Issues:\u00a0<\/strong>Plaintiff makes two related arguments in support of his Motion for Summary Judgment.<\/p>\n(1) First, he argues that Liberty\u2019s denial of benefits was unreasonable because it ignored important evidence in defining his Own Occupation. Further, Plaintiff contends that the information he provided to Liberty when he submitted his appeal was also outright ignored. When appealing his decision, Plaintiff included and incorporated additional information into his claim. Regarding his job description, Plaintiff included that he was driving more than 24,000 miles per year, filling shelves, lifting cases of wine that weigh an average of 45 pounds, bending, kneeling, and reaching for wine bottles on store shelves. He also provided medical notes, as requested by Liberty.<\/p>\n
(2) Second, Plaintiff argued that Liberty failed to consider the more appropriate occupational title of 53.3021.00- \u201cDriver\/Sales Worker,\u201d which is a \u201cmedium work\u201d position. In its initial determination that Plaintiff was not disabled, Liberty asserted that Plaintiff\u2019s \u201cOwn Occupation\u201d was \u201c41-4012.00-Outside Sales Representative,\u201d which is categorized as a \u201clight work\u201d position per the Department of Labor\u2019s occupational guidelines. In conjunction with this finding, Liberty concluded that the post-surgery restrictions placed on Plaintiff by his doctors would not interfere with a \u201clight work\u201d position, and as such, he did not qualify as disabled.<\/p>\n
Holdings:\u00a0<\/strong><\/p>\n(1) The Court concluded that Liberty abused its discretion in denying Plaintiff Long Term Disability benefits. In support of its conclusion, the Court first stated that in determining that Plaintiff\u2019s \u201cOwn Occupation\u201d was that of an \u201cOutside Sales Representative,\u201d Liberty ignored or failed to consider important evidence about Plaintiff\u2019s actual physical job duties. More specifically, the Court stated, \u201cLiberty did not engage in the \u2018deliberate, principled reasoning process\u2019 that was required of it.\u201d When Plaintiff filed his appeal on August 22, 2014, he laid out in precise detail the substantial physical demands of his job, which the vocational expert and Liberty failed to consider. The Court stated, \u201cIt was unreasonable for Liberty to not consider the job\u2019s actual physical duties in performing its occupational analysis.<\/p>\n
(2) Secondly, the Court determined that in light of all the evidence, Liberty\u2019s vocational expert should have considered the alternate DOT occupation of \u201cDriver\/Sales Worker\u201d as opposed to \u201cOutside Sales Representative.\u201d The plaintiff provided Liberty with ample evidence concerning the exact nature of his job and coinciding physical duties, which involved driving over 24,000 miles a year and regularly lifting approximately 45 pounds. The Court stated, \u201cIt seems only reasonable that the expert would search the DOT and other databases more broadly to look for other similar occupations based on the job descriptions provided.\u201d Liberty\u2019s complete failure to consider the Driver\/Sales Worker occupation was a fatal flaw in deciding the outcome of the Plaintiff\u2019s claim.<\/p>\n
(3) The Court further concluded that Liberty\u2019s dual roles of being responsible for administering the plan and making the benefits determination created a clear conflict of interest. When Liberty assessed Plaintiff\u2019s claim and rendered its decision, it chose to rely almost exclusively on the report generated by a vocational expert who was deeply intertwined with Liberty. The Court concluded that had the vocational expert been independent and therefore unbiased in its relation with Liberty, there would be no evidence of a conflict of interest. However, because Liberty was responsible for both administering the plan and assessing the validity of Plaintiff\u2019s claim and thus making the final determination as to benefits, there was a clear conflict of interest.<\/p>\n
Summary:\u00a0<\/strong>The Court granted Plaintiff\u2019s motion for Summary Judgment. Specifically, the Court stated, \u201cLiberty abused its discretion in denying Plaintiff\u2019s claim for long-term disability benefits.\u201d Because Liberty failed to consider the evidence of Plaintiff\u2019s job description in its determination of Plaintiff\u2019s occupation, ultimately leading to their denial of Plaintiff\u2019s claim, Liberty abused its discretion under the policy and incorrectly denied Plaintiff\u2019s claim. In assessing the appropriate remedy for the case, the Court saw no need to remand the case back to the administrator. The Court stated, \u201cThere is no need for remand in this case because there was no evidence missing from the initial determination. The Court concluded that a remand here would prove to be a \u201cuseless formality.\u201d As a result, the Court concluded that Plaintiff was entitled to retroactive long-term disability benefits that began when his short-term benefits expired.<\/p>\n\n
Disclaimer: This case was not 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.<\/p>\n
Here is a PDF copy of the decision: Sapp v. Liberty Life<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"Because Liberty failed to consider the evidence of Plaintiff\u2019s job description in its determination of Plaintiff\u2019s occupation, ultimately leading to their denial of Plaintiff\u2019s claim, Liberty abused its discretion under the policy and incorrectly denied Plaintiff\u2019s claim. In assessing the appropriate remedy for the case, the Court saw no need to remand the case back to the administrator.<\/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":[246],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7556"}],"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=7556"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7556\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=7556"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=7556"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=7556"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}