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Corey v. Sedgwick Claims Management Services, Inc.

United States Court of Appeals, Sixth Circuit

June 8, 2017

Bruce Corey, Plaintiff-Appellant,
v.
Sedgwick Claims Management Services, Inc.; Eaton Corporation; Eaton Corporation Disability Plan for U.S. Employees; Eaton Health and Welfare Administrative Committee, Defendants-Appellees.

          Argued: March 16, 2017

         Appeal from the United States District Court for the Northern District of Ohio at Cleveland. No. 1:15-cv-01736-Patricia A. Gaughan, District Judge.

         ARGUED:

          Andrew L. Margolius, MARGOLIUS, MARGOLIUS AND ASSOCIATES, Cleveland, Ohio, for Appellant.

          Maynard A. Buck, BENESCH FRIEDLANDER, COPLAN & ARONOFF LLP, Cleveland, Ohio, for Appellees.

         ON BRIEF:

          Andrew L. Margolius, MARGOLIUS, MARGOLIUS AND ASSOCIATES, Cleveland, Ohio, for Appellant.

          Maynard A. Buck, Richard Hepp, BENESCH FRIEDLANDER, COPLAN & ARONOFF LLP, Cleveland, Ohio, for Appellees.

          Before: BOGGS, ROGERS, and COOK, Circuit Judges.

          OPINION

          COOK, Circuit Judge.

         Plaintiff Bruce Corey worked as a machine operator in Eaton Corporation's Northern Ohio factory. Corey has long suffered from cluster headaches- extremely painful attacks that strike several times per day for weeks on end. In 2014, Corey applied for short-term disability benefits under Eaton's disability plan after a bout of headaches forced him to miss work. After granting a period of disability, the third party administering Eaton's disability plan ("the Administrator") discontinued benefits because Corey failed to provide objective findings of disability.

         Under the plan, "[o]bjective findings include . . . [m]edications and/or treatment plan." Corey's physicians treated his headaches by prescribing prednisone, injecting Imitrex (a headache medication), administering oxygen therapy, and performing an occipital nerve block. We must decide whether Corey's medication and treatment plan satisfy the plan's objective-findings requirement. We hold that it does and therefore REVERSE the district court's contrary decision.

         I.

         Plan Terms. Eaton's disability plan accords the Administrator discretion to interpret the plan's terms and determine benefits eligibility. Under the plan's terms, an employee is eligible for short-term disability benefits if he has "a covered disability, " which the plan defines as "an occupational or non-occupational illness or injury [that] prevents [the employee] from performing the essential duties of [the employee's] ...


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