O'Hara v. Nat. Union Fire Ins. Co. of Pittsburgh, 642 F.3d 110

O'Hara, insured under National Union's disability plan through ITT, claimed total and permanent disability within one year of a March 15, 2001 accident.
She continued to report to work after the accident; by mid-2002 she was terminated for performance reasons.
Medical evidence showed posttraumatic headache disorder with memory and cognitive impairments; multiple doctors treated her over years.
AIG denied benefits in 2006 for lack of evidence of permanent disability; O'Hara appealed, submitting a June 2006 Mann letter describing total disability within one year.
District court granted summary judgment for National Union, applying deferential review and finding no evidence of disability within the plan's one-year window.
The Second Circuit vacated and remanded, holding the district court erred by misapplying summary judgment standards and that genuine issues of material fact remained.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Standard of review applied to denial of benefits	O'Hara argues de novo review due to lack of discretionary authority.	National Union contends de novo review is appropriate but the court can rely on the record's evidence.	District court erred; must remand for proper de novo review.
Effect of working while allegedly disabled	Working at ITT does not preclude disability under the plan if she was incapable of performing qualified work.	Presence at work indicates no total disability within plan terms.	Not dispositive; genuine issue of fact whether disabled within plan.
Disability within one year of the accident	Contemporaneous medical evidence shows disabling effects within one year from March 15, 2001.	No clear evidence of total and permanent disability from qualified work within that year.	Genuine disputes exist about whether O'Hara was totally and permanently disabled within one year.
Continuous disability for twelve months	Dr. Mann and other records show continuing disability through at least 12 months.	Other doctors' opinions undermine continuity of total disability.	There is a genuine dispute whether disability persisted for twelve consecutive months.
Timeliness waiver of notice	National Union waived timeliness objection by not contesting after claim in 2004.	Waiver is permissible only if timely raised; absence of objection creates waiver.	Argument not challenged on appeal; issue effectively waived in disposition.

Kunstenaar v. Conn. Gen. Life Ins. Co., 902 F.2d 181 (2d Cir.1990) (presence at work does not automatically negate disability under plan)
Locher v. Unum Life Ins. Co. of America, 389 F.3d 288 (2d Cir.2004) (employee can be disabled while continuing to work)
Demirovic v. Bldg. Serv. 32 B-J Pension Fund, 467 F.3d 208 (2d Cir.2006) (any gainful employment standard interpreted in ERISA context)
Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (Supreme Court 1989) (define standard of review for plan interpretations lacking discretionary authority)
Hobson v. Metro. Life Ins. Co., 574 F.3d 75 (2d Cir.2009) (de novo review when plan lacks discretionary authority to determine benefits)
Pucino v. Verizon Wireless Commc'ns, Inc., 618 F.3d 112 (2d Cir.2010) (summary-judgment standard in ERISA contexts; need for material facts)
Muller v. First Unum Life Ins. Co., 341 F.3d 119 (2d Cir.2003) (treatment of 'admin record' cases and summary judgment)