DeBofsky, Sherman & Casciari recently won a victory in the U.S. Court of Appeals for the Seventh Circuit in a case entitled Lacko v. United of Omaha Life Ins. Co., 2019 WL 2439786 (7thCir. June 12, 2019). The plaintiff, Shirley Lacko, stopped working as an senior auditing manager for an accounting firm when the effects of multiple chronic impairments cumulatively rendered her unable to continue working. Among other conditions, Lacko suffered from gastroparesis, diabetes, rheumatoid arthritis, congestive heart failure, breathing difficulties, anxiety, musculoskeletal impairments, and cognitive difficulties related in part to the medication needed to manage the other conditions. Although Lacko's short-term disability claim was initially approved and found to be ongoing on two review periods that followed, the STD benefits were terminated before the maximum STD period was reached, and long-term disability benefits were denied altogether. After unsuccessfully challenging both the STD and LTD denials, Lacko filed suit, but lost on summary judgment in the district court. She won on appeal, though.
Most people assume that if they become unable to perform their usual work on account of sickness or injury, that they would qualify to receive benefits under their work-sponsored long-term disability insurance coverage. That may not be the case, though. In Nichols v. Reliance Standard Life Ins. Co., 2019 WL 2223614 (5th Cir. May 23, 2019), the court permitted a disability insurer to classify the work of an inspector in a poultry processing plant as that of a "sanitarian," a quite different occupation. Although the district court delivered a blistering indictment of Reliance Standard's review of Juanita Nichols's claim for disability benefits (2018 WL 3213618 (S.D. Miss. June 29, 2018)), the Court of Appeals reversed and awarded judgment to the insurance company. The lower court was so incensed by the insurer's behavior, it cited over 100 examples of Reliance Standard's arbitrary and capricious conduct in other litigation and found similar misconduct in its treatment of Nichols. The Fifth Circuit had a different view, though.
DeBofsky, Sherman & Casciari attorneys Mark DeBofsky and Martina Sherman recently won the case of Wonsowski v. United of Omaha Life Ins. Co., 2016 WL 3088141 (N.D. Ill. June 2, 2016) following a bench trial before Magistrate Judge Geraldine Soat Brown in the federal court in Chicago.The case involved Shellie Wonsowski, who had worked as a mechanical engineer before becoming disabled on account of symptoms of idiopathic gastroparesis.Although Wonsowski initially qualified for benefits, United terminated her benefit payments after concluding she was capable of returning to her regular occupation, which was classified as requiring sedentary exertion.
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.