Disability Benefits


These executive summaries were compiled from EMPLOYEE BENEFITS INFOSOURCE database, a source for information on employee benefits and human resources.

Telecommuting as a Reasonable Accommodation: A Remote Possibility?
Rocco, Dean A.; Employee Relations Law Journal; v40 no3 pp 48-52 Winter 2014; journal article

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Abstract : The Americans with Disabilities Act requires employers to provide reasonable accommodations for disabled workers that would not amount to undue hardship for the employer. The Equal Employment Opportunity Commission (EEOC) has issued guidance on whether work can be performed at home, while recognizing a range of considerations such as adequate supervision, access to materials and resources and the need for face-to-face interaction. The EEOC notes that partial telecommuting may serve as an accommodation, and can be limited in time or on an as needed basis. While telecommuting can boost productivity and morale, many employers are disinclined to support it. Courts have respected their denial of telecommuting, though situations must be reviewed case by case. Employers choosing to limit telecommuting should address the issue in employee handbooks, policies and job descriptions, and ensure policies and past practices are consistent with their position.

7 Questions Toward More Effective Workers' Comp Programs.
Skrocki, Ron; Benefits Magazine; v51 no11 pp 48-52 Nov 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : A workers compensation program works most effectively for both employers and employees if certain critical issues are considered. The program can be customized to reflect the organization's commitment to accident prevention, wellness and return to work goals. An ergonomic evaluation can help uncover causes of injuries, and a qualified nurse case manager can serve as liaison between patient and employer. A medication safety program can help circumvent opioid abuse and balance drug utilization with price. Catastrophic claims are rare but costly and require early intervention and medical management. Employers should be alert to possible effects of the Affordable Care Act, such as claims shifting from group health plans to workers compensation. Data from the workers comp program should be integrated with other claims data and analyzed as a whole to drive improvements across the program.

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EEOC Adopts Controversial Positions in Recently Issued Enforcement Guidance on Pregnancy and Related Issues.
Ennis, Peter J.; Employee Benefit Plan Review; v69 no5 pp 5-7 Nov 2014; journal article

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Abstract : The Equal Employment Opportunity Commission (EEOC) put out guidance based on a broad view of the Pregnancy Discrimination Act regarding accommodations for employees who are pregnant, have been pregnant or hope to become pregnant. The guidance addresses discrimination and decisions based on assumptions about an employee. The EEOC discusses accommodations such as leaves of absence and light duty, a matter to be resolved by the Supreme Court in Young v. United Parcel Service, Inc. It also addresses health insurance coverage of pregnancy and related conditions as well as contraceptive coverage, parental leave, and pregnancy-related conditions under the Americans with Disabilities Act Amendments Act (ADAAA). The EEOC allows exceptions to eligibility rules in leave policies for pregnant women. The agency recommends that pregnant women be treated like others with a medical condition but that circumstances be considered under the ADAAA, Family and Medical Leave Act and other federal and state laws.

EEOC Targets Wellness Incentives.
Dunning, Matt; Business Insurance; v48 no21 pp 1, 41 Oct 13, 2014; journal article

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Abstract : Lawsuits brought by the Equal Employment Opportunity Commission (EEOC) against two firms demonstrate the agency's requirement of strict compliance with the Americans with Disabilities Act (ADA) in connection with wellness programs. Flambeau Inc. and Orion Energy Systems Inc. penalized employees who did not complete health risk assessments and biometric screenings, in violation of the Affordable Care Act's (ACA) requirement that wellness program participation be voluntary. The two lawsuits contradict the Eleventh Circuit Appeals Court's ruling that allowed Broward County, Florida, to penalize employees who did not complete a health risk assessment. Some efforts to promote employee wellness are backfiring and creating uncertainty and tension between the ADA and ACA, and the EEOC has not produced formal nondiscrimination guidance as of late 2014. Many of the chronic diseases that wellness programs target qualify as disabilities under the ADA, blocking employers from applying standard incentives and conditions to those individuals and requiring reasonable accommodations to get a reward.

The Next Chapter for Return to Work.
Kuehner-Hebert, Katie; Risk & Insurance; v25 no7 pp 42-43 Sep 1, 2014; journal article

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Abstract : The improving economy and requirements of the Americans with Disabilities Act Amendments Act (ADAAA) are stimulating a resurgence in return to work programs, often geared toward reasonable accommodations for obese workers classified as disabled under the ADAAA. But a conflict exists between the ADAAA and workers compensation. Workers comp incentivizes employers to get workers back on temporary light duty, while an employee disabled by a nonwork condition may need long-term light duty as a reasonable accommodation. Employers should consider limiting light duty assignments to a specific time period and evaluate accommodation options on a case-by-case basis. In some cases nonoccupational accommodations, such as transitional placement in volunteer positions, may be useful. Inconsistent treatment of work-related and non-work-related injuries and conditions may open them to litigation.

