Argument of Speaker
Mr. Speaker: The opinion of the Court in No. 02-469, Black & Decker Disability Plan versus Nord will be announced by Justice Ginsburg.
Argument of Justice Ginsburg
Mr. Ginsburg: Under a rule adopted by the Social Security administration, in determining whether a claimant is entitled to Social Security disability benefit, special weight is accorded opinions of the claimant's treating physician.
The question presented in this case, does a similar rule favoring opinions of treating physicians apply to disability determinations under Employee Benefit Plans covered by the Employee Retirement Income Security Act of 1974 an act known to the Bar and Bench as ERISA?
The answer we hold is no, treating physician opinions need not be favored over other evidence relevant to the claimant's medical condition.
ERISA and the Secretary of Labor's regulations under that act require full and fair evaluation of claims and when benefits are denied, clear communication to the claimant of the specific reasons for the denial.
These prescriptions by their terms did not command plan administrators to accord special deference to the opinions of treating physician.
Should a treating physician will be adopted for whatever potential it may have to increase the accuracy of disability determination under ERISA plans?
That question, we think is one the legislature or superintending administrative agency is best position to address.
Critical differences between the Social Security disability program and ERISA benefit plans portion against judicial importation of an agency ordered treating physician rule from the former area into the latter.
Social Security is an obligatory nationwide program in which the decision maker evaluates the claimant's condition under a uniform set of federal criteria.
ERISA plans come in different sizes and shapes; benefit determinations under those plans are likely to turn in large part on interpretation of the terms of the particular plan at issue.
Absent Department of Labor endorsement, today's opinion settles courts may not order application of a treating position rule to ERISA governed employee benefit claims.
The District Court so held in this case but the Court of Appeals for the Ninth Circuit disagreed declaring that a treating physician rule does apply to disability plans covered by ERISA.
Finding that declaration erroneous, we vacate the Ninth Circuit judgment and we ran the case for further proceedings.
The decision is unanimous.
