In Lopez v. Standard Insurance Company, the U.S. Court of Appeals for the Eleventh Circuit upheld Standard’s termination of long-term disability benefits to Plaintiff who, according to Standard, was not disabled from performing “any occupation.”
Plaintiff went to work as a sheetrock applicator for Palm Harbor Homes, Inc. in May 2003. In late September 2005, he had to leave work due to groin pain and cramping. He returned to work for one day in November 2005 and then was terminated.
Almost a year later, on October 13, 2006, he filed a claim for long term disability benefits with Standard, claiming he was injured June 1, 2005, while working for Palm Harbor Homes, Inc. After several denials and appeals, Standard finally awarded him long-term disability benefits, finding him disabled from performing the duties of his own occupation.
After two years, the definition of disability changed, requiring Plaintiff to be disabled from working in any gainful employment for which he was qualified. After several professionals reviewed his medical records, and a report from a vocational consultant, Standard determined that he could work in a sedentary position and terminated his disability benefits.
Plaintiff disagreed. After exhausting his administrative appeals, he filed an ERISA lawsuit in a Florida Federal Court, which agreed with Standard. Plaintiff appealed.
Policy Language Defining “Any Occupation”
According to Standard’s disability insurance policy, after two years of receiving benefits due to being unable to perform the duties of his own occupation, the policy required proof that Plaintiff was unable to perform the duties of “any occupation or employment…in which you can be expected to earn at least 60% of your Indexed predisability earnings…”.
The vocational consultant used the 2013 wage data from the Bureau of Labor Statistics (BLS) that determined Plaintiff would actually make more per hour in the consultant’s suggested sedentary occupations than he made while working as a sheetrock applicator.
Plaintiff objected, and in his ERISA lawsuit, he claimed that it was an error for Standard to use 2013 wage data when the analysis should have been based on his eligibility for benefits under the “any occupation” standard beginning in 2007, not 2013.
Standard provided the court with relevant data from 2007, showing the same result as its analysis based on 2013 data. Plaintiff then claimed it was wrong for the district court to use information that was not part of the administrative record and submitted for the first time in court. The court ruled any error was harmless and Plaintiff had not sustained his burden of proof, so Plaintiff appealed.
Appellate Court Agreed with Standard and the District Court
The one issue raised by Plaintiff on appeal was that the district court should not have considered evidence concerning the 2007 analysis since it was not part of the administrative record when the plan administrator “made its final decision to deny disability benefits.”
The appellate Court noted that “the analysis turned out the same no matter which data was used” and concluded that it agreed with Standard that Plaintiff “did not meet his burden of showing that he was disabled from performing any occupation because he could perform sedentary work.”
This case was not handled by our office, but we think it can be helpful to those who need to prove they are unable to perform the duties of any occupation. If you have a question about this or any other aspect of your disability claim, contact our disability attorneys at Dell & Schaefer for a free consultation.