What does it mean to be totally disabled from the “regular occupation”?
Is “regular occupation” defined as the duties the claimant is actually doing in his or her specific job? NO.
Each claim should be assessed from the perspective of duties of the job generally in the national economy and not how the job is “performed for a specific employer or in a specific locale.”
Here’s the case of Nichols v. Reliance Standard Life Insurance Co., __ F.3d __ 2019 WL 2223614 (5th Circuit May 23, 2019) (Claimant claimed she could not work in cold conditions at poultry plant. Court affirms benefit denial because job duties of “regular occupation” are defined in the national economy, not the specific employer, and working in cold is not a job duty nationally).
This important new case shows how the definitions of “regular occupation” should be defined. Kudos go to my friends Josh Bachrach and Wilson Elser for a nice win.
FACTS. Nichols worked as “Hazard Analysis” Coordinator or “Sanitarian” at a chicken processing plant. She claimed part of her “Regular Occupation” duties involved working in cold temperatures, around 40 degrees. She sought ERISA-governed long term disability benefits, claiming her Raynaud’s condition precluded her from working in cold temperatures—she would get gangrene (e.g., finger/toe body tissue dies). The policy defined “Regular Occupation” as duties “normally performed in the national economy”— not how the job is “performed for a specific employer or in a specific locale.” The benefit denial decision was reviewed under the abuse of discretion standard.
Reliance determined working in cold temperatures was not a material duty of Nichols’ Regular Occupation and concluded she was not totally disabled—she could perform the regular duties of a Sanitarian, as defined by the Dictionary of Occupational Titles (DOT). Nichols sued seeking benefits.
DISTRICT COURT HELD: Nichols was totally disabled from performing her position in cold temperatures.
FIFTH CIRCUIT HELD: REVERSED—Claimant properly denied benefits because she could perform “regular occupation” duties as defined generally by the Dictionary of Occupational Titles (DOT).
- “‘If the plan fiduciary’s decision is supported by substantial evidence and is not arbitrary and capricious, it must prevail.’” Op. at 7.
- “[P]recedent does not require that an administrator consider each of a claimant’s duties to determine his regular occupation.” Op. at 8.
- “Reliance’s classification [of job duties] was easily based on substantial evidence.” Op. at 8.
- [A] claimant’s regular occupation must be defined at a high level of generality, ‘referencing the activities that constitute the material duties of the [claimant’s occupation] as they are found in the general economy.’” Op. at 8.
- “Reliance’s finding that work in cold areas was not a material duty [and the decision to deny disability benefits] are supported by substantial evidence. Reliance [relied upon] reports from two vocational review specialists who used DOT to determine Nichols’s regular occupation was that of a sanitarian.” Op. at 10.
- “[A]ny requirement to work in the cold is specific to a subset of sanitarians who work in poultry processing plants…[and relates to a] particular position with a particular employer. It is not part of her “regular occupation” as defined by the plan and our precedent.” Op. at 11 (emph. added).