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6th Cir.: “Arbitrary and capricious” and its application to definitions of disability

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  • 6th Cir.: “Arbitrary and capricious” and its application to definitions of disability

    In a new case from the 6th Circuit, the court explores the breadth of the “arbitrary and capricious” standard, and how that standard is applied to the claims review process when a new definition of disability is used.

    Plaintiff was granted LTD benefits for a period of time before LINA notified him that the definition of “disability” under the plan would be changing, and requested that he provide them with current medical information. As a result of LINA’s review, they found that Plaintiff no longer met the new definition of disability and terminated benefits.

    A vocational rehabilitation specialist conducted a transferable skills analysis and identified three occupations compatible with Kemper’s limitations and restrictions: telephone solicitor, food and beverage order clerk, and gate guard. By letter dated September 9, 2013, LINA notified Kemper of its determination that he no longer met the definition of “disability” and that he was not eligible for LTD benefits beyond November 28, 2013.
    After exhausting his appeal rights, Plaintiff filed an ERISA action, in which the district court found for LINA. This appeal followed, and the court found:

    LINA provided a reasoned explanation, based on the objective evidence, for its determination that Kemper did not satisfy the definition of “disability” under the “any occupation” standard. Accordingly, LINA’s decision to terminate LTD benefits was not arbitrary and capricious.
    The full opinion is attached below.
    Attached Files
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