In evaluating occupational disability claims, insurers distinguish between the insured’s job and their occupation.  If an employee cannot perform their job, they may still be denied disability insurance benefits if they remain capable of performing their occupation as it is generally performed in the national economy.  Polnicky v. Liberty Life Assur.Co. of Boston, 2014 WL 6680725, 2014 U.S.Dist.LEXIS 164890 (N.D.Cal. November 25, 2014) is an illustration of this issue.  There, a mortgage broker employed by Wells Fargo   claimed he was no longer able to make calls upon realtors and customers due to a spine impairment. However, the insurance company insisted that the occupation of “sales representative, financial services” could be performed within the bank while seated at a desk.  The court disagreed.

The court found that “Liberty Life incorrectly applied the definition of ‘Own Occupation’ under the terms of the Policy which meant that Liberty “could not simply ignore plaintiff’s actual job duties at Wells Fargo and define his “Own Occupation” solely by reference to how the position of ‘Sales Representative, Financial Services’ could be performed in the local economy.”

This ruling highlights the importance of utilizing vocational resources in a case such as this.  The outside sales requirements of Polnicky’s job clearly made the difference here.  In addition to the Lasser ruling, other useful cases that require consideration of specific job requirements include Robinson v. Aetna Life Insur.Co., 443 F.3d 389 (5th Cir. 2006) (plaintiff deemed “outside” salesman, so driving was an essential job requirement); Kavanay v. Liberty Life Assur.Co., of Boston, 2012 U.S.Dist.LEXIS 171046 (S.D.Miss. December 3, 2012) (even though plaintiff was an “outside” insurance claim adjuster, the insurer had evaluated only the occupation of “adjuster”); Branca v. Liberty Life Assur.Co., 2014 U.S.Dist.LEXIS 46682 (E.D.Pa. April 3, 2014) (same, except case involved outside salesperson); Bishop v. Long Term Disability Plan of SAP America, Inc., 2008 U.S.Dist.LEXIS 103737 (N.D.Okla. December 23, 2008) (travel deemed essential requirement of occupation); Ganem v. Liberty Life Assur.Co. of Boston, 2013 U.S.Dist.LEXIS 160542 (D.Maine September 26, 2013) (finding sales employee at “big box” retailer had more strenuous job demands than generic “sales clerk”).

Related Articles

8th Circ. Ruling Sets Road Map For Disability Benefit Reviews

8th Circ. Ruling Sets Road Map For Disability Benefit Reviews

Disability benefit cases governed by the Employee Retirement Income Security Act are not only about whether someone qualifies for benefits, but often involve benefit terminations. While many courts have confronted that situation, the guidelines for assessing ongoing disability benefit claims have varied, especially under a deferential standard of judicial review.

New ERISA Rulings Diverge On Civil Procedure

New ERISA Rulings Diverge On Civil Procedure

Over the past several months, there has been a flurry of federal appellate opinions questioning civil procedure norms in Employee Retirement Income Security Act benefits litigation.[1] A pair of brand new appellate decisions have also focused on the same issue, although not necessarily in a direction that harmonizes ERISA civil procedure with the Federal Rules of Civil Procedure.