Varied Response to EEOC's New Pregnancy Guidance.
Employee Benefit News; v28 no11 pp 10-11 Sep 1, 2014; journal article

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Abstract : Updated enforcement guidelines from the Equal Employment Opportunity Commission (EEOC) blend aspects of the Pregnancy Discrimination Act of 1978 and the Americans with Disabilities Act regarding pregnant employees. President Barack Obama has recognized the prevalence of women in the workforce and stressed the need to accommodate pregnant workers. The EEOC has prioritized eliminating pregnancy-related discrimination. The guidance clarifies that the EEOC does not permit an employer to distinguish those with work-related injuries from those limited by a nonwork related condition when considering accommodations, protecting pregnant workers.

Supporting Employee Success When Mental Health Is a Factor.
Baynton, Mary Ann; Plans & Trusts; v32 no5 pp 6-11 Sep-Oct 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : According to the Mental Health Commission of Canada, as many as 500,000 Canadians will not go to work in any given week because of mental illness. The unseen nature of mental healing may mean that employers do not know how to accommodate a worker returning from a mental health issue. Support should begin as soon as an employee takes mental health leave, with employers making regular contact with the employee. Employees' issues often can be addressed by reducing or eliminating one or two key stressors in the workplace. Increasing an employee's involvement in the most comfortable elements of the job can also help. A group of top Canadian occupational health and safety professionals have created Supporting Employee Success, a free online tool to help managers create back-to-work programs for employees with mental health issues.

Benefits Integration Picks up Steam.
Goldberg, Stephanie; Business Insurance; v48 no18 pp 13-14 Aug 18, 2014; journal article

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Abstract : While the financial benefits of integrating short and long term disability, workers compensation leave, family and medical leave and other absences are well recognized, the demand for compliance is adding impetus to the drive toward integration. The Family and Medical Leave Act, Americans with Disabilities Act and the Rehabilitation Act, as well as state laws and company policies impose complex and intertwined rules, prompting many employers to outsource leave management. Aon Hewitt reports that 36 percent of employers tie worker absence to corporate financial status and 22 percent connect health and absence management with workers comp in 2014, though over half may start by 2019. Though compliance and penalty concerns may spur integration, managing absence holistically through a total absence management program yields substantial opportunities for human resource management.

Court Affirms Denial of Benefits and Awards Attorney Fees.
Benefits Magazine; v51 no8 p 53 Aug 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The employee plaintiff in Spenrath v. Guardian Life Insurance Co. of America had seizurelike episodes that were not definitively diagnosed by her primary physician and two neurologists. She failed to undergo additional recommended testing. Inability to focus and poor performance reviews led her to stop work three years later and seek long-term disability benefits. The defendant plan administrator denied the claim, lacking medical evidence of any condition causing the functional impairment. The district court found the administrator properly considered all evidence provided and granted attorney fees for the defendant. The Fifth Circuit Appeals Court found no substantial evidence of disability, upheld the lower court, affirmed the attorney fee award and granted the defendant an additional $6,000 for attorney fees for the prolonged litigation of the plaintiff's weak case.

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Court Upholds Disability Plan's Discretion and Full and Fair Review Process.
Benefits Magazine; v51 no8 p 57 Aug 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The plaintiff in Prezioso v. Prudential Insurance Company of America was injured at work and fired the next day for failing to meet sales targets. He applied for but was denied short- and long-term disability benefits. The plan administrator stated the injury did not prevent the plaintiff from performing his job during the plan elimination period. The district court granted summary judgment for the defendant. The plaintiff appealed contending the court wrongly used the abuse of discretion standard of review since the plan language did not specify discretion for the defendant. The Eighth Circuit Appeals Court disagreed, finding wording regarding proof of disability satisfactory to the plan to clearly indicate discretion.

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Employers, Employees Increasingly at Odds Over Wellness Incentives.
Employer's Guide to Fringe Benefit Rules; v21 no2 pp 7-8 Aug 2014; journal article

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Abstract : A Kaiser Family Foundation survey found 76 percent of general public respondents support wellness programs, but 62 percent oppose mandatory employee participation, with similar results found among adults with employer-sponsored health insurance. Women are more likely to participate at 73 percent compared to 54 percent of men. The Society for Human Resource Management shows shifts in prevalence of wellness programs to contain long-term health care costs, used by 36 percent of respondents in 2014, 43 percent in 2013 and 28 percent in 2012. Incentives were most widely used for getting yearly health risk assessments, refraining from tobacco use and wellness program participation. Aon Hewitt reports one in five employers use tiered incentives, richer for those carrying out specific wellness activities and basic for others.

