The plaintiff in Neno v. Aetna Life Insurance Company, employed as a Senior Forensic Professional by a computer corporation, received short term disability benefits under his employer’s welfare benefit plan due to his debilitating neck and hip pain. After 24 months, those benefits were exhausted and his application for long term disability benefits was denied.
According to Aetna’s policy, in order to obtain long term disability benefits, Neno would have to prove that he was unable to perform the material duties of his own occupation. It defined own occupation as the “occupation that you are routinely performing when your period of disability begins. Your occupation will be viewed as it is normally performed in the national economy instead of how it is performed for your specific employer.”
In order to determine how Neno’s occupation as a Senior Forensic Professional was normally performed in the national economy, Aetna looked to the Dictionary of Occupational Titles (D.O.T.) for a job description. The D.O.T. does not list Senior Forensic Professional, so Aetna relied on the D.O.T.’s job description of a Satellite-Instruction Facilitator as one closely analogous to it and Neno objected.
The federal court, relying on Fourth Circuit precedent, agreed with Aenta and concluded, “It is reasonable for an insurer to consider the D.O.T. description in order to define an applicant’s occupation and job duties.” The court noted that a lot of research and analysis has gone into the D.O.T.’s grouping of similar occupations and it is “widely and routinely used to define ‘occupation’ in the U.S. economy.”
Court Finds Aetna Acted Reasonably in Defining the Material Duties of the Plaintiff’s Own Occupation
At the time the plaintiff became disabled he was employed by Computer Sciences Corporation (CSC) as a Senior Forensic Professional, a job title not found in the D.O.T. But, according to the court, Aetna took reasonable steps to determine the job duties of the plaintiff in that occupation. Aetna compared CSC’s Job Analysis Worksheet of Neno’s actual position with that of a Satellite-Instruction Facilitator and found them very similar. Both involved sitting at computers and training students. Both were sedentary jobs. Both involved occasional lifting of up to 10 pounds and standing or walking for only brief periods of time.
An analysis of the medical records and results of a functional capacity exam (FCE) showed that Neno could meet the demands of the sedentary position. His ability to sit was not affected and he could stand and walk for 30 minutes at a time for a total of four hours in any eight hour workday. His records indicated he could occasionally lift up to 20 pounds.
The Maryland Federal District Court’s Final Decision Denying Long Term Disability Benefits
The court ultimately upheld Aetna’s denial of long term disability benefits holding, “Aetna’s decision was supported by substantial evidence and was made with deliberate and principled reasoning, as it reviewed Neno’s medical records and sought opinions from independent sources. Therefore, based on the undisputed facts in the record, Aetna did not abuse its discretion in denying Plaintiff’s claim for long-term disability benefits.”
This case was not handled by our office, but it may provide claimants guidance in their pursuit of long term disability benefits when they are disabled from performing the duties of their own occupation as defined by their disability insurance policy. If you need assistance with a similar matter please contact any of our lawyers for a free consultation.