The Tenth Circuit Court of Appeals issued a decent decision in favor of an ERISA long-term disability benefit claimant on May 7, 2007 in the case of Bishop v. LTD Plan of SAP America, Inc and LINA (Cigna), 2007 WL 1314523. The appeals court overturned an Oklahoma district court judge which had been favorable to LINA. Of particular interest was the Court’s rejection of LINA’s use of the DOT definitions of “sedentary” when the insurance policy language defines disability in terms of a claimant’s inability to perform “his occupation.” In this new case, Mr. Bishop was a technology consultant for SAP whose job required extension travel. The insurance company failed to consider travel as an essential duty of his job. Instead, in terminating his long-term disability benefits, LINA determined that he was capable of “light” duty and because the DOT defined a technology consultant as a “sedentary” job, he was able to perform all of the material duties of his regular occupation, and cut off his benefits. The Court ruled that LINA was required to analyze Mr. Bishop’s actual job and not his job as performed in the national economy, nor could LINA simply rely on the DOT definitions.
In handling LTD cases like Mr. Bishop’s, we often see this approach to claims handling by the insurance company or claims administrator. The insurance company will deny a claim without any real analysis of the disabled person’s actual, material duties of their actual occupation. This new case will provide additional support for the argument we have always put forth on behalf of client’s; that is, whether a person’s known restrictions and limitations which place her into the DOT category of “sedentary” or “light duty” has no real bearing on whether she can actually work in her occupation on a full time basis.