In Kavanay v. Liberty Life Assurance Company of Boston, the plaintiff sought long term disability benefits from Liberty Life, the insurer of his ERISA governed disability plan. The court held that Liberty abused its discretion, granted plaintiff summary judgment, and awarded disability benefits.
The plaintiff worked as an insurance adjuster for Allstate; he was an “outside claims examiner”. Plaintiff’s entitlement to benefits was subject to the “own occupation” definition of “disability”. Instead of considering the duties of an outside claims examiner, Liberty evaluated whether the plaintiff could work based upon the Dictionary of Occupational Titles job of “inside claims examiner”. The court held that even though Liberty had the right to look at how the plaintiff’s job was performed in the national economy it could not simply ignore his actual job duties:
However, the Fifth Circuit has rejected the argument that the specific tasks listed by a claimant’s own employer are irrelevant to an “own occupation” analysis, noting that “while the correct standard is the occupation in the general economy and not the specific job for a specific employer, the specific duties of the employee’s job, as described by the employer, are relevant.” See Burtch v. Hartford Life & Accident Ins. Co., 314 Fed. Appx. 750, 2009 WL 714078, at 4 (5th Cir. 2009)(citing Robinson v. Aetna Life Ins. Co., 443 F.3d 389 (5th Cir. 2006) (“Though her precise duties do not define her regular occupation, in this case they well illustrate the duties of a director of nursing at a small health care facility and nothing in the record provides any basis for thinking that such a position at a facility comparable to hers requires different duties.”). Here, it is apparent that in selecting the sedentary position of Inside Claims Examiner from the D.O.T. as establishing the requirements of Kavanay’s “own occupation,” Liberty arbitrarily disregarded the nature of Kavanay’s position with Allstate and the specific tasks he was required to perform as an Outside Claims Adjuster. Its consequent determination that Kavanay was not disabled because he was not medically precluded from performing the sedentary occupation of Inside Claims Examiner amounts to an abuse of discretion and cannot stand. It follows that Liberty’s motion for summary judgment must be denied.
Disclaimer: This was not a case handled by disability attorney Nick A. Ortiz. The court case is summarized here to give readers a better understanding of how Federal Courts decide long term disability ERISA claims.
Here is a PDF copy of the decision: Kavanay v. Liberty Life Assurance Co. of Boston