The casenote of the month is from the Disability E-News Alert! a monthly newsletter describing new disability insurance developments. For subscription information, e-mail Mark DeBofsky or visit www.disabilityenewsalert.com .
Smith v.
Champion Intl. Corp., 2008 U.S.Dist.LEXIS 65346 (D.Conn.
August 26, 2008)(Issue: Fibromyalgia).
This unbelievably long opinion involved 14 disability claims
submitted both by salaried and hourly employees. Although
most of the discussion is highly fact-specific, the court made
a number of points that deserve notation:
·
The court deemed a prior award of benefits relevant:
If benefits are
terminated absent any change in the participant's medical
condition, or the applicable policy language, the previous
decision to award benefits is relevant in evaluating the
reasonableness of terminating benefits. See Connors v. Conn.
Gen. Life Ins. Co., 272 F.3d 127, 136 (2d Cir. 2001) (noting
significance of a decision to terminate long term disability
benefits absent any evidence of a change in the plaintiff's
condition). *36.
·
The court deemed allegations of pain relevant:
"This Circuit has
long held that the subjective element of pain is an important
factor to be considered in determining disability." Mimms v.
Heckler, 750 F.2d 180, 185 (2d Cir. 1984), quoted by Connors,
272 F.3d at 136. Even when a plan gives the administrator
discretionary authority, the administrator may only evaluate
the credibility of the claimant's subjective complaints of
pain; the administrator may not dismiss the claimant's
subjective pain as legally insufficient evidence. Krizek v.
Cigna Group Ins., 345 F.3d 91, 101-02 (2d. Cir. 2003) ("[W]hile
a district judge is not required to accept a plaintiff's
subjective complaints as credible, it cannot dismiss
complaints of pain as legally insufficient evidence of
disability.") (internal quotation marks omitted); Short v.
UNUM Life Ins. Co., No. Civ. 302CV827 (MRK), 2003 WL 22937720,
at *6, *9 (D. Conn. Dec. 3, 2003) (noting that even when the
plan administrator has discretionary authority, the
administrator still has a duty to consider all relevant
evidence, including subjective evidence). Indeed, when
credible evidence is before the administrator, "subjective
pain may serve as the basis for establishing disability, even
if such pain is unaccompanied by positive clinical findings or
other 'objective' medical evidence." Marcus v. Califano, 615
F.2d 23, 27 (2d. Cir. 1979); see also Lijoi v. Cont'l Cas.
Co., 414 F. Supp. 2d 228, 245 (E.D.N.Y. 2006) (holding that
"credible complaints of pain . . . cannot be disregarded" even
though plan terms required participant to submit "objective
medical findings" to substantiate a disability claim).
*36-*37.
·
The court also found that a determination of capability to
perform “sedentary” work is not enough.
"A finding that a
claimant is physically capable of sedentary work is
meaningless without some consideration of whether [he or] she
is vocationally qualified to obtain such employment, and to
earn a reasonably substantial income from it, rising to the
dignity of an income or livelihood, though not necessarily as
much as she earned before disability." Demirovic v. Bldg.
Serv. 32 B-J Pension Fund, 467 F.3d 208, 213-14 (2d Cir. 2006)
("[A] reasonable interpretation of a claimant's entitlement to
payments based on a claim of 'total disability' must consider
the claimant's ability to pursue gainful employment in light
of all the circumstances.") Thus, an administrator must
consider whether a beneficiary has "the vocational capacity to
perform any type of work . . . that actually exists in the
national economy." Id. at 215.
Age is a relevant
factor in determining vocational capacity. Id. at 213, 216;
see also SSR 83-10 "Determining Capability to do other
Work--the Medical-Vocational Rules of Appendix 2" available at
1983 WL 31251 (noting that age must be considered to determine
a claimant's vocational adaptability).
·
The court found defendant’s transferable skills analysis was
flawed.
o
The evaluator failed to obtain sufficient information about
the plaintiffs’ work history.
o
The court cited SSR 82-41 "Work Skills and Their
Transferability as Intended by the Expanded Vocational Factors
Regulations Effective February 26, 1979," for a conclusion
that neither an occupational title itself nor a “skeleton
description” of the job is sufficient.
o
The evaluator treated “worker functions” as “skills.” *48.
o
The evaluator failed to consider non-exertional limitations
such as pain, intellectual and psychological limitations, and
limited manual dexterity. The court cited Rabuck v.
Hartford Life and Accident Ins. Co., 522 F. Supp. 2d 844,
876-77 (W.D. Mich. 2007) (holding that failure to consider
non-strength limitations of former company president with
short-term memory limitations rendered Transferable Skills
Analysis "incredible").
o
Finally, the evaluator gave no consideration as to whether the
identified alternative occupations even existed. Since the
Dictionary of Occupational Titles was last updated in
1977, some of the jobs were obsolete by the mid-1990’s.
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