable deadline. Physicians, like other professionals, are busy and cannot always return calls immediately. Thus, although persons conducting a file review are not per se required to interview the treating physician, … the cursory manner in which the Plan attempted to contact Shaw’s treating physicians is evidence that the Plan’s decision was not the result of a deliberate, principled reasoning process. [quotation marks omitted].”
After finding the determination arbitrary and capricious, the court next found that remand would be “a useless formality” because it was “clear that Shaw was denied benefits to which he is entitled.”