Worksite Education Key to Voluntary Disability Plan Success.
Lundquist, Barry; Broker World; v34 no8 pp 28-30, 32 Aug 2014; journal article

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Abstract : Health care reform has contributed to unprecedented change in the employee health benefit and disability insurance industries, for better or worse. Slightly more employers offered long term disability plans in 2013 than previously, but fewer employees took up the offer, according to the Council for Disability Awareness (CDA). The CDA's 2014 report also showed the average age of new disability claimants to be rising, though 41 percent of those approved were in their 40s or younger, women claim more but men are catching up, and the number of new claimants fell in 2013 but the payments increased. Most employees and brokers mistakenly see disability rising from accidents, failing to realize how often common disorders and illnesses interrupt the ability to work. These facts point to the need for stronger education on disability preparedness and rising opportunities for voluntary product sales.

Court Affirms VEBA's Denial of Disability Benefits.
Benefits Magazine; v51 no7 p 60 Jul 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Second Circuit Appeals Court ruled in St. Onge v. Unum Life Insurance Company of America that the defendant's benefit denial did not amount to abuse of discretion. The voluntary employee benefits association (VEBA) plan administrator found the plaintiff not disabled and denied disability benefits. The plaintiff asserted the defendant ignored evidence and misconstrued the record, applied the wrong criteria to assess the demands of the job and had a conflict of interest. The administrator consulted independent physicians, arranged a functional capacity exam and reviewed the plaintiff's physician's opinion. The Appeals Court found the medical review sufficient, the job task analysis unpersuasive and any conflict of interest to be absent, upholding summary judgment for the defendant.

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Court Awards Attorney Fees to Successful Plaintiff in Claim for Disability Benefits.
Benefits Magazine; v51 no7 p 62 Jul 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : After an employee suffered debilitating anxiety and depression following heart surgery, he applied for but was denied long-term benefits, despite his psychiatrist's recommendation. In Donachie v. Liberty Life Assurance Company of Boston the district court granted summary judgment for the plaintiff but denied the requested attorney fees. The Second Circuit Court of Appeals ruled the defendant's denial of disability benefits was arbitrary and capricious for ignoring substantial medical evidence. Considering the issue of attorney fees, the court noted fees should be granted to a prevailing party unless there is particular justification for not doing so. Finding no such justification, the appeals court vacated that portion of the lower court's decision and remanded the case to determine reasonable attorney fees for the plaintiff.

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Court Dismisses Benefit Claims Under the ERISA Antiretaliation Statute.
Benefits Magazine; v51 no7 p 61 Jul 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Fifth Circuit Court of Appeals upheld the lower court's grant of summary judgment for the defendant in Parker v. Cooper Tire and Rubber Company. Fired for missing several work days and failing to provide proper notice, the plaintiff sued for wrongful termination to avoid having to pay medical costs and for violating ERISA Section 510 on retaliation. The district court found the plaintiff did not establish a case showing specific intent to interfere with his benefits since the plaintiff had never applied for long-term disability benefits. The Appeals Court agreed and noted no retaliation claim could be based on the short-term disability benefit plan since it was not an ERISA plan. The court also noted the plaintiff could not establish a prima facie ERISA retaliation case since he was physically unqualified to perform his job.

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Disability Insurance Benefits Impact Employees' Financial Outlook.
Owenby, Matthew; Employee Benefit Plan Review; v69 no1 pp 14-15 Jul 2014; journal article

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Abstract : Being unable to work for a year would be financially devastating for nine in ten households, according to America's Health Insurance Plans, but voluntary disability insurance can provide a financial safety net. Offering disability insurance as an option has little monetary effect on an employer but serves as a competitive advantage with employees. While few employees think much about disability, the Social Security Administration reports that one in four 20-year olds will become disabled before retirement age, most likely from a chronic illness. Disability insurance pays cash benefits for costs not covered by major medical insurance, including living expenses such as mortgage and other necessary payments. It also delivers fast and reliable coverage not provided through workers compensation of Social Security Disability.

