You know that employer disability policies define “disability” as the inability to perform each of the material duties of the employee’s “regular occupation.”
But what happens when the policy does not define the term “regular occupation”?
And…what if the employer’s job description is different from the Dictionary of Occupational Titles, which provides a generalized description of the job?
Here’s the case of Dahlka v. Unum Life Ins. Co. of Am., 2008 WL 2944518 (W.D. Wisconsin June 12, 2018)(Reasonable for an ERISA plan administrator to interpret “‘regular occupation’ as meaning a general occupation, rather than a particular position with a particular company.”)
FACTS. Dahlka sought ERISA-governed short term and long term disability benefits due to severe foot and ankle pain. The plan contained discretionary language. After Unum issued multiple denials of long term disability benefits, Dahlka sued, claiming among other things: (1) Unum kept changing its reasons for denial, which constituted an unfair, arbitrary and capricious “moving target”; and (2) Unum improperly used the Dictionary of Occupational Titles job description, rather than the unique job description provided by the employer.
TRIAL COURT HELD:
1. Moving Target Issue. Plaintiff contended Unum kept “moving the target” because Unum did not tell “him sooner that it found his medical evidence insufficient because it was based on self-reported symptoms.”
a. “The fact that Unum requested additional information and proof that plaintiff satisfied the elimination period after relying on information provided by plaintiff’s employer does not qualify as a moving target. Unum acted reasonably and rationally in relying on [information provided by the employer] and revisiting its decisions when plaintiff provided further evidence showing that his employer had not accurately or fully described his work attempts.” Op. at 14 (emph. added).
b. “Unum also did not move the target by then analyzing plaintiff’s medical records and work restrictions after finally receiving a more complete description of plaintiff’s work history.” Op. at 14.
c. “Unum’s rejection of Dr. Floren’s retrospective restrictions because it was based on plaintiff’s self-reports of pain did not involve a ‘new’ expectation or requirement.” Op. at 14.
2. Defining the Term “Regular Occupation.” Plaintiff contended Unum improperly used a general definition of his job from the Dictionary of Occupational Titles, rather than the job description provided by the employer.
a. “[M]any other federal courts have upheld as reasonable an ERISA plan administrator’s interpretation of ‘regular occupation’ as meaning a general occupation rather than a particular position with a particular company.” Op. at 16 (cases cited).
b. “[T]he Dictionary of Occupational Titles is an acceptable source for nationwide job descriptions and classifications.” Op. at 17.