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ERISA Blog

First Circuit Puts the Kibosh on Standard’s Attempts to Generalize Occupations

In Jane Doe v. Standard Insurance Company, the claimant, an environmental lawyer, filed a claim for LTD benefits.  During its review, Standard labeled the claimant’s occupation as “Attorney” and went about denying the claim based upon her supposed ability to perform the duties of an Attorney.  The First Circuit rejected Standard’s generalization and held its feet to the fire:

We agree with Doe that Standard’s reliance on the DOT description of a generic “lawyer,” rather than a job description that fully and accurately encompassed the material duties of Doe’s specialized area of legal practice, rendered Standard’s decision arbitrary and capricious. The Plan defines the key inquiry as whether Doe was disabled from performing the material duties of her Own Occupation, and so “a reasoned determination of the existence of disability vel non require[d], inter alia, a review of the material duties of [Doe’s] particular position.” McDonough, 783 F.3d at 380. Standard was obligated to “assess[] whether and to what extent . . . [Doe’s] impairments compromised h[er] ability to carry out” the specialized duties of an environmental lawyer. Id. Standard charged an enhanced premium for the promise of enhanced specialty coverage, and it was unreasonable for Standard to undercut that overage by failing to ascertain and consider the specific requirements of Doe’s specialty.

A significant takeaway from this case is to make sure that you emphasize the specialized nature of your profession so that you can argue that your insurer’s generalization of your occupation is arbitrary and capricious if it, as insurers often do, attempt to fit your job title in to a broad generalized category of occupations.

Here is a link to this great decision.

Andrew Davis