Mohamed Mokbel-Aljahmi v. United Omaha Life Ins. Co., 706 F. App'x 854

Background

Aljahmi filed an ERISA LTD claim after United discontinued benefits under a policy with two disability definitions (0–24 months 80% earnings, thereafter 60%).
Doctors treating Aljahmi diagnosed severe back/neck pain and radiculopathy; they opined he could not perform sedentary or light work on a sustained basis.
United initially paid benefits through 2013; in 2013 it relied on a TSA by Palmer (without treating-record review) to conclude transferability to several jobs could yield earnings above threshold.
In 2014 United obtained an IME (Salama) and conducted covert surveillance; it later reinstated benefits but continued reviewing eligibility with additional TSAs (Thal).
Thal’s November 2014 TSA identified six light/sedentary jobs with earnings around or above the threshold; Fuller later opined Aljahmi was illiterate in English and unemployable.
District court reviewed de novo and credited treating physicians, rejected Lambur’s file-review conclusions, and found Aljahmi unable to earn above the 60% threshold; district court awarded benefits.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether treating physicians’ opinions control.	Treating doctors show disability; their conclusions should be given substantial weight.	Medical opinions must be weighed against vocational evidence; some treating notes are inconsistent or outdated.	The district court did not err in crediting treating physicians and rejecting cherry-picked file reviews.
Whether Thal’s TSAs were properly weighed given literacy and evidence gaps.	Fuller’s assessment shows no transferrable skills; Thal relied on flawed data and outdated wage figures.	Thal’s TSA used available data and concluded several jobs met the threshold; Thal was not bound to interview Aljahmi.	Thal’s conclusions were not dispositive; the district court properly discredited their reliability when inconsistent with treating doctors.
Whether the surveillance evidence and outdated job data void denial.	Surveillance and outdated job data show lack of credibility in United’s findings; the surveillance monitor job no longer exists.	Surveillance data and job data support United’s determination under the policy.	The district court could disregard obsolete job descriptions and rely on reliable medical evidence showing impairment.
Whether the district court erred in applying de novo review and in weighing the vocational evidence.	De novo review should reflect comprehensive medical and vocational evidence; district court properly weighed both.	Administrative record supported denial; district court erred by not deferring to certain conclusions.	No clear error; district court appropriately weighed medical and vocational evidence and found disability.

Key Cases Cited

Javery v. Lucent Techs., Inc. Long Term Disability Plan, 741 F.3d 686 (6th Cir. 2014) (preponderance standard for disability under ERISA plan)
Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (U.S. 1989) (role of plan terms and discretion in benefit determinations)
Balmert v. Reliance Std. Life Ins. Co., 601 F.3d 497 (6th Cir. 2010) (deference to treating physician opinions when supported by record)
Moore v. Lafayette Life Ins. Co., 458 F.3d 416 (6th Cir. 2006) (de novo review framework and record-based analysis)
Calvert v. Volvo Car Corp., 409 F.3d 209 (6th Cir. 2005) (SSA criteria comparison and ERISA record interpretation)
Cunningham v. Astrue, 360 F. App’x 606 (6th Cir. 2010) (obsolescence of DOT-based job titles; need for full record)
Velikanov v. Union Sec. Ins. Co., 626 F. Supp. 2d 1039 (C.D. Cal. 2009) (bias concerns with vocational consultants)
Spangler v. Lockheed Martin Energy Sys., Inc., 313 F.3d 356 (6th Cir. 2002) (avoid cherry-picking records in vocational analysis)
Black & Decker Disability Plan v. Nord, 538 U.S. 822 (U.S. 2003) (crediting treating opinions and overall record in disability determinations)
Shaw v. AT&T Umbrella Ben. Plan No. 1, 795 F.3d 538 (6th Cir. 2015) (functional capacity evaluation reliability)