In Mullins v. Consol Energy, Inc. Long Term Disability Plan, No. 22-2930, __F.4th__, 2024 WL 3564555 (3d Cir. Mar. 22, 2024), an opinion issued on March 22, 2024, which the Third Circuit unsealed on July 29, 2024, the court determined that Defendant Consol Energy, Inc. Long Term Disability Plan (administered by Lincoln Financial Group) abused its discretion in terminating Plaintiff’s long-term disability benefits because the Plan relied on a vocational report which listed Plaintiff’s job as a Mine Superintendent instead of a Section Supervisor, which are two completely different positions. Due to this mistake, the court vacated the district court’s judgment in favor of the Plan and remanded to the district court for reinstatement of Plaintiff’s benefits.
By way of background, Plaintiff has a 10th grade education and a GED. He worked for Consol’s Buchanan Mine in Virginia as a Section Supervisor before he became disabled by an ankle injury. He could no longer perform his own occupation which included extracting coal manually and by machine with his crew of 10-15 people, setting up ventilation systems, and building roof supports. After a couple of denials, appeals, and reinstatements, the Plan ultimately paid Plaintiff benefits for 12 months under the own occupation definition of disability. For Plaintiff to continue to receive benefits, he had to be unable to engage in any Suitable Employment, which is employment in a position for which the employee was trained in vocational training, or for which the employee is qualified by experience or education. The Plan had the discretion to determine what is Suitable Employment. In a vocational review done in 2016, the Plan determined that the records did not show he could perform any other Suitable Employment. When it did a review in 2019, it relied on a vocational review showing his job as a Mine Superintendent instead of a Section Supervisor, the former of which requires education and experience which Plaintiff did not have. The district court ruled for the Plan and Plaintiff appealed.
On appeal, the court addressed the Plan’s conclusion that Plaintiff has the physical capacity, as well as the relevant education, training, or experience for alternative employment, and that he has the qualifications for three alternative jobs. The court found that the Plan’s medical conclusion that Plaintiff was physically capable of performing limited sedentary work was reasonable and supported by substantial evidence where it relied on its own paper reviews instead of Plaintiff’s treating physicians’ opinions. The court found that Plaintiff did not provide evidence concerning his ability to perform sedentary work when he had the opportunity to do so. However, with respect to the second prong of disability—whether Plaintiff could satisfy the relevant occupational education, training, or experience necessary for alternative employment—the Plan had to identify alternative suitable jobs, which it did not. The jobs the Plan identified were based on qualifications that Plaintiff did not possess. The court found that the district court erred in concluding that Mine Superintendent and Section Supervisor are similar managerial positions. The court compared it to saying that there is no difference between an elementary school teacher and a university professor. Because the basis for terminating benefits was not based on substantial evidence, the court found that benefits should be reinstated to restore the status quo.
Lastly, Plaintiff argued that the Plan improperly offset the SSDI benefits received by his dependent children. The district court did not decide this issue because it did not reinstate his benefits. The court remanded this issue to the district court to determine whether the SSDI offset was in error.
*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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