Employees in Chicago with claims for long-term disability who work in sedentary occupations, or whose definition of disability has changed to the “any occupation” standard, often wonder why insurers rate their physical capabilities in terms of “occasionally” and “frequently,” and what these terms really mean. Simply, to do a task “occasionally” means performing it up to one-third of an eight-hour workday. To do a task “frequently” means performing it between one-third and two-thirds of an eight-hour workday. For a good discussion of how these ranges work, see our prior blog post here. By definition, “sedentary” work involves sitting “most of the time.” With the high availability of sit-stand workstations, insurers find individuals can work in sedentary positions if they can sit “frequently,” though historically sedentary work required sitting at least six hours a day. But where in the “frequently” range is enough sitting capacity? Is anything in that range sufficient? A recent case demonstrates merely finding one can sit frequently may not be enough.
In Waldrip v. Reliance Standard Life Insurance Co., No. 3:21-cv-5602, 2023 WL 3090837 (W.D. Wash. Apr. 26, 2023), Waldrip suffered from relapsing/remitting multiple sclerosis. After her long-term disability insurance policy’s definition of disability changed to an “any occupation” standard, Reliance Standard contended Waldrip could perform sedentary work and terminated her benefits. Reliance Standard sent Waldrip to an Independent Medical Examiner who opined Waldrip could sit frequently. Waldrip’s doctors maintained she could only sit “occasionally.” After Waldrip unsuccessfully appealed, she sued under ERISA § 502(a).
The United States District Court for the Western District of Washington noted that in the Ninth Circuit, where that District Court sits, sedentary work requires ability to sit at least 4 hours per day. On de novo review, where the court makes findings of fact, rather than merely reviews the insurers decision to determine if it is arbitrary and capricious, the court weighed the evidence and found that Waldrip was disabled from performing full-time sedentary work. It noted that Reliance Standard did not ask its IME doctor where within the “frequently” range Waldrip’s sitting capacity fell. Weighing the evidence, together with treating physicians’ opinions Waldrip’s sitting capacity was only occasional, the court found Waldrip could not sit over four hours per day and found her totally disabled.
If you have a claim for long-term disability insurance benefits, contact a skilled ERISA long-term disability attorney today.