Anderson v. Trumbull-Mahoning Medical Group, Inc., 2000 U.S. App. LEXIS 5482 (6^th Cir. Mar. 22, 2000) (unpublished)-Anderson sued Trumbull-Mahoning Medical Group Inc. and Paul Revere Insurance Company, after it determined that she was due a monthly disability benefit of only $1,250 instead of $3,400.  The issue was the timing of her disability.  This court affirmed the district court's decision that Anderson did not suffer a "loss" under the terms of the policy until the time at which she was unable to work—not the time when she first noticed her sickness.  "The coverage provided to Anderson by Revere was, after all, disability insurance and not health insurance."

Before this later date, Anderson had signed a "change application" with Revere, requesting less disability coverage in exchange for lower annual premiums.  Therefore, the plan entitled her to coverage under the policy rider that reduced the monthly benefit payments.

            This court hedged on the issue of the appropriate standard of review of the administrator's decision. Anderson had alleged that the district court improperly reviewed the plan administrator's decision under the arbitrary and capricious standard, rather than the de novo standard. The court simply stated that it need not reach the issue since it would affirm under either standard.  The policy language conditioned benefits on ". . . [receiving] satisfactory written proof of loss."  In a footnote, this court observed that while the 6^th Circuit had found that discretion flowed from this language, a 7^th Circuit decision found that it did not.  See Osborne v. Cyprus Mountain Coals Corp., 1998 U.S. App. LEXIS 30021 (6^th Cir. Nov. 19, 1998) and Herzberger v. Standard Ins. Co., 205 F.3d 327 (7^th Cir. 2000).