ERISA Claims Accrues With First Clear Underpayment.
Benefits Magazine; v51 no7 p 64 Jul 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The plaintiff in Riley v. Metropolitan Life Insurance Company worked for the defendant until debilitated by pain and depression. After receiving short-term disability benefits, he returned to work in a power paying position, then left again and was awarded long-term benefits, calculated relative to the lower salary. The plaintiff disputed the calculation, brought a state suit two years later and finally sued under ERISA seven years after first receiving the benefits in question. The court agreed with the defendant that the suit was time barred and was upheld by the First Circuit Court of Appeals, using Massachusetts' six-year statute of limitations. While the plaintiff asserted each benefit payment restarted the limitations period, the appeals court held the claim accrues on the date of receipt or notice of the first underpayment, siding with three other circuit courts.

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10 Valuable Tips for FMLA, ADA Compliance.
Leave and Disability Coordination Handbook; v17 no4 pp 2, 16 Jun 2014; journal article

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Abstract : A variety of court cases and DOL claims of interference with benefits or retaliation highlight important details for compliance with the Family and Medical Leave Act and the Americans with Disabilities Act. Employers may not seek a health care provider's opinion on an employee's fitness to return to duty until the individual has resumed work. An employee may agree not to pursue retrospective interference or retaliation claims through a signed severance contract. Employers should have clear criteria for choosing individuals and positions affected by a workforce reduction. FMLA protections cover employees caring for seriously ill family members. Notices of disability-related termination of employment should be unequivocal. Employees returning from FMLA leave are entitled to an equivalent job, if not the job they left. Additional tips pertain to protected leave, requirements to take FMLA leave, physician's notes for intermittent absences and extensions of leave as reasonable accommodation.

Can an Employer Require 'Job Readiness' in a Return-to-Work Form?
Susser, Peter A.; Leave and Disability Coordination Handbook; v17 no4 pp 1, 6-7 Jun 2014; journal article

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Abstract : Employers may require medical documentation showing an employee ending a medical leave is ready to return to work but must be mindful of differing requirements of the Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA). The FMLA requires employers to notify employees at the start of leave about any required fitness for duty examination, though it applies only to the condition prompting the leave and must be applied uniformly. Employers may not mandate a second opinion but may seek clarification from the employee's physician with the employee's consent. The ADA allows a return-to-work exam by a physician of the employer's choice. An employer is not required to reinstate the employee in the same or equivalent position if it would cause undue hardship for the company. The employer may provide for an examination to judge whether the employee's condition poses a direct risk to personal safety, in view of a formal job description, and then consider reasonable accommodations or other actions.

Court Affirms the Denial of Short-Term Disability Benefits.
Benefits Magazine; v51 no6 pp 57, 59 Jun 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : In Fite v. Bayer Corporation et al. the plaintiff was diagnosed with major depressive disorder and was granted short-term disability (STD) benefits for up to 26 weeks. The plan's third-party administrator (TPA) extended the benefits within the time limit but reversed when it did not receive satisfactory medical evidence of disability. The plaintiff submitted additional evidence which was reviewed by the TPA's independent psychiatrist, leading the TPA to uphold the denial for lack of evidence of functional impairment. The plaintiff submitted more evidence when appealing to the defendant ERISA committee, leading to consultation with a third independent psychiatrist and an examination by a fourth, who found inadequately documented disability and attributed it to the plaintiff's employment. This point was key since employment-related mental conditions were excluded from STD plan coverage. The district court granted summary judgment for the defendants and was upheld by the Tenth Circuit Appeals Court. The plaintiff had stated her condition was a result of her job, the plan language was clear and her claim had been given a full and fair review.

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Court Finds Claims Time-Barred and Preempted Under ERISA.
Benefits Magazine; v51 no6 p 64 Jun 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The plaintiff in Costa v. Astoria Federal Savings and Loan Association et al. alleged she became totally disabled in 2003 and unable to work. She filed for and was awarded Social Security disability benefits and requested disability pension benefits from her employee welfare benefits plan. She asserted her requests to the benefit plan were denied and that she was told she was not entitled to benefits until age 55. In her suit she stated she was entitled to benefits and a declaratory judgment on her rights to future benefits and that the defendants violated ERISA in denying her benefits and breached their fiduciary duty. Since the legal action started in 2013, over seven years after the clear denial of benefits in 2005, the court ruled all claims are time-barred. The court also ruled that ERISA preempts the state law causes of action and dismissed the entire complaint with prejudice.

