On April 14, 2011, the Second Circuit ruled that an employee’s continued presence at work does not preclude a finding that the employee was disabled during that time. Even though the employee continued to report to work until she was fired 15 months after her accident, the Court in O’Hara v. National Union Fire Insurance Company held that a reasonable factfinder could conclude that she nevertheless was disabled.
Patricia O’Hara worked for ITT Flygt Corporation as an office administrator. During her employment, she participated in a voluntary disability insurance plan, which was issued by National Union Fire Insurance Company of Pittsburgh. Under the plan, O’Hara was eligible to recover if an accidental injury rendered her totally and permanently disabled and prevented her from engaging in “each and every occupation or employment . . . for which [she was] reasonably qualified by reason of [her] education, training or experience” within one year of the accident, and the disability continued for at least a year.
In March 2001, O’Hara tripped and fell while working, hitting her head on the floor. Despite persistent headaches, O’Hara continued to work at ITT. However, her coworkers began to complain to her supervisor that she was behaving unprofessionally and having difficulty in her relationships with her colleagues. O’Hara’s supervisor initially gave her a warning, but ITT ultimately terminated O’Hara’s employment in June 2002 because of her performance and negative interactions with other employees.
O’Hara submitted a claim for disability benefits under the National Union disability plan in January 2004. In support of her claim, she submitted a letter from her neurologist indicating that, immediately after her March 2001 injury, and continuously thereafter, O’Hara was disabled because of posttraumatic migrainous headache disorder. Nonetheless, National Union’s ERISA Appeal Committee denied O’Hara’s claim, stating that there was not sufficient evidence that she was totally and permanently disabled and prevented from engaging in each and every occupation for which she was reasonably qualified within one year of her March 2001 fall.
O’Hara filed suit against National Union in the Western District of New York in March 2008, alleging that National Union violated ERISA by denying her disability benefits. National Union moved for summary judgment, and in March 2010, the district court granted National Union’s motion.
O’Hara appealed the district court’s decision. National Union argued that, because O’Hara continued to report to work, she could not simultaneously be deemed disabled for purposes of receiving benefits under the plan. The Court, citing its earlier decision in Locher v. Unum Life Ins. Co. of America, disagreed, stating that “[o]ne may be at one’s place of employment but not able to work.” Even the district court had observed that there was substantial evidence that O’Hara was disabled from her job within one year of her March 2001 fall. O’Hara’s neurologist concluded that she had a posttraumatic headache disorder. In addition, she had chronic daily headaches and memory disturbance which prevented her from engaging in other work, and was unable to get along with her coworkers. Therefore, the Court concluded that the district court erred in granting National Union’s summary judgment motion, stating that a reasonable factfinder could conclude that O’Hara was totally and permanently disabled from engaging in qualified work as of March 2002.
In light of the Second Circuit’s decision in O’Hara, companies should make sure to educate the employees who administer their disability insurance plans. Specifically, when interpreting a plan’s qualification standards and determining whether an employee meets the plan’s definition of disability, plan administrators must understand that the mere fact that an employee continues to report to work is, in and of itself, insufficient to conclude that the employee is not disabled. If an employee continues to work following an injury and files a claim for disability benefits, the plan administrator should carefully review any information from the employee’s physicians and should find out from the employee’s supervisor whether the injury impacted the employee’s ability to do his or her job and, if so, how.