We all know that ERISA disability claim decisions can hinge on the definition of the claimant’s “regular occupation” or “own occupation.”
But how do you define a claimant’s “regular occupation”? Must you use the claimant’s actual duties, or can you rely upon the Department of Labor’s generic definitions contained in the Dictionary of Occupational Titles? It depends.
What language confers discretion? Must the plan language contain the word “discretion”? No.
Here’s the case of Hankins v. Standard Insurance Company [PDF], __.3d__, 2012 WL 1660951 (8th Cir. May 14, 2012). The case highlights answers to these issues.
FACTS: Hankins was “Director of Security Operations” for seven years, but was terminated after he failed a physical evaluation to confirm he could continue to perform the physical duties of the job. Hankins made a claim for ERISA disability benefits, administered by Standard Insurance Co. The ERISA plan language “granted the administrator sole responsibility for the administration and interpretation of the plan.” Standard relied on the Department of Labor’s Dictionary of Occupational Titles (DOT) which designated a “Security Manager” position as sedentary. Based on this, Standard denied the disability claim. Hankins appealed and submitted a vocational expert’s report concluding that Hankins actual duties resembled the much more physical position of Public Safety Officer. Standard upheld its decision and Hankins sued.
- Did the plan language confer discretion?
In determining the claimant’s “regular occupation” or “own occupation,” does the Plan have to rely on “actual job duties,” or may it rely on the DOT?
HELD: EIGHTH CIRCUIT AFFIRMS SUMMARY JUDGMENT DISMISSING LAWSUIT
- Language conferred discretion. Although “explicit discretion-granting language” must appear in the policy, the actual word “discretion” need not be there. “[P]olicy language granting the administrator sole responsibility for the administration and interpretation of the plan gives discretionary authority that triggers deferential review.” Op. at 4. “Standard’s policy language reserving power to “resolve all questions…[of] interpretation” indicates the administrator has discretionary power…” Id.
- Actual duties versus DOT to define “Regular Occupation.” In the absence of a more precise definition, “Regular Occupation” could be interpreted as referring to duties that are commonly performed by those who hold the same occupation as defined by the DOT, or the duties the specific claimant actually performed….” Op. at 5.
- Standard’s policy explains that it is not limited to the individual claimant’s actual or specific job duties. Op. at 5. Consequently, Standard’s use of the DOT to determine Hankin’s “Own Occupation” was not at odds with the plain language of the policy.
- Reasonable persons may disagree over which of Hankin’s duties were “generally required by employers.”