Armani v. Northwestern Mutual Life Insurance Co.
2016 U.S. App. LEXIS 19925
| 9th Cir. | 2016Background
- Avery Armani, a controller, injured his back at work in January 2011 and stopped working May 18, 2011; treating providers consistently limited him to sitting no more than four hours in an 8‑hour day.
- Armani was covered by a group long‑term disability (LTD) plan from Northwestern Mutual that pays if a claimant is disabled from "own occupation" during the first 24 months and from "any occupation" thereafter.
- Northwestern Mutual initially approved benefits under the "own occupation" standard (effective July 18, 2011) but later closed the claim as of April–July 2013, concluding Armani could perform sedentary work.
- The insurer’s vocational analyst relied on the Dictionary of Occupational Titles definition that sedentary work "involves sitting most of the time," and identified four sedentary positions Armani could perform.
- Armani sued under ERISA; the district court reviewed the denial de novo, awarded benefits for the remainder of the own‑occupation period, but denied benefits after that period, rejecting Armani’s proposed definition of "sedentary" (derived from Social Security cases).
- The Ninth Circuit vacated the portion denying post‑24‑month benefits and remanded, holding that a person who cannot sit more than four hours in an eight‑hour day cannot perform "sedentary" work that requires "sitting most of the time."
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether an inability to sit >4 hours precludes performing DOT "sedentary" work | Armani: "Sedentary" requires ability to sit ~6 hours; unable to sit >4 hours means cannot perform sedentary occupations | Northwestern Mutual: DOT definition controls; "sedentary" means "sitting most of the time" but not limited to Social Security definitions | Court: Agrees with plaintiff; inability to sit >4 hours in an 8‑hour day precludes performing sedentary work that requires "sitting most of the time." |
| Whether district court properly rejected Social Security‑based sedentary definition | Armani: Social Security/precedent definitions are appropriate and persuasive for ERISA/DOT interpretation | Northwestern Mutual: Social Security criteria are not transferable to ERISA claims; insurer’s doctors say Armani could do sedentary work | Court: Rejects defendant; adopting Social Security/other courts’ interpretation is proper—definition applies in ERISA/DOT context |
| Whether administrative record supported insurer’s finding of ability to perform "any occupation" | Armani: Medical records uniformly show sitting limited to ≤4 hours, so record does not support ability to do sedentary jobs | Northwestern Mutual: Reviewing physicians concluded Armani could perform sedentary work and reposition occasionally; vocational analyst identified suitable jobs | Court: District court erred by accepting insurer’s conclusion without reconciling it with unanimous treating‑provider limits; insurer’s positions classified as sedentary require more sitting than Armani could do |
| Whether district court properly excluded extra‑record evidence | Armani: Proffered post‑record medical evidence showing continued ≤4‑hour sitting limit | Northwestern Mutual: Evidence was not necessary for review; standard limits extra‑record materials | Court: Did not reach this issue because it vacated denial on sedentary‑definition grounds |
Key Cases Cited
- Connors v. Connecticut Gen. Life Ins. Co., 272 F.3d 127 (2d Cir. 2001) (ability to sit for four hours generally insufficient for sedentary work)
- Muniz v. Amec Constr. Mgmt., Inc., 623 F.3d 1290 (9th Cir. 2010) (plaintiff bears burden to show disability by preponderance in de novo ERISA review)
- United States v. Bell, 602 F.3d 1074 (9th Cir. 2010) (standard: factual findings reviewed for clear error; legal conclusions de novo)
- Robertson v. Standard Ins. Co., 139 F. Supp. 3d 1190 (D. Or. 2015) (courts conclude four‑hour sitting tolerance is insufficient for sedentary work)
- Wykstra v. Life Ins. Co. of N. Am., 849 F. Supp. 2d 285 (N.D.N.Y. 2012) (recognizes sedentary work as involving up to two hours standing/walking and about six hours sitting)