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Pulmonary Irritants Unique to Employee

Pulmonary Irritants Unique to Employee's Work Site Did Not Support Disability from Her Occupation

Kennedy v. United of Omaha Life Ins. Co. 556 F. App'x 893 (11th Cir. Feb. 28, 2014)

ERISA and Life Insurance News
(August 29, 2014)

Kennedy sued United of Omaha to recover long-term disability benefits under an ERISA plan, based on an allegedly debilitating pulmonary condition. United of Omaha denied the claim after reviewing the opinions of Kennedy’s pulmonologist, her primary care physician, and an independent pulmonologist who reviewed her medical records.

The federal district court held that the claim decision was not arbitrary and capricious, having taken into account any conflicts of interest. Kennedy appealed, and the Eleventh Circuit affirmed the district court, noting that Kennedy’s pulmonologist had concluded that she was capable of working in her regular occupation if she was not exposed to respiratory irritants.

“Kennedy had not pointed to any evidence in the administrative record demonstrating that the workplace irritants she encountered at River Point were universal and unavoidable, as opposed to being unique to her specific employer and office space,” the court said. “Accordingly, there was a reasonable basis for United to conclude that Kennedy could work in her regular occupation when, as dictated by the Policy, it set aside peculiarities of Kennedy’s work at River Point and instead considered her occupation generally.”

Although Kennedy emphasized that United of Omaha operated under a conflict of interest, the court said that this was only one factor for the district court to consider in reviewing the claim decision. “The fact that United awarded Kennedy long-term disability benefits pending its investigation, which it did not later seek to recover, is evidence that it rendered an impartial decision despite its conflicts,” the court said.

Click here to view the full August 2014 Edition of the ERISA and Life Insurance News.

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