250 F. Supp. 3d 338
N.D. Ill.2017Background
- Plaintiff Ramona Contreras worked as a packer/cell operator for Flexco until November 2012 and stopped working due to worsening musculoskeletal pain and related conditions.
- United of Omaha funded and administered Flexco’s group long-term disability (LTD) plan; the Policy pays benefits if insureds are "unable to perform all of the Material Duties of any Gainful Occupation."
- The Policy defines Gainful Occupation as one that the insured is reasonably fitted for by training, education, or experience and that can be expected to provide at least 85% of Basic Monthly Earnings within 12 months of return to work; 85% of Contreras’s monthly earnings equals $2,808.17.
- Vocational consultant Patricia Thai identified Order Clerk as the only occupation consistent with Contreras’s background and cited BLS median wage data ($2,897.50/month) to opine Contreras could attain that wage, but Thai did not analyze timing to reach that wage within 12 months.
- Vocational expert James Radke concluded Contreras has minimal transferable skills, cited an Order Clerk/entry-level starting wage of $2,271/month, and doubted she could obtain customer-service/order-taker jobs at higher wages without significant training.
- Parties submitted the case for a bench decision on the administrative record; the court conducted an independent (de novo) determination of entitlement to LTD benefits.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Contreras is reasonably fitted for the occupation of Order Clerk | Thai: Contreras has transferable skills making her reasonably fitted for Order Clerk | Radke: Contreras lacks transferable skills; her prior jobs don’t qualify her for clerical roles | Close question but not decided because outcome turns on wage issue; court assumed arguendo she could be fitted but ruled for plaintiff on wage timing |
| Whether Contreras could be expected to earn >=85% of Basic Monthly Earnings ($2,808.17) within 12 months of starting as an Order Clerk | Thai: BLS median ($2,897.50) exceeds Policy threshold and Contreras could attain it (opinion of vocational certainty) | United: Record does not show Contreras would reach that wage in 12 months; Radke’s starting wage figure is lower ($2,271) | Held for Contreras: record does not support that she would reach $2,808.17 within 12 months; therefore she is entitled to LTD benefits since May 6, 2015 |
Key Cases Cited
- Krolnik v. Prudential Ins. Co. of Am., 570 F.3d 841 (7th Cir. 2009) (ERISA benefits review requires an independent decision, not deferential review)
- Diaz v. Prudential Ins. Co. of Am., 499 F.3d 640 (7th Cir. 2007) (burden allocation in ERISA benefits actions in bench ‘‘paper trials’’)
- Geiger v. Aetna Life Ins. Co., 845 F.3d 357 (7th Cir. 2017) (vocational expert opinion can suffice absent a time-limit wage requirement)
- Fritcher v. Health Care Serv. Corp., 301 F.3d 811 (7th Cir. 2002) (prejudgment interest in ERISA cases is presumptively appropriate and is a matter of discretion)
- Gorenstein Enters., Inc. v. Quality Care-USA, Inc., 874 F.2d 431 (7th Cir. 1989) (advising district courts to use the prime rate for prejudgment interest where no statutory rate applies)