What is full-time work? The issue is important because eligibility to receive critical benefits such as health and life insurance is dependent on the employee meeting certain active at work requirements in the applicable benefit plan.

    A recent ruling from a federal court in California focused on this issue and took a disability insurer to task for its ambiguous policy wording as to the meaning of “full time” employment. In Connor v. Unum Life Ins. Co. of Am., 2020 WL 6891829 (N.D. Cal., Nov. 24), the court found the plaintiff, Dr. Caroline Connor, met the policy requirements and was entitled to disability benefits due to migraine headaches. Although there was no dispute as to Connor’s disability, benefits were nonetheless denied on the issue of whether she was employed on a “full time” basis.

    Connor, a family practice physician, maintained she was working an average of 32.5 hours a week before inclusion of on-call hours, which amounted to an average of 15 hours a week. The practice where she worked corroborated both in writing and during a phone call with the insurer that she worked at least 30 hours a week. However, Unum still maintained the eligibility requirement was not met because Connor’s employment contract deemed her a part-time employee.

    The policy contained the following definition:

    “ACTIVE EMPLOYMENT means you are working for your Employer for earnings that are paid regularly and that you are performing the substantial and material acts of your usual occupation. You must be working at least 30 hours per week.” (Emphasis in original.)

    The policy also limited coverage eligibility to “All Full-Time Employees in active employment in the United States with the Employer.” (Emphasis in original.)

    The court framed the issue as follows:

    “Here, the analysis turns on whether the term ‘full-time’ has a meaning separate and apart from the characteristics describing ‘active employment,’ namely that (i) earnings are paid regularly, (ii) substantial and material performance of usual occupation, and (iii) at least 30 hours of work per week. If so, then what is the meaning? Unum’s argument that ‘full-time’ carries a separate and distinct meaning, and therefore requirement, outside of the confines of the plan ignores the full context of the Glossary definition.”

    Citing the Merriam-Webster dictionary, the court observed “the common definition of ‘full time’ is the ‘amount of time considered normal or standard for working during a given period.’” Since the policy’s only numerical work requirement was working 30 hours per work, the court concluded: “That 30 hours could be sufficient to satisfy a ‘full-time’ definition not only makes logical sense but is supported by numerous other plans.” (Citing Campos v. Reliance Standard Life Insurance Company, 2017 WL 1370691, at *1 (C.D. Cal. Apr. 12, 2017) (“The LTD Plan terms define ‘full-time’ as follows: ‘Full-time’ means working for you for a minimum of 30 hours during a person’s regular work week.’”); Montoya v. Reliance Standard Life Insurance Company, 2016 WL 5394024, at *1 (N.D. Cal., Sept. 27, 2016) (Full-time means working “for a minimum of 30 hours during a person’s regular work week.”); Ruttenberg v. U.S. Life Ins. Co. in City of New York, 413 F.3d 652, 666 (7th Cir. 2005) (“The term ‘full-time’ is defined to mean[ ] active work on the Participating Employer’s regular work schedule for the class of employees to which you belong. The work schedule must be at least 30 hours a week.”)).

    In line with the cited rulings, the court determined:

    “In construing the plan, the Court gives it its plain, and explicit, meaning. Unum could have required some other number of hours, such as 40 hours per week, to define ‘full time.’ It did not. Therefore, Unum cannot now impose such a definition different than one which contradicts the explicit timing requirement referenced. Such would not be plain to a lay reader. The three requirements set forth explicitly in the plan define both a full time and active employee. Unum cannot impose more.”

    Since the evidence established that Connor worked at least 30 hours a week, the court ruled she met the eligibility requirement in the policy and was entitled to benefits.

    Although the plaintiff’s employment contract did not require her to work at least 30 hours a week, the court was persuaded by the plaintiff’s representations, which were corroborated by her employer. Because Unum failed to define “full time” by any means other than linking eligibility for coverage to working at least 30 hours a week, the court easily sided with the plaintiff in construing the ambiguity in the manner that would be generally understood.

    In addition to this case and the rulings cited in the decision, most courts have taken a liberal view of the meaning of “full time” employment. For example, in Burke v. Blue Cross Blue Shield of Nebraska, 251 Neb. 607; 558 N.W.2d 577, 581 (1997), the court found:

    “Full-time employment does not mean full-time pay. It means being available for full employment; and full employment does not mean a hand at the helm throughout the entire voyage; it means standing by to take over when the exigencies of the passage require the application of one’s skill acquired over many journeys of the past.”

    Burke was a health insurance dispute which involved an individual who served as a part-time deputy county attorney, although he received group health insurance coverage as a full-time employee. When the insurer challenged his eligibility, the court found that since Burke was available for work on a full-time basis, he met the policy requirements.

    Similarly, in Jetson v. CNA Ins.Cos., 536 So.2d 569 (La.App. 1988), the court found a legislator was a “full time” employee for the purposes of a group life insurance policy covering legislators. Although the legislature was only in session part of the year, the court found that once elected and sworn in, the insured was a full-time legislator due to other constituent-related duties. Also, see generally, Annot., “Group Insurance: Construction of Provision Limiting Coverage to Full Time Employees,” 57 A.L.R.3d 801 (1974). These cases illustrate that the concept of “full-time” employment can have many meanings.

    I represented the plaintiff in the Ruttenberg case cited in this article.

Mark DeBofsky is a shareholder at DeBofsky Sherman Casciari Reynolds PC.

This article was published by Law Bulletin on December 10, 2020

©2020 by Law Bulletin Media. Content on this site is protected by the copyright laws of the United States. The copyright laws prohibit any copying, redistributing, or retransmitting of any copyright-protected material. The content is NOT WARRANTED as to quality, accuracy or completeness, but is believed to be accurate at the time of compilation. Websites for other organizations are referenced at this site; however, the Law Bulletin Media does not endorse or imply endorsement as to the content of these websites. By using this site you agree to the Terms, Conditions and Disclaimer. Law Bulletin Media values its customers and has a Privacy Policy for users of this website.

Related Articles

High court social security ruling’s implications for ERISA

It is a generally accepted tenet in litigation under the Employee Retirement Income Security Act that claimants challenging benefit denials must first exhaust prelitigation claim appeals as a condition precedent to filing suit. While an administrative exhaustion requirement applies to claim exhaustion, whether ERISA claimants are barred from raising new issues in court that were not previously asserted in their claim appeals remains open to question. […]

When to hire a lawyer to claim against health insurance denial

When to hire a lawyer to claim against health insurance denial

Navigating a denial of your private health insurance claim at a time when your focus is on receiving the medical care you need can seem like an uphill battle with your insurance company. Healthcare claims are often complex. It is important to consult with a lawyer who focuses on health insurance claims and possesses the expertise and knowledge to get your claim approved and prevent you from being stuck with a medical bill that your health insurer should pay. […]