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

In Aisenberg v. Reliance Standard Life Insurance Company, No. 1:22-CV-125, 2023 WL 2145499 (E.D. Va. Feb. 21, 2023), involving a dispute over long-term disability benefits, 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, but concluded that the administrator did not abuse its discretion in defining Plaintiff’s “regular occupation” as an “attorney.” The Court remanded the matter to the plan administrator for further consideration.

This ERISA action arises from Defendant Reliance Standard Life Insurance Company’s (“Defendant”) denial of Plaintiff Michael Aisenberg’s (“Plaintiff”) application for long-term disability (“LTD”) benefits. 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 Standard.

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 Standard denied Plaintiff’s LTD claim, concluding that the physician letters “did not provide any physical exam findings, clinical findings, symptoms, or review of systems that would preclude [Plaintiff] from work function beyond January 12, 2021.” Plaintiff appealed. Reliance Standard upheld the denial citing to a peer review report that concluded there was no objective evidence of cardiac impairment after December 16, 2020, and “no randomized controlled trial that shows relieving chronic job stress results in the secondary prevention of cardiovascular events.” Reliance Standard noted “[e]ven if [Plaintiff] does not work at his prior exact position, there is no evidence to suggest that he could not work as an attorney doing ‘less stressful’ legal work.”  The instant action ensued.

On November 15, 2022, Magistrate Judge Anderson issued a Report and Recommendation that summary judgment issue in favor of Plaintiff, concluding that Reliance Standard had abused its discretion in denying Plaintiff’s LTD claim because it had failed to consider the potential for future harm to Plaintiff were he to return to his high stress job at MITRE, and it incorrectly characterized Plaintiff’s “regular occupation” as an “attorney” and thus failed to consider the specific high stress characteristics of Plaintiff’s job at MITRE.

Reliance Standard raised multiple objections, which the Court addressed in turn. First, although the Fourth Circuit has not yet specifically held that the risk of future harm from cardiac conditions may constitute a disability for LTD benefits, its decision in Stanford v. Continental Casualty Co., 514 F.3d 354 (4th Cir. 2008), citing Lasser v. Reliance Standard Life Ins. Co., 344 F.3d 381, 391 (3d Cir. 2003), indicated in dicta that the risk of future harm from cardiac-related conditions should be evaluated in determining whether LTD benefits are warranted. In light of Lasser and Stanford, the Court found that Reliance Standard should have and failed to consider the risk of future harm to Plaintiff if he returns to a high stress job.

The Court overruled Reliance Standard’s objections that the Magistrate Judge: (1) incorrectly applied a burden-shifting framework to its analysis; (2) incorrectly relied on a case applying de novo review even though review in this matter is under an abuse of discretion standard; (3) reached a conclusion that was contrary to the facts contained in the administrative record; and (4) improperly “questioned” why Reliance Standard concluded that even though Plaintiff met the requirements for total disability on January 12, 2021, it then determined that Plaintiff was not totally disabled one day later on January 13, 2021. The Court found that these arguments were either immaterial to the Magistrate Judge’s ultimate conclusion, or they were not substantiated.

Reliance Standard also objected to the Magistrate Judge’s conclusion that it unreasonably construed the policy term “regular occupation” too broadly as an “attorney,” rather than as an attorney performing Plaintiff’s high-stress duties at MITRE. The Court agreed, noting that the phrase “regular occupation” is not defined in the policy, and Reliance Standard has discretion to interpret policy terms and provisions. The Court found that Reliance Standard’s interpretation of the term “regular occupation” to be that of an “attorney” was not unreasonable. However, Reliance Standard concluded that Plaintiff’s “regular occupation” encompassed other “less stressful” attorney positions, but failed to analyze whether such positions indeed exist in the national economy. And there was no indication that Reliance Standard considered any evidence of the stress levels of various attorney positions. The Court remanded the matter to Reliance Standard for further consideration of whether there exist less stressful attorney positions that Plaintiff could perform without risk to his cardiac condition.

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