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Is Plaintiff Entitled to LTD Benefits When Unable to Work in Any Occupation?

In Tiedel v. Reliance Standard life Insurance Company (Reliance), Plaintiff Tiedel, a full-time flight engineer for Kalitta Air, was in the pilot seat of a single engine plane that crashed in January 1979. He suffered numerous fractures and required surgery. He developed Hepatitis C due to a blood transfusion he received following the accident.

In December 2013, the Hepatitis C recurred and there was a remarkable increase in his viral load. He suffered from weight loss, fatigue, memory lapses, joint pain, and fluctuating blood pressure. These symptoms made it impossible for him to fly planes and he did not pass a requalification exam that was administered on or about March 17, 2014.  

Plaintiff began a 12-week treatment for the Hepatitis, but the side effects of this medication, along with the side effects of medications he was taking to control his blood pressure, caused dizziness, tunnel vision, and fatigue. At the advice of his treating physician, Dr. Wagner, Plaintiff voluntarily relinquished his flying privileges while he waited for his health to improve. 

Dr. Wagner also wrote to Plaintiff’s employer explaining that the recurrence of the Hepatitis C, along with the side effects of the medications, were the reasons Plaintiff did not pass the requalification exam. Reliance then granted Plaintiff both short-term disability (STD) and long-term disability (LTD) benefits effective March 18, 2014. He was told by letter that to continue receiving benefits, he would need to remain totally disabled.

Reliance terminated Plaintiff’s LTD benefits on March 10, 2015, but on administrative appeal, reinstated his benefits. The letter informing him that the termination of benefits decision was reversed did not explain why it made that decision.

On October 22, 2015, Reliance again terminated Plaintiff’s LTD benefits. The termination letter stated that a “claim specialist concluded that the medical records did not support the conclusion that [Plaintiff] could not perform the material duties of any occupation.” The claims specialist listed several “transferable skills” and for an example, identified one occupation Reliance believed Plaintiff could perform: An Aircraft Log Clerk. The claim specialist relied on a report authored by Carol Vroman called a “Residual Employability Analysis Report.”

Plaintiff filed another appeal. Both Plaintiff and Reliance provided additional reports concerning Plaintiff’ physical and mental abilities. Plaintiff submitted several medical reports supporting his claim.

Reliance required Plaintiff to undergo an IME with Dr. Mandel who provided a report. Reliance also submitted a report from a licensed psychologist who reviewed the opinion of Dr. Harris, Plaintiff’s psychologist.

Reliance then upheld its termination decision and Plaintiff filed this ERISA lawsuit in the U.S. District Court for the Western District of Michigan, Southern Division. The District Court reversed the decision of Reliance and held on April 15, 2020, that Plaintiff had proven he was totally disabled and deserved benefits dating back to the date of the erroneous termination decision of September 17, 2015.

De Novo Standard of Review Applied

Both parties agreed that de novo was the correct standard of review. This means that the Court reviewed the administrative record with a “fresh eye” and gave “no deference or presumption of correctness” to the plan administrator’s decision. The Court noted it was required to give “proper weight to each expert’s opinion in accordance with supporting medical tests and underlying objective findings.”

Relevant Plan Requirements

The plan provisions were fairly common. Plaintiff had the burden of proving he was totally disabled. At the time of the termination, he had to prove he was disabled from performing “any occupation” for which he was qualified based on his education, training, and experience. Reliance agreed that Plaintiff could not perform his job as a flight engineer. Instead, Reliance argued that he was “not so disabled that he cannot perform the material duties of any occupation.”

Although Reliance argued that “Plaintiff’s medical records… do not provide any evidence that would not allow Plaintiff to return to work in a sedentary exertion occupation…” the Court reviewed all the evidence provided by both Reliance and Plaintiff and reversed Reliance’s decision terminating LTD benefits. The Court did not remand the case to Reliance, but instead ordered Reliance to reinstate Plaintiff’s LTD benefits.

The Administrative Medical Record

The District Court conducted an extensive review of the administrative record and noted the weight it gave to each report. The court gave little weight to three letters from Plaintiff’s treating physician Dr. Wagner. The Court found them conclusionary without support by any medical evidence in the record. The Court did rely on medical evidence in the file from Dr. Harris that supported the Court’s finding of disability.

The Court gave short shrift to the report of Dr. Ilka, who was retained by Reliance and who submitted an initial IME reportThe Court found this report to be “largely unhelpful to the inquiry” and afforded them “little weight.” This meant little weight was given to the transferable skills report provided by Reliance’s Carol Vroman since she based her report on Dr. Ilka’s conclusion that Plaintiff was capable of sedentary work.

The Court afforded greater weight to the report of Psychologist Harris which was submitted by Plaintiff. Dr. Harris met with Plaintiff twice and conducted six tests. He concluded that the tests provided “objective evidence of impaired speed of information processing, divided attention, short-term recall, and executive function.” Harris concluded that Plaintiff suffered from “neurocognitive dysfunction” with “underlying organic pathology.”

The Court finally concluded: “On this record, as of September 17, 2015, [Plaintiff] could no longer perform the duties of Any Occupation. Accordingly, Reliance should have awarded him long-term disability benefits… Plaintiff Michael Tidal cannot perform the duties of any occupation, as that term is defined in his disability insurance plan… He provided objective medical evidence to show a cognitive impairment and expert opinion evidence that the impairments prevent him from working. The evidence offered by Defendant Reliance Standard Life Insurance does not undermine Tiedel’s evidence.”

This case was not handled by our office, but we feel it may be helpful to claimants who need to prove they are unable to work in any occupation. For questions about this case, or any question concerning your STD or LTD benefits, contact a disability insurance attorney at Dell & Schaefer for a free consultation.

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