You already know that the Elimination Period in long term disability cases is a key focus in assessing eligibility for benefits.
This new Sixth Circuit case explains:
- the very high burden of proof a Plaintiff must meet to establish “continuous” disability during the Elimination Period; and
- when medical evidence obtained after the Elimination Period cannot satisfy the Plaintiff’s burden to prove disability during the Elimination Period.
Tranbarger v. Lincoln Life & Annuity Co. of New York, ___ F.4th __, 2023 WL 3527418 (6th Cir. May 18, 2023) (Affirming denial of benefits the Court held: “[T]he bar set by the plan’s requirement of ‘continuous’ disability…is a high one. Even one day of partial work ability during the Elimination Period is enough to defeat Tranbarger’s claim.…‘[W]e only consider [evidence from outside the Elimination Period] to the extent that it speaks to plaintiff’s condition during the relevant time period.’”)
FACTS: Plaintiff Tranbarger, an avid 10-mile-a-day cyclist, had surgery to remove her gallbladder and later experienced fibromyalgia and chronic fatigue syndrome. Fourteen months after she resigned from her sedentary account receivable manager role, she sought ERISA-governed long term disability benefits. The Lincoln disability insurance plan required that she prove she was continuously unable to perform each of the main duties of her own occupation during a six month Elimination Period. Lincoln denied her claim and Tranberger brought suit.
ISSUE: Whether Plaintiff established she was continuously unable to perform the main duties of an account receivable manager during the six months after she resigned from employment.
DISTRICT COURT HELD: Applying de novo review, the District Court concluded Plaintiff did not establish continuous disability during the Elimination Period.
SIXTH CIRCUIT COURT OF APPEALS AFFIRMS, HOLDING:
- “[T]he bar set by the plan’s requirement of ‘continuous’ disability…is a high one. Even one day of partial work ability during the Elimination Period is enough to defeat Tranbarger’s claim.” Op. at 3 (emph. added).
- “Ample evidence suggests she could perform some work in some instances.” Op. at 4-5.
- Having a diagnosis of fibromyalgia and chronic pain syndrome “do not answer the more granular question about her ability to work during the period in question.” Op. at 5.
- Plaintiff’s doctors opined Plaintiff was “totally disabled from working any occupation,” was limited to “20 minutes of effort” daily, and “faced a ‘progressive, unrelenting disease….” But “these assessments were made years after the Elimination Period closed, none speaks to the critical issue of whether Tranbarger could work during that period. Rather, they detail her condition at the time of (much later) treatment.” Op. at 5.
- “‘[W]e only consider [evidence from outside the Elimination Period] to the extent that it speaks to plaintiff’s condition during the relevant time period.’” Op. at 5.
- The Social Security Administration disability decision, that concluded Plaintiff was totally disabled, was not persuasive because it “primarily relied on evidence we have already said does not prove Tranbarger’s claim, [and] the post-Elimination Period evidence …does not speak to the timeframe at hand.” Op. at 6.
A lengthy concurring opinion argues that when the district court applies de novo review, then the Court of Appeals should apply “clear-error” review like that applied in the Fourth Circuit. Op. at 7.