Employees in Chicago who receive long-term disability benefits due to disability from their own occupation frequently want to know if they can work in another capacity and continue to receive long-term disability benefits. For a discussion of “own occupation” long-term disability policies, see our past blog post here. The question often arises whether this poses any risk to continued receipt of the long-term disability benefits. Like in response to most questions, the answer is it depends. In theory, an own occupation disability policy pays you if you cannot work in your own occupation, so working in another capacity with your restriction and limitations should not affect continued receipt of the benefits. But there is also a practical consideration. Might the insurer view your ability to work in the substitute occupation as evidence you really can work in your own occupation? A recent case shows how this occurred.
In MacNaughton v. The Paul Revere Insurance Co., No. 4:19-40016, 2023 WL 2601624 (D. Mass. Mar. 22, 2023), Dr. MacNaughton was a diagnostic radiologist. She claimed long-term disability after a pregnancy complication left her with ischemic optic neuropathy in her left eye, and unable to see properly. Paul Revere approved the claim and paid benefits for ten years due to Dr. MacNaughton being disabled from her own occupation. Then Dr. MacNaughton began working part-time in a supervisory, non-diagnostic position. Paul Revere quickly terminated benefits, contending Dr. MacNaughton could perform the essential functions of her own occupation and had sufficient use of both her eyes. Dr. MacNaughton unsuccessfully appealed, and then sued under ERISA § 502(a).
The United States District Court for the District of Massachusetts remanded the case once due to procedural irregularities in Paul Revere’s claim handling. After the remand, Paul Revere upheld its position that Dr. MacNaughton was not disabled. On cross-motions for summary judgment, the court granted Paul Revere’s motion and ruled in its favor. The court declined to resolve the question of whether inability to use one eye rendered Dr. MacNaughton disabled from working as a diagnostic radiologist because it determined Paul Revere had enough evidence that Dr. MacNaughton had sufficient use of both eyes.
If you receive long-term disability benefits due to disability from your own occupation and are contemplating starting work in another capacity, speak to a skilled ERISA long-term disability lawyer to learn how to best protect yourself.