Practicing law can create real headaches.

But do headaches constitute a disabling condition justifying ERISA-governed long term disability benefits?  

This new case explains the correct process in assessing “job duties” in the “Own Occupation” analysis…

Foster v. Principal Life Ins. Co., 920 F. 3d 298 (5th Circuit April 4, 2019)(Benefit denial when based on “passing references” to the claimant’s ‘own occupation’ or ‘own sedentary level occupation’ when “unaccompanied by any attempt to articulate the material duties of the appellant’s own occupation” is inadequate to sustain benefit denial).

FACTS: Foster, a “healthcare attorney,” sought ERISA-governed long term disability benefits claiming she had “chronic and intractable” migraine headaches. Her physicians opined she could not perform full-time sedentary work, yet surveillance showed her ably shopping and picking up children. Principal Life denied the claim and Foster’s appeal of the claim denial after independent reviews by a psychologist, neurologist, neuropsychologist, along with normal MRIs and EEGs, found no clinical evidence of any functional impairment to perform a sedentary job. The plan vested discretion with the administrator.

Foster sued, however, claiming Principal never evaluated whether she could perform the specific duties of a healthcare attorney, “e.g., meeting deadlines, handling stress…prolonged computer use…and [the] intellectual challenges of handling complex situations.”

DISTRICT COURT HELD: Principal did not abuse its discretion in denying long term disability benefits.

ISSUE: Whether Principal failed to analyze Foster’s disabling condition in light of her actual job duties as a healthcare attorney?

FIFTH CIRCUIT AFFIRMS:

  1. “[A]n ERISA plan administrator abuses its discretion by denying benefits under an ‘Own Occupation” clause based on reports couched only in terms of a claimant’s ability to work “a full time sedentary position.” Denial of benefits, when based on “passing references” in medical reviews to the appellant’s ‘own occupation’ or ‘own sedentary level occupation’ when “unaccompanied by any attempt to articulate the material duties of the appellant’s own occupation” is inadequate to sustain benefit denial.  Op. at 10 (Citing cases from the 1st, 2nd, 3rd, 5th, and 6th circuits).  
  2.  [T]here is substantial evidence showing that at least one of the [independent reviewing doctors] considered Foster’s disability in light of the specific duties required by her occupation as an attorney.”  Op. at 11.
  3. “Principal asked Foster for a description of her job duties and then provided to all reviewing physicians the documents she gave them.” Op. at 11.
  4. “To be sure, Foster adduced evidence of her own suggesting that her headaches rendered her unable to perform as an attorney. But that does not entitle her to prevail under the substantial evidence standard….Principal marshaled enough evidence to satisfy its burden, and Principal did not abuse its discretion on this ground. Op. at 11-12.