{"id":7466,"date":"2020-04-06T22:04:38","date_gmt":"2020-04-07T03:04:38","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7466"},"modified":"2024-02-01T13:28:26","modified_gmt":"2024-02-01T18:28:26","slug":"cheney-v-standard-court-rules-claimant-meets-the-definition-of-disability","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/cheney-v-standard-court-rules-claimant-meets-the-definition-of-disability\/","title":{"rendered":"Cheney v. Standard – Court Rules Claimant Meets the Definition of Disability"},"content":{"rendered":"\n

Case Name: <\/strong>Carole Cheney v. Standard Insurance Company<\/p>\n\n\n\n

Court: <\/strong>United States District Court for the Northern District of Illinois<\/p>\n\n\n\n

Date of Decision: <\/strong>August 28, 2014<\/p>\n\n\n\n

Type of Claim:\u00a0<\/strong>Long-Term Disability<\/a>\u00a0under the\u00a0Employee Retirement Income Security Act (\u201cERISA\u201d)<\/a><\/p>\n\n\n\n

Insurance Company: <\/strong>Standard Insurance Company<\/a><\/p>\n\n\n\n

Claimant\u2019s Employer: <\/strong>Kirkland & Ellis<\/p>\n\n\n\n

Claimant\u2019s Occupation \/ Job Position:\u00a0The plaintiff<\/strong> was a long-time attorney at Kirkland & Ellis LLP, eventually becoming a non-share partner specializing in appellate and commercial litigation.<\/p>\n\n\n\n

Disabilities:\u00a0<\/strong>Plaintiff had had a twenty-year history of back<\/a> and neck pain<\/a>, with periods of \u201cflare-ups\u201d that have required physical therapy and surgery, having her workstation modified according to an ergonomic assessment, and ultimately working from home on most days starting in 2003. Plaintiff explained that after years of struggling with severe neck and back pain, she finally reached a point where she could no longer sit, stand, or work at a desktop computer for prolonged periods without debilitating cervical spinal pain.<\/p>\n\n\n\n

Definition of Disability:\u00a0<\/strong>The parties agree that the plaintiff\u2019s eligibility for benefits is determined based on whether she can perform her \u201cown occupation.\u201d The policy provides,<\/p>\n\n\n\n

\n

\u201cDuring the Benefit Waiting Period and the Own Occupation Period, you are required to be Disabled only from your Own Occupation.<\/p>\n\n\n\n

You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury, Pregnancy, or Mental Disorder, you are unable to perform with reasonable continuity the Material Duties of your Own Occupation.\u201d<\/p>\n<\/blockquote>\n\n\n\n

Other Key Definitions in the Policy: <\/strong>The \u201cActive Work\u201d clause found in the policy provides that a participant,<\/p>\n\n\n\n

\n

\u201cMust be capable of Active Work on the day before the scheduled effective date of your insurance or your insurance will not become effective as scheduled. If you are incapable of Active Work because of Physical Disease, Injury, Pregnancy or Mental Disorder on the day before the scheduled effective date of your insurance, your insurance will not become effective until the day after you complete one full day of Active Work as an eligible Member.<\/p>\n\n\n\n

Active Work<\/strong> and Actively At Work<\/strong> mean performing with reasonable continuity the Material Duties of your Own Occupation at your Employer\u2019s usual place of business.\u201d<\/p>\n<\/blockquote>\n\n\n\n

The policy defines \u201cOwn Occupation\u201d and \u201cMaterial Duties\u201d to mean,<\/p>\n\n\n\n

Own Occupation<\/strong> means any employment, business, trade, profession, calling, or vocation that involves Material Duties of the same general character as the occupation you are regularly performing for your Employer when Disability begins. In determining your Own Occupation, we are not limited to looking at the way you perform your job for your Employer, but we may also look at the way the occupation is generally performed in the national economy. If your Own Occupation involves the rendering of professional services and you are required to have a professional or occupational license in order to work, your Own Occupation is as broad as the scope of your license.<\/p>\n\n\n\n

Material Duties<\/strong> means the essential tasks, functions, and operations, and the skills, abilities, knowledge, training, and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted.<\/p>\n\n\n\n

Benefits Paid?\u00a0<\/strong>No. On October 9, 2012, Standard informed the plaintiff that her claim for long-term disability benefits was denied. In evaluating the plaintiff\u2019s claim for benefits, the defendant Standard consulted with three specialists. Dr. Waldram concluded that the plaintiff,<\/p>\n\n\n\n

\n

\u201cwould have been able to work at a sedentary level position up to the time of surgery as long as she was able to change workstation positions, which in my understanding had been allowed, moving and standing after periods of sitting for 45 minutes to an hour.
***
I find no evidence that desktop use of the extremity would be an issue as she has no neurologic findings. Her low back would require again moving around in the workplace avoiding prolonged sitting.\u201d<\/p>\n<\/blockquote>\n\n\n\n

