200 W. Madison St. | Suite 2670 | Chicago, IL 60606 | Resource Links | Directions

Call Now 312-702-1842
800-237-5182 Toll Free
We Return Calls The Same Day.

How to Interpret the "Each and Every Duty" Requirement in a Disability Insurance Policy

Many disability insurance policies require a showing of an inability to perform each and every regular job duty.  Does that mean you can't be considered disabled if you are unable to perform some but not all of the required job duties? In most jurisdictions, the answer is yes - you need not prove an inability to perform every single job duty in order to receive benefits. 

A recent ruling from Florida offered insight into this issue.  In Granger v. Life Ins. Co. of N. Am., 2016 WL 2851434 (M.D. Fla. March 28, 2016), the plaintiff worked for State Farm insurance and alleged he was disabled due to cognitive limitations following brain surgery.  The court overturned CIGNA's claim denial after applying a de novo evaluation of the evidence.  Although CIGNA argued for the application of a deferential standard of review, because the policy was issued in Illinois and specified the policy would be interpreted under Illinois law, the court applied 50 Ill. Admin. Code § 2001.3.  That provision invalidated the policy provisions that CIGNA relied on to support discretionary review. 

Applying the de novo standard, the court concluded that CIGNA's decision was wrong after interpreting the policy's definition of "disabled" as follows: 

to determine that an individual is not disabled, the evidence must support a finding that the claimant can perform each duty that is material to performing the occupation in question. The inability of the claimant to perform even one such duty would preclude a finding that the individual is not disabled under the Plan. See Lain v. UNUM Life Ins. Co. of Am., 279 F.3d 337, 345 (5th Cir.2002) (holding that a policy defining disability as the inability to "perform each of the material duties of" the occupation should be construed to mean "that in order to be considered disabled, an insured must be unable to perform only a single material duty of" the occupation), abrogated on other grounds by Glenn, 554 U.S. at 115-19; McClure v. Life Ins. Co. of N. Am., 84 F.3d 1129, 1133-34 (9th Cir.1996) (holding that a person is disabled under a plan requiring that person to perform "every duty" of the relevant occupation if the "employee is unable to perform one of the essential duties of his or her position").

The court found that CIGNA erred in relying on one of its medical consultants, who failed to take into consideration the other doctors' uncontradicted findings that Granger could not efficiently multitask, perform under stress, or attain precise limits, all of which were essential job functions.

The court also concluded that CIGNA's "any occupation" determination was wrong as well.  The cognitive limitations that supported a finding that Granger could not perform his regular occupation also supported a finding that he was unable to perform any of the three occupations identified in the defendant's transferrable skills analysis.  The court pointed to "core" occupational requirements set forth in the O*NET to conclude that he could not meet the requirements of such occupations which all had mental demands that conflicted with Granger's documented limitations.  Accordingly, judgment was entered for the plaintiff.

The court's analysis of the definition of disability as necessitating the ability to perform all of the job duties was critical; and the detailed discussion of the transferable skills analysis (TSA) and comparison of the job duties to the O*NET core job requirements eviscerated the TSA's validity.

 

No Comments

Leave a comment
Comment Information

DeBofsky, Sherman & Casciari, PC