Employees in Chicago with claims for long-term disability insurance coverage sometimes partially recover and feel healthy enough to return to work, but get medical advice of the risks of doing so. This occurs more frequently with certain medical conditions, like cardiac conditions and for those with high stress jobs. This frequently raises the question of whether you still qualify for long-term disability insurance benefits if you are physically capable of working, but the risk of returning is future harm, or another adverse health event. The concept is known as “risk of disability,” and insurers frequently overlook it, merely evaluating your physical condition, and ignoring the risks of returning to work. But the insurers are wrong, as demonstrated by a recent case.
In Aisenberg v. Reliance Standard Life Insurance Co., No. 1:22-cv-125, 2023 WL 2145499 (E.D. Va. Feb. 21, 2023), Aisenberg worked as principal cyber security lawyer for MITRE Corporation, which was a demanding and stressful occupation. He underwent open heart surgery with double coronary artery bypass. After recovering from the surgery, Aisenberg felt unable to return to his role due to the high stress and demands placing him at risk of another coronary event. He claimed long-term disability insurance benefits, which Reliance Standard denied. After Aisenberg appealed, Reliance Standard upheld the decision, contending there were no objective physical examination findings precluding him from working in his occupation, ignoring the risk returning to work would pose. Aisenberg then sued under ERISA § 502(a).
The district court held Reliance Standard’s decision to ignore the risk of future harm was arbitrary and capricious. It stated the risk of future harm from work-related stress for a claimant with heart conditions can qualify as being legally disabled under a long-term disability insurance policy, and Reliance Standard improperly failed to consider that risk of returning to work. Reliance Standard argued that the “occupation” should be attorney, rather than Aisenberg’s specific job. For a discussion of “occupation” versus your job, see our prior blog here. The court also held there was a lack of evidence in the record to determine whether the general occupation included the same type of demands and work-related stress as Aisenberg’s job, and thus remanded to Reliance Standard to consider whether returning to work in a different role as an attorney would similarly include the same risk of future harm to Aisenberg.
If your claim for long-term disability insurance benefits has been denied, and returning to work places you at risk of a future adverse health event, call an experienced ERISA long-term disability attorney right away to explore your rights and options.