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May 28, 2003
Supreme Court Shoots Down 'Treating Physician' Rule

The U.S. Supreme Court ruled Tuesday that employer-sponsored disability programs need not defer to the views of an employee's personal doctor when deciding whether to provide disability benefits.

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The court unanimously rejected a lower-court ruling that private-sector disability plans provided under the Employee Retirement Income Security Act (ERISA) must apply a "treating physician rule" when evaluating employee claims.

The Dow Jones Newswires reports that the ruling could give companies more control over the cost of long-term disability programs.

Until Tuesday's ruling, courts had issued conflicting rulings on whether the treating physician rule - used by the Social Security Administration for federal disability programs - should also apply to private-sector disability plans.

The high court clarified the issue in ruling on a dispute between Black & Decker Corp. and one of its employees, Kenneth Nord. A back injury led Nord to file for long-term disability in 1997, but his request was rejected after an independent examination determined the injury didn't prevent Nord from doing his job. Nord's personal doctor felt differently. Litigation ensued.

A federal trial judge sided with Black & Decker, then the 9th U.S. Circuit Court of Appeals in San Francisco reversed, holding the treating physician's view takes precedence when there are conflicting opinions about an employee's condition.

The Supreme Court, in turn, reversed the appeals court. "We hold that plan administrators are not obliged to accord special deference to the opinions of treating physicians," Justice Ruth Bader Ginsburg wrote in the court's opinion.

She added that state legislatures, not the courts, should decide if relying on the treating physician would help plans make more accurate decisions about medical conditions.

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