Archives for November 17, 2016

It is very common for an insurance company to deny a claim for long-term disability insurance governed by ERISA after concluding that a claimant can perform the duties of a sedentary occupation.  The U.S. Department of Labor’s Dictionary of Occupational Titles (DOT) states that “[s]edentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.”  In other words, an occupation is classified fbifas “sedentary” when a majority of the work can be performed while sitting down, and the job does not require much, if any, movement and heavy lifting.

Insurers often assert that disability insurance claimants can work in a sedentary occupation, regardless of the physical restrictions from which the claimants suffer, including the ability to sit for four-to-six hours per day at a sedentary job.  However, this practice was recently rejected by the Ninth Circuit Court of Appeals in Armani v. Northwestern Mutual Life Insurance Company, __ F.3d __, No. 14-56866, 2016 WL 6543523, *3-4 (9th Cir. November 4, 2016), which created a bright-line rule that a person who cannot sit for more than four hours a day cannot perform a sedentary occupation.

In Armani, a case governed by ERISA, the Ninth Circuit held that, when all of claimant’s attending physicians agreed he could sit at most four hours of an eight-hour workday, he was unequivocally disabled from performing his own sedentary occupation (and from any other sedentary occupation), because sedentary jobs require mostly sitting and generally at least six hours per day.  After citing numerous cases that offered similarly findings, the Armani court stated:

[T]hese cases reflect the logical conclusion that an employee who is unable to sit for more than half of the workday cannot consistently perform an occupation that requires sitting for “most of the time.”  We agree with this commonsense conclusion and hold that an employee who cannot sit for more than four hours in an eight-hour workday cannot perform “sedentary” work that requires “sitting most of the time.”  Id. at *4 (emphasis added).

Given the finding by the claimant’s treating physicians that he could not sit for more than four hours, the Armani court ruled that the claimant was entitled to long-term disability benefits.  This ruling was made despite the fact that the insurer’s medical consultants disagreed with the insured’s attending physicians about the claimant’s sitting limits.  The insurer’s paid physicians concluded, based on reviewing his medical records, that the claimant had no sitting restrictions or limitations that would prevent him from performing a full-time sedentary job (when the insurer had contended sedentary work involves sitting most of the time).  Id. at *2.  The Ninth Circuit placed no weight on the insurer’s paper review opinions and, despite them, stated there was “undisputed evidence that . . . Armani was unable to sit for more than four hours a day” based solely on the attending physicians’ opinions.  Id. at *4 (emphasis added).

Overall, this is a very good ruling for disability insurance claimants who are unable to sit for more than four-to-six hours a day.  With this ruling, insurers are precluded from asserting that a claimant can work at a sedentary job if he or she cannot sit for more than four hours a day.  In fact, the Armani court even suggested that someone who can sit for more than four, but less than six hours a day, would also be precluded from sedentary work as the court cited to several decisions holding that a disability claimant who is unable to sit for more than six hours per day is disabled.

If you are an employee covered under your employer’s group short-term disability, long-term disability, life insurance or health insurance policy and had your claim denied, do not give up.  If your insurer denied your claim without examining you, or, even after you were awarded Social Security disability benefits, there is a good chance we can help.  You should immediately contact the McKennon Law Group, a law firm specializing in ERISA insurance and employee benefits litigation.  Let us decide whether your claim was wrongfully denied and let us see if we can assist you.