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Court Finds No Specific Intent to Interfere With ERISA Benefits.
Benefits Magazine; v51 no6 p 59 Jun 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : An individual who filed for short-term disability benefits two weeks after being terminated from employment was found ineligible for benefits and unable to show the employer's intent to interfere with her benefits under ERISA, the Family and Medical Leave Act and disability discrimination laws. The plaintiff in Barnhardt v. Open Harvest Cooperative asserted the defendant employer knew she would apply for disability benefits during a medical leave and terminated her employment to block her claim. The district court ruled for the defendant. The Eighth Circuit Court of Appeals noted the plaintiff must prove a defendant's specific intent to interfere with an employee's ERISA benefits to win an ERISA Section 510 interfere claim. The plaintiff was unable to show direct evidence of such intent, nor that the employer's failure to pass through a premium payment indirectly reflected specific intent to interfere, nor that she was terminated in order to interfere with her rights. The Eighth Circuit upheld the district court's summary judgment for the defendant.

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Other Recent Decisions.
Benefits Magazine; v51 no6 pp 66-69 Jun 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : In The American Medical Association v. Connecticut General Life Insurance Company the Eleventh Circuit Court of Appeals upheld the district court's dismissal of the case. The plaintiffs had complained that the defendant improperly distributed reimbursement payments for out-of-network health care services, but the claims had already been released through previous settlement agreements. The district court had discretion to dismiss and an appeal would violate that court's order. In Garrett v. Principal Life Insurance Company the Tenth Circuit upheld the lower court's decision to reverse the defendant insurance company's denial of benefits. After the plaintiff received inpatient substance abuse treatment, the defendant first denied coverage for a noncovered facility and then stated inpatient treatment was not covered at all. The defendant contested the court's award of full costs to the plaintiff, but the court rejected any new arguments about costs or calculations not present in the administrative record. In Melamed v. Blue Cross of California and Anthem Blue Cross Life and Health Insurance Company the Ninth Circuit affirmed the lower court's judgment in dismissing the plaintiff's case with prejudice. The plaintiff alleged he was underpaid by the defendant company for health services delivered as an out-of-network provider. Preempted by ERISA, the case was dismissed with prejudice under the two dismissal rule of the Federal Rules of Civil Procedure Rule 41, since the plaintiff had voluntarily dismissed other substantially similar claims. In Salz v. Standard Insurance Co. the Ninth Circuit reversed the district court's decision to deny long-term disability benefits. The plaintiff was injured on the job and was granted Social Security benefits. The appeals court found the lower court erred by permitting an overly narrow consideration of job performance requirements and definition of sedentary, and further noted the potential conflict of interest in the defendant's dual role as plan funder and administrator. In Central States, Southeast and Southwest Areas Pension Fund v. Wingra Stone Company, the plaintiff multiemployer pension fund sought compensation for years of defendant contributions at a rate governed by an outdated and nonspecific contract addendum. The defendant continued payments to meet its contribution obligations despite questions as to the amount. The Seventh Circuit Appeals Court found the lower court erred by not looking at the defendant's contribution history in light of amended contracts. The court found summary judgment inappropriate and vacated and remanded the case to examine the contract negotiating history.

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Time to Tackle Telecommuting.
Hyman, Joe; Workforce; v93 no6 p 20 Jun 2014; journal article

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Abstract : Yahoo's 2013 ban on telecommuting was roundly criticized, and in 2014 a federal appeals court recognized that technology advances support telecommuting as a reasonable accommodation for disabled workers. The limited scope of that recognition is likely to expand as working at home becomes more feasible. Employers who want to prohibit work at home should have a solid defense based on job descriptions, cost of managing a telecommuting program and alternative accommodations for the disabled. Tracking hours to comply with the Fair Labor Standards Act and making accommodations for the Americans with Disabilities Act can be a challenge. Those employing telecommuters should clearly communicate the work hours, require employees to carefully track their time and oversee the work product. Overall, the benefits of permitting telecommuting outweigh disadvantages.

Court Affirms Denial of Disability Benefits.
Benefits Magazine; v51 no5 pp 53, 55 May 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Following a back injury, an employee was granted 24 months of benefits under a long-term disability plan, but continuing coverage required total and continuous inability to work in any occupation. Reports from the employee's health care providers supported her light duty, sedentary, part-time work. The claims administrator considered these reports and additional medical evidence and found the employee did not meet the plan's definition of disabled and terminated benefits. In McClain v. Eaton Corporation Disability Plan, the district court granted summary judgment for the defendant plan and administrator. The Sixth Circuit Appeals Court upheld the denial of benefits, finding the defendant gave due consideration to the treating physician's reports, followed the terms of the plan and ultimately came to its conclusion using a deliberate and principled reasoning process.

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