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LTD Claim Remanded for Consideration of Plaintiff

LTD Claim Remanded for Consideration of Plaintiff's Social Security Disability Award


ERISA and Life Insurance News
(April 20, 2011)

Timmerman v. Hartford Life & Acc. Ins. Co.,
2010 U.S. Dist. LEXIS 7044 (D.S.C. Jan. 28, 2010)

Timmerman sought to recover long-term disability benefits under an ERISA-governed plan sponsored by his employer, which was funded by a group insurance policy issued and administered by Hartford.

Timmerman, who was a sales manager for a liquor distributorship, claimed that he was unable to work due to shortness of breath. In order to determine whether Timmerman was disabled from his “own occupation,” Hartford conducted an occupational analysis.

Because the plan defined “own occupation” as it was performed in the general workforce, not the specific job performed for an employer, Hartford relied on the Department of Labor’s Dictionary of Occupational Titles in determining that Timmerman’s occupation was that of “Manager, Sales.” Significantly, the DOT classified the occupation as sedentary, whereas the job description provided by Timmerman’s employer described more strenuous physical duties.

After reviewing Timmerman’s medical records and the opinion of his treating physician, who opined that Timmerman could perform the physical requirements of his sedentary occupation as described by the DOT, Hartford determined that Timmerman was not disabled from his “own occupation.”

On appeal, Timmerman submitted an affidavit stating that he had been approved for Social Security disability benefits, but he did not include any documentation of those benefits. Hartford’s letter upholding its determination on appeal did not reference Timmerman’s receipt of SSDI benefits. Timmerman then filed suit.

The district court reviewed Hartford’s claim decision under the arbitrary and capricious standard, and determined that the denial of Timmerman’s claim was not fully supported by the evidence, given the failure to adequately consider his receipt of SSDI benefits. The court determined that the case turned on whether the job duties as described by Timmerman’s employer were representative of the job in the general workplace, or whether the sedentary duties described in the DOT were more accurate.

The court noted that disability, as defined by the Social Security Administration, was similar to the plan’s definition, and even required a greater showing to establish disability. In addition, the Fourth Circuit said that the DOT is used in SSDI benefits cases as an acceptable way to determine a claimant’s occupation in the general workforce. Thus, the court concluded, Hartford had used a resource often used by the SSA in assessing disability and had applied a similar definition of disability, yet failed to obtain or consider the Social Security award.

Although the court noted that the contrasting Social Security opinion did not “inherently render Hartford’s decision denying benefits an abuse of discretion,” by not reviewing it, Hartford had made its decision without adequate evidence.

Hartford argued that it was not required to consider a Social Security award because Timmerman had not provided a copy of the award and it was under no obligation to secure evidence. The court agreed in part, determining that it would be “inappropriate” to reverse Hartford’s decision based on its failure to obtain the Social Security information, and it also noted that it did not find any improper motivation or bad faith on Hartford’s part.

Nevertheless, the court determined that it was within its discretion to direct a remand to consider the information. Indeed, the information was readily available from Timmerman or the SSA, and the plan required participants to apply for SSDI, and described how the benefits would impact LTD benefits.

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Authors
H. Sanders Carter
T (404) 962-1015
F (404) 962-1220
Kenton J. Coppage
T (404) 962-1065
F (404) 962-1256
Associated Attorneys
Associated Industries
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