The vocational expert<\/a> also submitted a report documenting that the occupation of a lawyer would be defined as \u201csedentary as it is generally performed\u201d and noted,<\/p>\n\n\n\n

\n

\u201cA lawyer could further alternate between periods of sitting and periods of standing or walking by making use of commonly accessible ergonomic accommodations. Equipment such as a sit\/stand station for duties involving computer work or keyboarding as well as a standing height desk for tasks such as paperwork or document reviews would allow an individual to further vary the amount of time spent in different positions.\u201d<\/p>\n<\/blockquote>\n\n\n\n

The report also found that these accommodations would allow a lawyer to go from sitting to standing every 45 minutes.<\/p>\n\n\n\n

Basis For Denial \/ Termination of Benefits:\u00a0<\/strong>Defendants, Standard Insurance Company, and Long Term Disability Insurance argue several reasons for the plaintiff\u2019s lack of coverage during the relevant period. But even if she was covered, they assert that she cannot establish disability because of her lack of consistent medical treatment, Standard\u2019s consulting physicians\u2019 opinions that she was capable of sedentary work, and because there were no objective measurements of functional limitations at the time she ceased work.<\/p>\n\n\n\n

Key Medical Provider Opinions:<\/b> By 2011, the plaintiff claimed that her condition had become intolerable. Physical therapy notes in April and May show pain from sitting for prolonged periods and constant pain that makes it hard for her to \u201cconcentrate while trying to work.” By November 2011, the plaintiff\u2019s chiropractor noted that the plaintiff\u2019s pain \u201cinhibits her ability to perform her job, and disrupts every [activity of daily living] once exacerbated\u201d and indicated that the plaintiff \u201conly felt better when she had a break from paperwork\/computer.\u201d<\/p>\n\n\n\n

After the plaintiff started her leave of absence, she claims her condition worsened, and by March 2012, her chiropractor recommended that she consult with a specialist. The next month, the plaintiff saw neurosurgeon Douglas Johnson, M.D., Ph. D., who recommended a twelve-week physical therapy program with concurrent cervical epidural injection therapy with pain specialist Narayan Tata, M.D. By June 2012, Dr. Tata performed a cervical discogram showing \u201cinternal disc disruption,\u201d indicating the plaintiff\u2019s pain was \u201cemanating from the C5-C6 disc level.\u201d Because of \u201cno notable change in her condition\u201d and an indication that physical therapy seemed to make the plaintiff feel worse, Dr. Johnson recommended surgery \u201cto decompress nerve tissue.\u201d Dr. Johnson also indicated that the plaintiff was \u201cunable to work.\u201d<\/p>\n\n\n\n

In August 2012, before the insurance company issued its decision, the plaintiff underwent surgery to fuse her cervical spine. During surgery, it was discovered that the plaintiff\u2019s C5 disc was unstable, requiring it to be removed. The plaintiff wore a fixed collar for six months post-surgery to restrict her neck movement.<\/p>\n\n\n\n

Issues: <\/strong>The case presents two principal issues: whether the plaintiff, Carole Cheney, had insurance coverage on her date of disability, making her eligible for long-term disability benefits, and, if so, whether the plaintiff can establish that she indeed was disabled under the policy.<\/p>\n\n\n\n

As to the coverage issue, Defendants argue that the plaintiff\u2019s coverage terminated on December 20, 2011, because she ceased working on December 19, 2011. Not disputed is that the plaintiff took a leave of absence from the law firm beginning on January 3, 2012. Everything else, however, is disputed. Defendants argue that it is more likely that the plaintiff\u2019s coverage ended even before December 20, 2011, because she had been working from home for several years. Defendants\u2019 argument here focuses on the \u201cActive Work\u201d clause found in the policy.<\/p>\n\n\n\n

Concerning proving disability, the plaintiff argues that under an occupation-specific disability insurance policy, an insured is entitled to recovery if that individual cannot perform even a single material job duty. In the case of the plaintiff, because she experiences pain while sitting, which hinders her ability to concentrate, she argues that she is unable to fulfill both the physical and cognitive requirements of her \u201cOwn Occupation.\u201d<\/p>\n\n\n\n

\u201cBut plaintiff argues that under an occupation-specific disability insurance policy, an insured is entitled to recovery so long as that individual is unable to perform even a single material job duty. In the case of the plaintiff, because she experiences pain while sitting, which hinders her ability to concentrate, she argues that she is unable to fulfill both the physical and cognitive requirements of her \u201cOwn Occupation.\u201d<\/p>\n\n\n\n

Plaintiff principally relies on\u00a0McFarland v. General American Life Insurance Company<\/em>, where the Seventh Circuit analyzed policy language requiring that a person be \u201ctotally disabled\u201d to receive benefits. That term was defined as \u201c\u2018unable to perform the material and substantial duties of [his] regular occupation.\u2019\u201d In that case, the parties agreed that the plaintiff could not perform 65% of his former duties. The court was left to determine whether that reduction in abilities rendered the plaintiff unable to execute the \u201cmaterial and substantial duties\u201d of his job.<\/p>\n\n\n\n

