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The First Circuit Court Of Appeals Determines That Standard Insurance Company Acted Unreasonably Denying A Claimant Benefits, Where It Failed To Consider The Claimant’s Actual Occupational Duties.

On Behalf of Disability Insurance Law Group | | Appealing A Claim Denial

In a recent case, the First Circuit Court of Appeals determined that Standard Insurance Company acted arbitrarily and capriciously when it denied an environmental attorney with severe depression Long-Term disability insurance benefits.

The claimant was an equity partner in a law firm in Maine for almost three decades.  In August of 2011, the claimant became a non-equity partner handling environmental law cases.  Towards the end of 2011, the claimant was diagnosed with severe major depressive disorder with suicidal ideation, resulting in impairments in memory and concentration.  The claimant continued to work until the end of January 2012, at which point she filed her claim for disability benefits under her Long-Term disability policy issued by Standard Insurance Company.

Rather than considering the claimant’s Own Occupation as an environmental attorney, Standard Insurance Company considered the duties of a generic attorney found in the Dictionary of Occupational Titles (“DOT”).  Based on this, Standard Insurance Company determined that the claimant was not Totally Disabled under the policy.  The claimant filed an administrative appeal with Standard Insurance Company, but Standard Insurance Company refused to overturn its denial of benefits.

The claimant filed suit under the pseudonym, Jane Doe.  The district court ruled for Standard Insurance Company, finding that the denial was reasonable.  Accordingly, Jane Doe appealed to the First Circuit Court of Appeals.

The First Circuit found that Standard Insurance Company’s reliance on the DOT description of a generic attorney, rather than Jane Doe’s actual occupational duties as an environmental attorney was arbitrary and capricious.  Accordingly, the First Circuit overturned the district court’s decision and awarded Jane Doe her Long-Term Disability benefits.

5We agree with Doe that Standard’s reliance on the DOT description of a generic “lawyer,” rather than a job description that fully and accurately encompassed the material duties of Doe’s specialized area of legal practice, rendered Standard’s decision arbitrary and capricious. The Plan defines the key inquiry as whether Doe was disabled from performing the material duties of her Own Occupation, and so “a reasoned determination of the existence of disability vel non required], inter alia, a review of the material duties of [Doe’s] particular position.”

Doe v. Standard Ins. Co., No. 16-2085, 2017 WL 1101609, at *4 (1st Cir. Mar. 24, 2017)

There are even more cases this week than last week.  As such, it was hard to pick just one “notable”
decision but I settled on the nice win reported at Jane Doe v. Standard Insurance Company, No. 16-2085, __F.3d__, 2017 WL 1101609 (1st Cir. Mar. 24, 2017).

Doe was an equity partner at a Maine law firm for more than 25 years before she became a non-equity partner in August 2011 and remained in that position for the next six months before she stopped working altogether.  At the end of 2011, Doe was diagnosed with Major Depressive Disorder, including suicidal ideation and diminished attention, concentration, and memory.  Her last day of logging work at the firm was January 27, 2012.

Doe worked as an environmental lawyer, but when considering her claim for long-term disability benefits, Standard evaluated her vocation as a “generic” lawyer.  Because it did so, Standard determined that after November 2011, Doe was not working in her own legal specialty but she was performing the work of a lawyer on a reasonably continuous basis.  Standard denied Doe’s benefit claim and appeal.

The district court ruled in Standard’s favor.  However, the First Circuit Court of Appeals reversed, finding that Standard acted arbitrarily and capriciously in relying on the DOT description of a generic lawyer rather than a job description that accurately encompassed the material duties of Doe’s specialized area of practice.  Further, there was no evidence in the record supporting the assumption that an “environmental lawyer” and “lawyer” are equivalent terms that may be used interchangeably.  The court found that the appropriate remedy is an award of benefits rather than a remand to Standard.

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