In Chicago, and many other major metropolitan areas, the main functions of one’s job to be taken into account in reviewing a claim for long term disability insurance are no longer just the physical elements. Even in trades, the cognitive demands and travel requirements of working have been increasing as we become a more mobile workforce and as we work smarter, in addition to harder. These types of elements are what long term disability insurers and claims administrators most frequently overlook. Courts all over the country have long been holding the administrators must consider the actual duties of a claimant’s occupation when evaluating whether he or she is disabled under an “own occupation” standard. But without proper representation, errors still occur.
In McMillan v. AT&T Umbrella Benefit Plan No. 1, No. 14-CV-717-GKF-FHM, 2016 U.S. Dist. LEXIS 15542 (N.D. Okla. Feb. 9, 2016), McMillan sought benefits due to being disabled from his own occupation—a senior IT consultant. McMillan suffered from sleep apnea, diabetes, stage III kidney disease, shortness of breath, and chronic obstructive pulmonary disease. McMillan was unable to stand and walk for long periods of time and he was unable to focus, concentrate, and retain short-term memory. Without considering the travel and cognitive demands of McMillan’s job, Sedgwick denied McMillan’s claim, stating that there were no “observable” findings preventing McMillan from performing the sedentary requirements of his position. McMillan’s appeal included a treating physician opinion that because of his illnesses, McMillan was unable to sustain focus to adequately perform his work tasks. McMillan argued that he was unable to travel for work and that he was unable to maintain adequate cognitive function to perform his job.
McMillan sued under ERISA § 502(a). The court granted McMillan summary judgment and ordered Sedgwick to evaluate whether McMillan was unable to perform the travel and cognitive functions of his job. The Plan’s reliance on the medical consultants who only reviewed medical records was unreasonable because those medical consultants only opined on whether McMillan could perform a sedentary occupation, but never addressed any cognitive or travel requirements. Sedgwick’s review was thus incomplete, and the matter had to be remanded to Sedgwick to properly review the claim.
If you suffer from any illness that leave you unable to maintain focus, or with symptoms that are not easily measurable, call an experienced ERISA long term disability attorney today to discuss how to make your claim as strong as possible.
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