Employees in Chicago and around the rest of Illinois making claims for long-term disability insurance benefits often underestimate the value of a functional capacity evaluation. A functional capacity evaluation is an examination performed by a physical therapist that objectively measures your capacities for various physical activities, such as sitting, standing, walking, lifting/carrying, balance, etc. Standing alone, functional capacity evaluations may nor may not carry much weight. The optimal use of a functional capacity evaluation is to corroborate your doctors’ opinions of your functional capacity. A recent appellate court case highlighted how courts weigh functional capacity evaluations.
In Scanlon v. Life Insurance Co. of North America, 81 F.4th 672 (7th Cir. 2023), Lewis worked as a Windows Systems Administrator at McKesson Corporation. His job was a sedentary one. Scanlon was an army veteran with a history of chronic pain and sleep disorders. His doctors opined he lacked capacity to perform sedentary work. When he made a claim for long-term disability insurance benefits to Life Insurance Company of North America (“LINA,” a subsidiary of New York Life Insurance Company), LINA denied the claim. LINA obtained a medical consultant’s opinion stating Scanlon’s impairments were not severe enough to preclude sedentary work. Scanlon appealed, submitting with the appeal a functional capacity evaluation showing he could sit 15 minutes at a time, and stand 45 minutes at a time, and that he could only sit a total of 2 hours and 50 minutes in a day, and stand only 4 hours and 22 minutes in a day. LINA upheld its denial on appeal, and Scanlon then sued under ERISA § 502(a).
The United States Court of Appeals for the Seventh Circuit noted the District Court found Scanlon could perform sedentary work, and reviewed the District Court’s opinion for clear error. The appeals court held the District Court had committed clear error by not properly weighing the functional capacity evaluation. The District Court disregarded the findings of the functional capacity evaluation because none of Scanlon’s treating physicians flatly opined Scanlon was totally disabled. The appeals court explained the correct way to weigh a functional capacity evaluation is to ask “whether the results are consistent or conflicting with other medical examinations,” citing Marantz v. Permanente Medical Group, Inc. Long Term Disability Plan, 687 F.3d 320, 332 (7th Cir. 2012). Because Scanlon’s functional capacity evaluation was consistent with his treating physicians’ opinions, the District Court should have given it greater weight. The appeals court ultimately vacated the District Court’s decisions and remanded for revised fact-finding consistent with the appellate court’s opinion.
If you have a claim for long-term disability benefits, contact a knowledgeable ERISA long-term disability lawyer today.