{"id":7556,"date":"2020-04-28T19:21:13","date_gmt":"2020-04-29T00:21:13","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7556"},"modified":"2024-01-19T14:25:42","modified_gmt":"2024-01-19T19:25:42","slug":"sapp-v-liberty-life-liberty-failed-to-consider-plaintiffs-job-description","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/sapp-v-liberty-life-liberty-failed-to-consider-plaintiffs-job-description\/","title":{"rendered":"Sapp v. Liberty Life – Liberty Failed To Consider Plaintiff\u2019s Job Description"},"content":{"rendered":"

Case Name:\u00a0<\/strong>Mark Sapp v. Liberty Life Assurance Company of Boston, also known as Liberty Mutual Insurance Company<\/p>\n

Court:\u00a0<\/strong>United States District Court for the Eastern District of Virginia<\/p>\n

Type of Claim:\u00a0<\/strong>Long-Term Disability<\/a><\/p>\n

Insurance Company:\u00a0<\/strong>Liberty Life Assurance Company of Boston a\/k\/a Liberty Mutual Insurance Company (hereinafter \u201cLiberty\u201d)<\/a><\/p>\n

Claimant\u2019s Employer:\u00a0<\/strong>Republic National Distributing Company<\/p>\n

Claimant\u2019s Occupation \/ Job Position:\u00a0<\/strong>Wine Salesman<\/p>\n

Disabilities: The plaintiff<\/strong>\u00a0suffered from severe back pain<\/a>. On February 25, 2014, Plaintiff injured his back on the job while lifting boxes of wine that weighed approximately 45 pounds. The injury was so extensive that it required surgery. After the surgery, Plaintiff was discharged with restrictions limiting the amount of weight he could lift and how long he could sit or stand.<\/p>\n

Definition of Disability: <\/strong>The Plan defines a \u201cdisabled employee\u201d as one who: \u201cas a result of injury or sickness, is unable to perform the Material and Substantial Duties of his Own Occupation.\u201d<\/p>\n

For purposes of determining Disability under the Plan, Liberty considers the Covered Person\u2019s occupation as it is normally performed in the national economy.<\/p>\n

Further, the Plan defines \u201cMaterial and Substantial Duties\u201d as:\u00a0\u201cresponsibilities that are normally required to perform the Covered Person\u2019s Own Occupation, or any other occupation, and cannot be reasonably eliminated or modified.\u201d<\/p>\n

The Plan provides that \u201cOwn Occupation\u201d is:\u00a0\u201cthe Covered Person\u2019s occupation that he was performing when his Disability or Partial began.\u201d<\/p>\n

Benefits Paid? <\/strong>The claimant received short-term disability benefits. Long-term disability benefits were not paid to the claimant. Liberty denied coverage on August 8, 2014, stating that the post-surgery restrictions placed on the claimant by his doctors would not interfere with a \u201clight work\u201d position, and, as a result, he did not qualify as disabled.<\/p>\n

Procedural history:\u00a0<\/strong>The claimant was denied coverage on August 8, 2014. On August 28, 2014, the claimant appealed the denial and incorporated additional key information regarding the nature of his duties as a wine salesman. On October 21, 2014, Liberty denied the appeal.<\/p>\n

Key Physician Opinions:\u00a0<\/strong>Liberty employed a vocational expert to analyze the validity of Plaintiff\u2019s claim<\/a>. The vocational expert reviewed the entire claims file and the Dictionary of Occupational Titles (a standard vocational resource) to make her determination. Liberty had described Plaintiff\u2019s position as a \u201cSales Representative-Retail,\u201d to which the vocational expert concluded that no appropriate DOT description was applicable to that job description. Specifically, the vocational expert assessed two other classifications- (1) Sales Representatives, Services, All Other and (2) Sales Representatives, Wholesale and Manufacturing, Except Technical and Scientific Products.\u201d The vocational expert concluded that the \u201coccupation of Sales Representatives is not performed in one definitive manner in the national economy. Rather taking into consideration the nature of the work descriptions, the occupation is most performed at the sedentary and light levels of physical demand based on the Department of Labor descriptions found in the DOT, with sufficient opportunity at both levels.\u201d Liberty utilized the vocational expert\u2019s report in denying Plaintiff coverage. Liberty described Plaintiff\u2019s occupation as one that is categorized as a \u201clight work\u201d position under the Department of Labor occupations. Further, Liberty concluded that the post-op restrictions placed on Plaintiff would not interfere with a \u201clight work\u201d position, and therefore he did not qualify as being disabled under the policy.<\/p>\n

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}]}}