Doe v. Standard Insurance Company
2017 U.S. App. LEXIS 5232
1st Cir.2017Background
- Plaintiff "Jane Doe" worked for decades as an environmental lawyer and held specialized "Own Occupation" LTD coverage under a Standard Insurance Company (Standard) policy that treats a claimant as "Disabled" if unable to perform the material duties of her Own Occupation.
- Doe’s 2011 billable hours and income plunged; she reported onset of disabling depression in October–November 2011, sought treatment late 2011–early 2012, and stopped logging work on January 27, 2012.
- Under the Policy, Predisability Earnings are measured by the prior tax year; an onset in 2011 (vs. 2012) would substantially increase Doe’s benefits and entitle her to the full 24 months of LTD payments for Mental Disorders.
- Standard’s vocational reviewers ignored Doe’s specialized job description and treated her Own Occupation as the generic DOT occupation “Lawyer,” concluding disability began in January 2012 rather than November 2011.
- Standard denied benefits through administrative appeals, then approved benefits with a January 2012 onset; Doe sued under ERISA. The district court entered judgment for Standard; the First Circuit reviews de novo whether Standard’s discretionary decision was arbitrary and capricious.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Standard lawfully used a generic "lawyer" standard instead of Doe’s specialized "environmental lawyer" Own Occupation when determining disability onset | Doe: Standard must assess ability to perform the material duties of her specific specialty; Standard’s use of a generic DOT "Lawyer" standard eviscerated the enhanced Own Occupation coverage and was arbitrary | Standard: DOT lacks an "environmental lawyer" entry; generic "Lawyer" duties reasonably represent Doe’s work and justify January 2012 onset | Court: Reversed — Standard’s reliance on a generic DOT "Lawyer" description was arbitrary and capricious because it failed to assess Doe’s material duties as an environmental lawyer |
Key Cases Cited
- McDonough v. Aetna Life Ins. Co., 783 F.3d 374 (1st Cir.) (Own-occupation analysis requires review of claimant’s particular position)
- Metro. Life Ins. Co. v. Glenn, 554 U.S. 105 (U.S. 2008) (abuse-of-discretion review of conflicted plan administrators requires multifactor balancing)
- Colby v. Union Sec. Ins. Co., 705 F.3d 58 (1st Cir.) (court has remedial latitude in ERISA cases; remand not always required)
- Tsoulas v. Liberty Life Assurance Co. of Bos., 454 F.3d 69 (1st Cir.) (generic DOT description may suffice only if duties are equivalent to claimant’s own occupation)
- Miller v. Am. Airlines, Inc., 632 F.3d 837 (3d Cir.) (own-occupation benefits require assessing ability to perform specialty duties)
- Glista v. Unum Life Ins. Co. of Am., 378 F.3d 113 (1st Cir.) (range of equitable remedies for ERISA violations)
- Cook v. Liberty Life Assurance Co. of Bos., 320 F.3d 11 (1st Cir.) (plan administrators should not get repeated remands after arbitrary decisions)
- Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914 (7th Cir.) (claimant’s limited efforts to work do not forfeit disability benefits)