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.

 

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Photo of Mike Reilly Mike Reilly

Mike Reilly is a nationally recognized labor, employment and employee benefits attorney, named one of the “Top 100 Most Powerful Employment Attorneys in the Nation” for the past five consecutive years by Human Resource Executive®. He has decades of experience providing strategic employment…

Mike Reilly is a nationally recognized labor, employment and employee benefits attorney, named one of the “Top 100 Most Powerful Employment Attorneys in the Nation” for the past five consecutive years by Human Resource Executive®. He has decades of experience providing strategic employment advice, and has represented clients in more than 75 jury trials, arbitrations, bench trials and claims before the EEOC and Washington State Human Rights Commission.

Small and large employers retain Mike for his strategic advice and decades of experience in employment issues and litigation, business decisions and litigation avoidance. Mike provides advice in claims involving discrimination, retaliation, wrongful discharge, disability accommodation, ERISA and non-ERISA employee benefit claims, and wage/hour claims. He served as lead counsel in an employee raiding/trade secret case as reported in the Wall Street Journal, and defends employers in class action claims.

Mike’s remarks on employment issues have been quoted in NewsweekCorporate Legal TimesSeattle TimesEmployee Relations Law JournalPuget Sound Business JournalCFO.com, and other professional journals and management publications. Chambers USA’s Guide to America’s Leading Lawyers for Businessrates Mike in the top ranking (band one) for his work in labor and employment law, and has described him as “one of Seattle’s top-rate attorneys” who is “truly phenomenal [with] superb legal instincts” and “an amazingly assertive litigator.” His clients include Nordstrom, Seattle Seahawks, Home Depot, KeyBank, Starbucks, Fred Hutchinson Cancer Research Center, Red Robin and Seattle Chamber of Commerce, among others.