What happens when the ERISA long term disability benefit plan does not define “full-time”?
The Department of Labor says “full-time” is defined by the employer.http://webapps.dol.gov/elaws/faq/esa/flsa/014.htm
The Affordable Care Act defines “full-time” as working 30 hours a week. https://www.healthcare.gov/glossary/full-time-employee/
When interpreting undefined ERISA plan provisions, courts apply general principles of contract law.
So, applying general principles of contract, what is the definition of “full-time”? It’s the “amount of time considered customary or standard”—and that could be a lot more than 40 hours per week.
The recent case of Safdi v. Covered Employer’s Long Term Disability Plan, et al., [PDF] __Fed. Appx. __ (6th Cir. November 24, 2015) highlights the point.
FACTS: Safdi, a physician, typically worked 70-80 hours per week, until he began cancer treatments. Then, his weekly hours dropped to 30-40 hours per week. He received ERISA-governed long term disability benefits for 7 years. Then, the benefits were terminated. To satisfy the applicable Recurrent Disability requirement, Dr. Safdi had to prove that there was a gap period in which he was no longer disabled… and was working “full-time”. The term “full-time” was not defined in the Plan. Dr. Safdi could not prove he returned to “full-time” work.
ISSUE: For physician Safdi, was 40 hours per week working “full-time”? NO.
6th CIRCUIT HELD:
- When interpreting ERISA plan provisions, “general principles of contract law apply[.]” Op. at 9.
- The Court “may also consider ‘the intent underlying the provision.’” Op. at 9.
- To satisfy the Recurrent Disability requirement, Dr. Safdi had to prove he had been “Residually Disabled at some point, then no longer disabled, and then Residually Disabled again…. The Policy’s definition recognizes this gap only if a participant returns to work full-time.” Op. at 10.
- “[T]he Policy does not define the term “full-time basis[.]” Op. at 11.
- “[T]he ordinary meaning of ‘full time’ is … ‘employed for or working the amount of time considered customary or standard.’” Op. at 11.
- If a participant works at each of his material duties for the customary amount of time, he is performing on a full-time basis.” Op. at 11.
- Dr. Safdi had to resume working at pre-disability levels, which for him was 70-80 hours per week. Op. at 10.
- Dr. Safdi did not satisfy the Recurrent Disability provision because he could not show two distinct periods of Residual Disability, separated by a return to work on a full-time basis. Op. at 9.