On August 25, 2014, the Ninth Circuit upheld a District Court decision that an ERISA administrator’s denial of a short-term disability (STD) benefit claim may not be based solely on an independent physician’s review of the “paper file.” May v. AT&T Umbrella Benefit Plan No. 1, 2014 WL 4180224 (9th Cir. 2014). While the Ninth Circuit chose not to publish its decision, it may nonetheless be used as authority against ERISA plans and administrators and raises the specter that paper reviews may be considered per se arbitrary under certain conditions.

The procedural posture of this ERISA benefit case was not unique. The Plaintiff, Marcus May, was a retail sales consultant for AT & T Mobility. May v. AT & T Umbrella Ben. Plan No.1, 2012 WL 1997810, *2 (N.D.Cal. 2012). After experiencing severe knee pain, he went on leave and sought treatment. During the course of treatment, he submitted a claim for STD benefits and, for a period of time, received STD benefits until the plan denied further benefits. Id. at *3 – 8. He then filed an appeal with the claims administrator. Id. at *8