\u2026<\/p>\n\n\n\n

The plaintiff also refers to our sister courts that have determined, where the policy language is occupation-specific, that the loss of a single material job duty is sufficient to find disability. For example, in\u00a0Lockhart v. Jefferson Pilot Financial Insurance Company<\/em>, Judge Coar held that \u201ceven if plaintiff\u2019s hands can literally grasp a telephone, but doing so would exhaust her or cause her pain, then she cannot be said to be able to functionally perform that task.\u201d In\u00a0Rahman v. Paul Revere Life Insurance Company<\/em>, Judge Aspen found that because it was uncontroverted that one of the \u201cessential aspects\u201d of the plaintiff\u2019s pre-injury job, who was an emergency room cardiologist<\/a>, was to run to his patients, his inability to run alone rendered him disabled.\u201d<\/p>\n\n\n\n

Holdings:<\/b> (1) The provision dictating when coverage ends is more appropriate than the provision referenced by the plaintiff because she indeed received approval, in advance and in writing by her employer, for temporary leave, which was to last six months. Considering any ambiguity in the policy in favor of the insured, the appropriate date for coverage to end is nine months after her temporary leave, which would be in September 2012.<\/p>\n\n\n\n

(2) \u201cA fair reading of the policy language here supports the view that to be considered disabled, Plaintiff must be unable to perform only a single material duty of her occupation. At this point in our analysis, then, we must determine whether the severity of her condition, degenerative disease of her cervical spine, has caused her such severe pain that an \u201cessential\u201d or material duty of her job has been lost. Defendants paint a picture of the plaintiff\u2019s condition as lacking inconsistent treatment, with few serious problems documented by medical professionals, and a work history that had limited hours and maximum flexibility.\u201d<\/p>\n\n\n\n

The Court continued,<\/p>\n\n\n\n

\u201cBut we do agree with the plaintiff that the record corroborates her pain complaints, and her attempts to use ergonomic accommodations to alleviate her pain to no avail. And the non-examining doctors relied on Standard, who found the plaintiff capable of general sedentary work, failed to opine on the plaintiff\u2019s non-exertional limitations<\/a> and how those would affect her ability to perform the high-stress work of a litigation partner. We can say in relying on the non-examining doctors, Standard \u201cglossed over\u201d the issue of the plaintiff\u2019s need to concentrate and perform the \u201cmental demands of the active practice of law.\u201d<\/p>\n\n\n\n

Important for this case is the distinction that the policy allows for benefits if the plaintiff is unable to perform a single \u201cessential\u201d duty of her occupation, not whether she can perform any sedentary occupation.\u201d<\/p>\n\n\n\n

\u2026.<\/p>\n\n\n\n

\u201cSedentary work, in general, may accommodate such a condition, as Standard\u2019s medical consultants stated. But their conclusion did not consider the qualitative and quantitative aspects of the plaintiff\u2019s work as a litigation partner. We find this is the crux of this case. Whether the plaintiff can find other, less demanding, work as a lawyer is not the question. \u201cOwn occupation\u201d is defined as \u201cduties of the same general character\u201d as the occupation plaintiff is \u201cregularly performing.\u201d Even looking to the duties of a litigation partner \u201cin the national economy,\u201d as the policy allows Standard to do, the essential duties affected by the plaintiff\u2019s condition remain the same. We, therefore, find that because of her reduced abilities, she was \u201cunable to perform enough of the tasks or to perform [them] for a long enough period\u201d to continue working as a litigation partner, which sufficiently places her within the definition of Disability in the policy.<\/p>\n\n\n\n

This case was updated in 2016. Click here to learn more about how the U.S. Court of Appeals reversed the lower court decision in favor of the Plaintiff and ruled in favor of the insurance company here<\/a>.<\/p>\n\n\n\n

Disclaimer:<\/strong> The Ortiz Law Firm did not handle this claim. It is merely summarized here to help claimants understand how Federal Courts handle long-term disability insurance claims.<\/p>\n\n\n\n

Here is a copy of the decision in PDF: Cheney v. Standard (2014)<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Case Name: Carole Cheney v. Standard Insurance Company Court: United States District Court for the Northern District of Illinois Date of Decision: August 28, 2014 Type of Claim:\u00a0Long-Term Disability\u00a0under the\u00a0Employee Retirement Income Security Act (\u201cERISA\u201d) Insurance Company: Standard Insurance Company Claimant\u2019s Employer: Kirkland & Ellis Claimant\u2019s Occupation \/ Job Position:\u00a0The plaintiff was a long-time attorney at Kirkland & Ellis …<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[254],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7466"}],"collection":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/comments?post=7466"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7466\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=7466"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=7466"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=7466"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}