Do Federal Courts Nationwide Differ on the Meaning of Regular Occupation in ERISA Long Term Disability Plans?

The easy and unfortunate answer to this question is yes. Federal courts across the nation differ on the meaning of “Regular Occupation” as the term is used in disability insurance policies. So, what state you live in, and the specific language of your disability policy, determines whether you receive disability benefits based on your inability to perform the material duties of your regular occupation.

The Fifth Circuit Definition of “Regular Occupation” Which Binds Mississippi, Louisiana, and Texas Federal Courts

An example of how some courts reason is found in the recent case of Juanita Nichols v. Reliance Standard Life Insurance Company (Reliance). Plaintiff Nichols worked at Peco Foods, Inc., a chicken processing plant. Her job description as defined by Peco was that of a Hazard Analysis Critical Control Point (HACCP) Coordinator. Her job routinely exposed her to temperatures around 40 degrees.

Nichols developed Raynaud’s phenomenon (also known as Raynaud’s Syndrome), a circulatory condition that could cause gangrene if Plaintiff continued working in the cold. She stopped working on January 28, 2016, and applied for long-term disability benefits through Peco’s long-term disability policy issued by Reliance Standard.

According to the terms of the policy, Nichols would be eligible for benefits if she proved she was unable to perform a material duty of her regular occupation, which was defined as the occupation she held at the time she filed her claim for disability. In addition, the policy stated that it “defines Regular Occupation as the way the claimant’s job ‘is normally performed in the national economy’ and not the way it is ‘performed for a specific employer or in a specific locale.’”

Reliance engaged a vocational rehabilitation specialist to determine Plaintiff’s regular occupation. He concluded that, based on the Department of Labor’s Dictionary of Occupational Titles (DOT), the components of her HACCP job description were most closely related to the job duties of a Sanitarian. The DOT job description of a Sanitarian does not include exposure to the cold. Peco provided the specialist with a list of Plaintiff’s job duties and that list did not include exposure to the cold.

Reliance acknowledged that Plaintiff could not work in a cold environment, but denied her LTD benefits finding that since her Regular Occupation was that of a Sanitarian, which did not require exposure to cold, she had not proven that she could not perform a material duty of her Regular Occupation.

Plaintiff appealed. She argued that her job inspecting chicken for sanitary defects meant she was exposed to cold in her regular occupation since federal law requires processed poultry to be kept at cold temperatures. Reliance engaged a second vocational specialist who came to the same conclusion as the first one: her Regular Occupation was best defined in the DOT as that of a Sanitarian. In its denial of her appeal, Reliance explained that while it acknowledged that she could not work in the cold, that was a job requirement specific to Peco Foods, Inc., and not specific to her occupation as a Sanitarian.

After she exhausted her administrative remedies, Nichols filed an ERISA lawsuit in the U.S. District Court for the Southern District of Mississippi. The District Court agreed with Plaintiff that exposure to cold was a material duty of her regular occupation and ordered Reliance to pay her LTD benefits. This time, Reliance Standard appealed.

The U.S. Court of Appeals for the Fifth Circuit held that the Plaintiff was not entitled to long term disability benefits. The Court said that Reliance Standard did not abuse its discretion when it refused to consider the specific duties of the claimant’s regular occupation.

The Fifth Circuit acknowledged that other federal courts defined Regular Occupation differently, but concluded “No matter what other circuits require, our precedent dictates that regular occupation is to be defined generally and need not account for each of a claimant’s unique job duties.” Therefore, the Court held that Reliance Standard’s denial of disability benefits was valid, and that Reliance did not need to consider the specific duties of the claimant’s regular occupation.

The Fifth Circuit’s decision binds courts in Mississippi, Louisiana, and Texas. This means that those courts must rule according to the way the Fifth Circuit ruled in the Nichols case. So, if you work in one of the named states, whether you can prove you are entitled to LTD benefits depends on the definition of your Regular Occupation according to the DOT, not according to your actual job duties.

Not All Courts Agree with the Fifth Circuit

At least two other circuit courts disagree with this ruling by the Fifth Circuit and have ruled that Regular Occupation means the actual duties the claimant was performing at the time he or she stopped working. Some examples of other court definitions of regular occupation are:

Kinstler v. First Reliance Life Insurance Co.

Lasser v. Reliance Standard Life Insurance Co.

Darvell v. Life Insurance Company of North America

Bishop v. Long Term Disability Income Plan of SAP Am., Inc.

Leave a comment or ask us a question

Questions About Hiring Us

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Mr. & Mrs. S

You work with many people throughout your life, but few people touch your life in such a positive way beyond the settlement. We truly felt that Cesar cares about the people Dell & Schaefer serves. We may not cross paths again but we will always pray that the work you do continues to be successful on many levels. It is obvious that you also take your work to heart and we choose the right person to be our attorney.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us