Court Again Finds Reliance Standard Abused Its Discretion in Failing to Consider Long-Term Disability Claimant’s Risk of Future Harm from Cardiac Condition

In February 2023, Virginia Eastern District Judge T.S. Ellis, III granted partial summary judgment to Plaintiff finding that the plan administrator abused its discretion in failing to consider the risk of future harm from Plaintiff’s cardiac condition and remanded the matter to the plan administrator for further consideration. We wrote about that decision here. One year later, in Aisenberg v. Reliance Standard Life Insurance Company, No. 1:22CV125 (DJN), 2024 WL 711608 (E.D. Va. Feb. 21, 2024), the Court (Judge David J. Novak) again granted summary judgment to Plaintiff finding that Reliance abused its discretion when it denied Plaintiff’s LTD claim a second time.

Plaintiff, an attorney and member of the District of Columbia Bar, worked as principal cyber security counsel for MITRE, providing policy advice and analysis in support of MITRE’s systems engineering work for federal agencies. Plaintiff’s supervisor described Plaintiff’s occupation as demanding and stressful consisting of constant work with senior leadership in government agencies. In July 2020, Plaintiff underwent open heart surgery with a double coronary artery bypass graft. After rehabilitation, Plaintiff’s cardiologist advised him in October 2020 not to return to his employment at MITRE because the high stress environment of the job would likely contribute to the worsening of Plaintiff’s heart condition over time. Plaintiff submitted an LTD claim to Reliance. Despite letters from Plaintiff’s doctors reporting the likelihood of his condition worsening if Plaintiff returned to his high stress occupation, on January 4, 2021, Reliance denied Plaintiff’s LTD claim, upheld the denial on appeal, and the lawsuit commenced. In the initial action, the Court remanded the matter after concluding Reliance should have and failed to consider the risk of future harm to Plaintiff if he returns to a high stress job.

On remand, Reliance ordered a labor market survey and vocational report to determine the material duties and exertional demands of Plaintiff’s occupation, “Business and Financial Counsel,” as it is performed in the national economy. Reliance also obtained another peer review from a physician specializing in cardiovascular disease. The peer review report echoed the report of its prior reviewer where the court found Reliance had abused its discretion. The report did not make clear whether the reviewer had considered the material duties of Plaintiff’s occupation when he rendered his assessment, except to note his opinion that the relationship between work-related stress and coronary disease had never “been proven in peer-reviewed clinical trials.”

On motion for summary judgment, the Court first found that Reliance disregarded its directive on remand and limited its interpretation of Plaintiff’s regular occupation from that of “attorney” to the narrower category of “Business & Financial Counsel.” With regard to the consideration of the “risk of future harm” which Reliance had been directed to consider, the Court analyzed the factors outlined in Booth v. Wal-Mart Stores, Inc. Assocs. Health and Welfare Plan, 201 F.3d 335, 342–43 (4th Cir. 2000), to determine the reasonableness of its claim denial. The Court found that in its most recent denial Reliance conceded that stress would flow from the performance of Plaintiff’s occupational duties, but focused instead on the peer reviewer’s contention that the relationship between work-related stress and coronary disease was tenuous. However, given that Plaintiff provided four scholarly articles and the opinions of multiple doctors that articulated the danger that high-stress levels would pose to Plaintiff’s condition, Reliance should have investigated this spectrum and provided the Court with evidence on whether there existed attorney positions that cause levels of stress that would not endanger Plaintiff’s cardiac condition. Instead, Reliance refused to follow the remanding judge’s instructions. The Court noted that Reliance provided no evidence of having considered the stress levels of various attorney positions. Instead, Reliance rejected outright that Plaintiff’s occupational duties cause any stress, because stress was not literally listed among the material duties returned by its labor market survey specialist nor did the Dictionary of Occupation Titles list “stress” as a duty.

The Court found that Reliance similarly ignored the second instruction on remand which called for it to incorporate stress levels experienced by attorneys into a medical opinion on Plaintiff’s ability to function as one without endangering his health. Reliance did not provide its second peer reviewer with any indication of the varying degrees of stress that may flow from the material duties of Plaintiff’s regular occupation. Rather, the peer reviewer used the term “typical work stress” in assessing that Plaintiff could sustain stress levels without harm to his cardiac condition but failed to articulate what level of stress the term “typical work stress” encompassed. Instead of assessing how much stress that Plaintiff could withstand given his cardiac condition, the peer reviewer and Reliance flatly rejected the existence of a relationship between work-related stress and cardiac health, and further failed to articulate why the conflicting scholarly articles provided by Plaintiff, which extensively demonstrate a link between cardiac health disease and work stress, were unpersuasive. Additionally, the peer reviewer apparently found no credibility in the reports of Plaintiff’s three physicians, each of whom described stress as a reason not to return to working as an attorney but did not provide any reasoning for his disagreement with them.

Finally, the Court found that Reliance inexplicably interpreted the term regular occupation to mean “attorney” in the first round of litigation, received a summary judgment opinion in its favor on that interpretation, and then decided to change its interpretation on remand – an inconsistency that was not trivial. As such the Court concluded that Reliance’s denial of Plaintiff’s application for LTD Benefits did not derive from a deliberate, principled reasoning process, and thus it had abused its discretion in denying Plaintiff his LTD Benefits.

As this case demonstrates, it can be difficult convince insurers of disability based on risk of future harm. If Reliance or your insurer has denied your disability insurance claim, contact us for assistance.