{"id":7454,"date":"2020-04-06T15:47:08","date_gmt":"2020-04-06T20:47:08","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7454"},"modified":"2024-02-06T13:30:02","modified_gmt":"2024-02-06T18:30:02","slug":"scott-v-union-security-court-upholds-denial-of-an-orthopedic-surgeons-ltd-claim","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/scott-v-union-security-court-upholds-denial-of-an-orthopedic-surgeons-ltd-claim\/","title":{"rendered":"Scott v. Union Security – Court Upholds Denial of an Orthopedic Surgeon\u2019s LTD Claim"},"content":{"rendered":"\n
In this case, Andrew Scott (\u201cScott\u201d) was an orthopedic surgeon<\/a> focusing on sports medicine. His employer had a long-term disability (LTD)<\/a> plan through\u00a0Union Security Insurance Company\u00a0(\u201cUnion\u201d)<\/a>. The LTD plan defined \u201cdisability\u201d as follows:<\/p>\n\n\n\n \u201cDisability <\/em>or disabled <\/em>means that in a particular month, you satisfy one or more of the three Tests, as described below:<\/p>\n\n\n\n Occupation Test<\/p>\n\n\n\n Earnings Test<\/p>\n\n\n\n You may be considered disabled<\/em> in any month in which you are actually working, if an injury<\/em> . . . prevents you from earning more than 80% of your monthly pay<\/em> in that month in any occupation for which your education, training or experience qualifies you. . . .<\/p>\n\n\n\n . . .<\/p>\n\n\n\n You may still be considered disabled<\/em> according to the Occupation Test, without regard to your level of current earnings, if you meet the requirements of that Test.<\/p>\n\n\n\n[Third test not applicable here.]. . .<\/p>\n\n\n\n Gainful occupation<\/em> means an occupation in which you could reasonably be expected to earn at least as much as your Schedule Amount [in this case $6,000 per month].\u201d<\/p>\n<\/blockquote>\n\n\n\n In October 2012, the Plaintiff had surgery for a\u00a0rotator cuff injury<\/a>. As a result, he stopped working as a surgeon<\/a>. Union then notified Scott in February 2013 that he was approved for benefits under the plan, which were to begin in April with the possibility of extending to April 2023. This notification also informed Scott that after a 36-month period, the definition of disability would change, and another evaluation would be made at that time.<\/p>\n\n\n\n When the time neared for the definition change, Union began looking into Scott\u2019s potential eligibility to continue receiving benefits. Union\u2019s review included a 2013 evaluation from Scott\u2019s surgeon, which concluded that while Scott could not perform the work of his own occupation, he could perform full-time work with light-duty restrictions above the waist. <\/p>\n\n\n\n Union then performed a transferable skills analysis<\/a> and a labor market study. The analysis and study determined that Scott was qualified to perform four positions in his geographical area wherein he could earn as much as his scheduled amount. On September 30, 2015, Scott notified Union of a new job working as a front-line crew member at a Culver\u2019s Restaurant. He stated that he obtained this job to satisfy the Earnings Test.<\/p>\n\n\n\n Union sent a letter to Scott on November 5, 2015, explaining that he needed to meet the Occupation and Earnings Tests to continue receiving benefits. The letter improperly stated that he would need to meet both tests instead of only one, as required by the plan. Union also stated that it would continue to gather information regarding the disability benefits, asking that Scott inform it of any changes in work or medical condition. Later, Scott left the job at Culver\u2019s and began working in a medical office with the FDA. Soon after, he left his job at the FDA to be closer to his family. Union was informed of each of these job changes.<\/p>\n\n\n\n\n
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