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Court Orders Sedgwick to Pay Disability Benefits to Claimant with Carpel Tunnel Syndrome Even though the Employer Offered Her Accommodations

Attorney Rachel AltersAuthor: Attorney Rachel Alters

Thornton v. Sedgwick is a fact-driven case in which a California district court ruled that Sedgwick “incorrectly determined in January 2014 that [plaintiff] was no longer eligible for disability benefits.” The plaintiff, Catherine Thornton, was a project manager for Southern California Edison (SCE) when she developed bilateral carpel tunnel syndrome, bilateral cubital tunnel syndrome and epicondylitis. She underwent surgery on both arms. Sedgwick granted her two years of disability on the grounds that she could not perform the material duties of her customary job.

After two years, the definition of disability changed and she could only continue collecting benefits if she could not perform “any reasonable job for the company.” A “reasonable job” was defined as “any gainful activity in any job classification for which you are or may reasonably become fitted by education, training, or experience.” Three physicians examined her and all three said she was very limited in her activities and could not type for more than 15 minutes at a time and would then need 45 minutes of rest. One doctor said she could only do fine manipulation for five minutes, followed by a 30-minute break.

Sedgwick’s Suggested Accommodations

On January 8, 2014, a vocational specialist determined Thornton could work as a Customer Specialist using voice activated software, but he made no mention of the job requirement that she use a mouse. Two days later, Sedgwick notified Thornton her benefits were terminated and she received her last payment on February 28, 2014. Thornton administratively appealed this decision. In response, a company representative said they could not “accommodate an employee who could not perform any mousing.”

A second vocational analysis was done by the same specialist who determined she could use both the voice-activated software along with a foot mouse. Sedgwick’s appeals specialist emailed SCEs disability manager stating it would be unfair to uphold the January decision terminating benefits when the mousing option had not been offered to Thornton at that time. SCE’s response said that such accommodations are standard accommodations and offering Thornton the Customer Specialist Job was a reasonable one. Based on this communication, Sedgwick denied Thornton’s appeal and Thornton then filed this ERISA lawsuit.

Sedgwick Abused Its Discretion in Denying Thornton’s Benefits

The court noted that the record did not support Sedgwick’s “assertion that a foot mouse is a ‘standard accommodation’ or that Sedgwick investigated whether Plaintiff could actually use a foot mouse as a Customer Specialist prior to denying her claim. In fact, three months after Plaintiff’s administrative appeal was denied, SCE’s disability management office indicated that employees are generally restricted to one assistive device.” SCE did not even purchase a foot mouse so plaintiff could take the Customer Specialist test until January 2016. The court concluded that “Sedgwick abused its discretion in denying Plaintiff benefits without fully considering her restrictions.”

Court Finds No Reason to Remand and Orders Sedgwick to Pay Benefits

Sedgwick requested the court to remand, but the court said there was no reason to, since there were no factual determinations left to be made. Sedgwick was “obligated to determine whether Plaintiff could perform a reasonable job for SCE. By January 22, 2016, it had done so.” The court then ordered benefits to be paid from the termination date of March 1, 2014 through January 22, 2016 as well as prejudgment interest.

This case was not handled by our office, but it may provide claimants guidance in their pursuit of long term disability benefits when the job the insurer determines that are eligible for does not take into account whether the insured can work within the suggested accommodations. If you need assistance with a similar matter, please contact any of our lawyers for a free consultation.



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