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Crider v. Highmark Life Ins. Co., 458 F.Supp.2d 487

Facts

Scott Crider worked as a Yard Supervisor for Wickes Lumber Company until he suffered a back injury while lifting heavy bundles of shingles. After receiving LTD benefits for 24 months, Highmark terminated his benefits, claiming he was no longer disabled under the policy's definition. Crider contested this decision, leading to a series of medical evaluations and vocational assessments, which ultimately concluded that he was still entitled to benefits due to his ongoing disability.

Plaintiff, Scott Crider, began working for Wickes Lumber Company as a truck driver on May 4, 1998. One month later, he was promoted to Yard Supervisor, a position he held until August 25, 1999. On that day, plaintiff suffered a back injury on the job while lifting 100–pound bundles of shingles.

Issue

Did Highmark Life Insurance Company properly terminate Scott Crider's long-term disability benefits under the terms of the ERISA plan?

Did Highmark Life Insurance Company properly terminate Scott Crider's long-term disability benefits under the terms of the ERISA plan?

Rule

The court applied a de novo standard of review due to the lack of proper delegation of discretionary authority to the claims administrator, and assessed whether the termination of benefits was arbitrary and capricious.

The District Court, Scoville, United States Magistrate Judge, held that: 1 because third-party claims administrator was not properly delegated discretionary authority, its decision terminating claimant's LTD benefits had to be reviewed under de novo standard.

Analysis

The court determined that the claims administrator's decision to terminate Crider's benefits was not adequately supported by the medical evidence and failed to consider the vocational assessments that indicated Crider's limitations. The court emphasized that the insurer's reliance on certain medical evaluations was flawed and did not align with the overall evidence presented.

Upon review of the administrative record, the court finds that the decision to terminate plaintiff's LTD benefits does not withstand de novo review.

Conclusion

The court ordered Highmark to reinstate Crider's LTD benefits and to provide a schedule of past-due benefits along with prejudgment interest, concluding that the termination of benefits was unjustified.

The court ordered the insurer to reinstate benefits and to file schedule of past-due benefits along with calculation of prejudgment interest.

Who won?

Scott Crider prevailed in the case because the court found that Highmark's termination of his benefits was not supported by sufficient evidence and did not comply with the required standards of review.

Scott Crider prevailed in the case because the court found that Highmark's termination of his benefits was not supported by sufficient evidence and did not comply with the required standards of review.

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