Worker's Compensation/Disability Evaluation

Question 1

Black & Decker v. Nord (2003)

Answer 1

1) Under ERISA, companies are not required to defer to the decision of a disability claimant’s personal physician.
2) Courts may not impose on plan administrators a discrete burden of explanation when they credit reliable evidence that conflicts with a treating physician’s evaluation.

Question 2

Damascus v. Provident Life and Accident Insurance Co (1996)

Answer 2

An insurance co can refuse to pay out d/a benefits to a claimant who lost his license if the co determines he lost his license due to negligence (And not a MI)

Question 3

Ervin v. Guardian Life Assurance Co (1988)

Answer 3

A physician who is retained by a 3rd party to conduct an exam of another person and reports the results to the 3rd party does not enter into a physician-patient rel with the examinee, and thus is not liable to the examinee for any losses he suffers as a result of the conclusions the physician reaches or reports.

Question 4

Mass Mutual Life Co v. Ouellette (1992)

Answer 4

Inability to practice/work due to a criminal conviction and subsequent imprisonment is not the same as inability to work due to an illness

Question 5

Ryans v. Lowell (1984)

Answer 5

If there is no physician-patient relationship (and thus, no duty owed to a patient), a malpractice suit cannot be pursued.

Question 6

Biestek v. Berryhill (2019)

Answer 6

A vocational expert’s refusal to provide the underlying private data during a Social Security disability benefits hearing does not categorically preclude the testimony from counting as “substantial evidence” in federal court. In a 6–3 opinion by Justice Elena Kagan, the Court held that whether testimony amounts to “substantial evidence” requires a case-by-case determination and cannot be subject to a categorical rule as Biestek proposed in this case.

“Substantial evidence” is anything more than “a mere scintilla.” Under the categorical approach proposed by Biestek, the testimony of a vocational expert who refuses a request for supporting data would never constitute substantial evidence, which is an illogical result. If there is no demand for underlying data, the vocational expert’s testimony may count as substantial evidence even without supporting data. The mere addition of a request for that data should not render the expert’s testimony categorically inadequate.

Question 7

Cleveland v. Policy Management Systems Corporation (1999)

Answer 7

the Court held that SSDI and ADA claims do not conflict in such a way as to automatically bar anyone from raising them jointly. The Court explained that when determining SSDI eligibility, the significant ADA question of whether someone would have been capable of performing their job if “reasonable accommodations” had been made by their employer, is not considered. As such, the “reasonable accommodation” issue is left open for resolution during an ADA claim. The Court added that any inconsistencies between ADA and SSDI claims are even more trivial if the ADA claim is brought prior to an actual SSDI award - as Cleveland did. Even in clear cases, where a contradiction would seem to lie between the two claims, alleged victims must still have the opportunity to present their cases.