Court Orders Principal Life to Pay Long-Term Disability Benefits to Plaintiff

In Craig Robertson v. Principal Life Insurance Company, Plaintiff, a National Account Sales Manager with XPO Logistics in Phoenix, Arizona, became disabled in July 2016 after severely injuring his left foot. His request for short-term disability benefits was granted. In October 2016 he filed a claim for long-term disability (LTD) benefits, but in November 2017, that claim was denied.

Plaintiff argued on administrative appeal that he could not perform the material duties of his own occupation, one of which was to travel and meet face-to-face with clients. Principal countered by saying his job was sedentary and travel was optional, so he was not disabled. After exhausting his administrative remedies, Plaintiff filed this ERISA action. According to the Court, the case raises one main issue: “Whether Principal applied the correct definition of ‘Own Occupation’ under the terms of the policy.”

The U.S. Court for the Northern District of California held in favor of Plaintiff ruling that “the record supports a conclusion that Prudential Life abused its discretion by defining Robertson’s occupation as sedentary and therefore denying his claim. Accordingly, judgment will enter in Robertson’s favor.”

Principal Abused its Discretion in its Interpretation of Policy Language

Robertson contended that his job was not sedentary and travel was required. Principal argued that according to the policy definition of own occupation, it could rely on the Occupational Analysis and Labor Market Survey, which defined the duties of a “National Sales Account Manager” as sedentary.

The Court disagreed and noted that the policy itself states that the Own Occupation is “the one the member is routinely performing when the Disability begins.” As such, Principal could not ignore Plaintiff’s actual job duties at the time of his disability. After careful analysis of the policy language, the Court noted that to ignore the actual job duties of claimants when assessing whether or not they are disabled “defies common sense.” Therefore, Plaintiff’s “actual job requirements must be taken into account” when determining if he is unable to perform the material duties of his own occupation.

Principal Abused its Discretion by “Giving Inadequate Consideration” to Significant Evidence that Plaintiff’s Job was Not Sedentary

In his claim for LTD benefits, Plaintiff stated that, among other things, his job required him to travel 4-6 days a month. His supervisor said that was not required and he could do his job at the home office. The supervisor said that Plaintiff was “permitted to travel” because of his experience and the relationships he had in California, but that traveling for the job was optional.

Contrary to the report of the supervisor, the Director of Human Relations of Plaintiff’s employer sent Principal numerous communications verifying that Plaintiff’s job description listed, “Must be able to travel within assigned territory without restriction.” Based on this, and other supporting evidence, the Court concluded principal abused its discretion in determining Plaintiff could perform the duties of his sedentary job and that travel was optional. “Accordingly, Robertson is disabled under the terms of the policy at issue and is entitled to benefits.”

This case was not handled by our office, but we believe it can be instructive for those who are dealing with insurance companies who are categorizing their job descriptions incorrectly. For questions about this case, or any aspect of your disability claim, contact one of our disability attorneys at Dell & Schaefer.

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Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Principal. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Principal.

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Our lawyers help individuals that have either purchased a Principal long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

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Leza A.

Desperarate & feeling like I was on a raft floating farther… out to sea. By the time I was diagnosed (it was close to a year) with fibromyalgia. I was in so much pain “ALL” over my body, feeling desperate for relief of my pain and the feeling of foggy headed (foggy headed is one of the conditions of Fibro). I wasn’t getting better instead my pain was getting worse. I was thinking about my career that I worked so hard to get where I was. I more than missed and loved my career.

My husband used to say that I loved my career more than him (so wasn’t true) but, I would do things like cancel a trip (40th birthday trip) in order to get the job done at work/make it happen (New Home R/E Sales). My career was a “very” physical and also required to be mentally sharp at all times.

What I thought at the beginning of feeling ill was going to be out from work for maybe a few days to a week, didn’t happen. Then I got to the point of being out from work for a year and realizing this was going to be a challenging and long road. In dealing with the short/long term disability company was getting to the point I couldn’t handle it. So… I got on the computer when I had short breaks from being foggy minded (took weeks of searching). So the search for someone/company who could take the challenge to keep up with the demands of paper work from the disability company with my short/long term disability company and who was successful at fighting this kind of case and with my medical diagnoses of fibromyalgia (I had been denied after the first few months of short term disability). I found Dell & Schaefer Law Firm who had a successful out come with not only the disability company that I had but, also against working with a fibromyalgia case.

I am blessed to have come across Dell & Schaefer and then I was blessed to have/be working with Rachel Alters! I found it was/hasn’t been easy in any way to deal with a case of fibromyalgia but, I am so more than happy I have/am working with Dell & Schaefer “Rachel Alter”. If I was up to it (not with fibro) I would be dancing all night long celebrating (I loved to dance all the time before fibro)! The many… appeals, time and all the hard work it took, my/our case has been over turned! I was caught off guard when I received the call from Rachel Alter! When I answered it I was thinking we were needing more documentation or another specialists to state where I am with my illness but, I got the best news in years and I just started crying out of control with tears of happiness! Tears of happiness have not been a part of my life in many years. Yea!!!!!! FYI… This was a challenge for me to write due to not being able to sit or type due to my pain of fibromyalgia but, so worth sharing my experience with choosing Dell & Schaefer “Rachel Alter & Team” ! Again… I am so blessed to have contacted Dell & Schaefer!!! Thank You Dell & Schaefer “Rachel Alter & Team”… :-)

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