In Geiger v. Zurich Am. Ins. Co., No. 22-1519, __F.4th__, 2023 WL 4217009 (4th Cir. June 28, 2023), the Fourth Circuit affirmed the district court’s grant of judgment to Zurich American Life Insurance Company of New York, in this lawsuit brought under ERISA § 502(a)(1)(B), where Plaintiff alleged that Zurich wrongfully terminated his long-term disability benefits. The Fourth Circuit concluded that Zurich’s decision followed a principled reasoning process and was supported by substantial evidence.
Plaintiff worked at CBS as a writer/editor when he became disabled due to moderate pulmonary hypertension and moderate-severe pulmonic regurgitation. While on disability leave, he developed a serious heart condition requiring open heart surgery. The court found that Zurich engaged in a reasonable decision-making process because it approved Plaintiff’s short-term disability benefits and then approved his long-term disability claim. To qualify for LTD benefits, Plaintiff must show that he is “unable to perform the material and substantial duties of [his] regular occupation due solely to [his] sickness or injury.” After Plaintiff relocated and started treatment with a new doctor, Zurich obtained and reviewed his new treatment records. Though his doctor supported disability, the court found that the treatment records did not support that conclusion. “[Plaintiff] had a normal echocardiogram, had no heart symptoms, was walking three miles a day and had lost substantial weight.” Zurich retained Dr. Mark Sims to review Plaintiff’s records and his doctor’s additional statement supporting disability. After review of the records and a peer-to-peer call, Dr. Sims concluded that Plaintiff could perform full-time work. The court found this to be sufficient substantial evidence supporting Zurich’s claim decision.
Plaintiff argued that Zurich abused its discretion by failing to evaluate his particular job responsibilities in determining his disability status. The court disagreed. It explained that the Plan defines “Regular Occupation” as the occupation that the employee is routinely performing when the disability begins, as that occupation is normally performed in the national economy, not for a specific employer. Zurich also completed a job demand analysis which concluded that his occupation of a writer/editor is sedentary with minimal physical requirements. The court also rejected Plaintiff’s argument that Zurich should have performed a vocational review or consulted the Department of Labor’s Dictionary of Vocational Titles. It was Plaintiff’s burden to provide written proof of his claim and Zurich’s responsibility to assess Plaintiff’s ability to work. Zurich did not abuse its discretion by failing to obtain additional vocational evidence, “as neither the Plan nor our case law affirmatively requires it to have done so.”
Lastly, Plaintiff argued “that Zurich failed to consider the amount of stress involved in his job and how that stress might impact his cardiac conditions.” The court explained that “nowhere in the records did [any] physician opine that Geiger cannot perform the duties of his prior job because of the stress associated with doing so. Perhaps an administrator might conclude that he is entitled to LTD benefits because stress is an inherent factor for anyone recovering from the type of heart conditions Geiger had experienced. But that does not mean Zurich’s reliance on the stated reasons for Geiger’s disability rather than allegedly implied problems from returning to work was unreasonable.” Judgment Affirmed.
*Please note that this blog is a summary of a reported legal decision and does not constitute legal advice. This blog has not been updated to note any subsequent change in status, including whether a decision is reconsidered or vacated. The case above was handled by other law firms, but if you have questions about how the developing law impacts your ERISA benefit claim, the attorneys at Roberts Disability Law, P.C. may be able to advise you so please contact us.
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