Employees in Chicago with claims for long-term disability benefits often suffer from conditions that cause them to need to take breaks from work during the day. The quantity and duration of these required breaks can determine whether you are legally disabled under your long-term disability policy. That is because long-term disability claims have three components: a medical component, a contractual component, and a vocational component. The medical component is your restrictions and limitations. The contractual component is how your long-term disability policy defines Disabled. The vocational component is whether you can perform your, or a different, occupation given the restrictions and limitations. So if you can work, but require a two-hour break during the day, does that render you disabled? A recent case addressed this vocational aspect of disability.
In Bombassei v. The Lincoln National Life Insurance Co., No. 22-10593, 2023 WL 3605968 (E.D. Mich. May 23, 2023), Bombassei was a nurse practitioner who suffered from type 2 narcolepsy with extreme daytime sleepiness and rheumatoid arthritis. After her condition worsened and she could not stay awake during the day, she ceased working and claimed long-term disability benefits. Lincoln approved her claim under the Regular Occupation standard of disability, but terminated payments after 24 months when the definition of disability changed to an Any Occupation standard. Bombassei submitted reports of treating physicians stating that due to her narcolepsy, Bombassei must take a two-hour nap during the work day. The Social Security Administration also found Bombassei disabled, finding she would need a two-hour break during the day, which was inconsistent with performing any occupation. Lincoln denied Bombassei’s appeal, after which Bombassei sued under ERISA § 502(a).
The United States for the Eastern District of Michigan ruled in Bombassei’s favor and awarded her long-term disability benefits. The court found the treating physicians’ opinions Bombassei must take a two-hour break to nap during the day credible, and noted the Social Security Administration even found that Bombassei had such a limitation in its analysis. The court criticized Lincoln for not even addressing Bombassei’s narcolepsy beyond acknowledging the diagnosis; it never addressed whether Bombassei would work given the need to take a two-hour break during the day. The court found, from a vocational standpoint, Bombassei was not employable in any occupation given her need to take such a long break daily.
If you have a claim for long-term disability benefits, contact an experienced ERISA long-term disability lawyer today.