Third Circuit Finds “Ridiculous” Reliance Standard’s Position that Gastroenterologist Is Not an Occupation Under Its Disability Insurance Policy

In Patrick, M.D. v. Reliance Standard Life Insurance Company, No. 21-1681, 2023 WL 7381460 (3d Cir. Nov. 8, 2023), the Third Circuit Court of Appeals affirmed the district court’s grant of summary judgment in favor of Plaintiff-Appellee Amy Patrick, M.D. and against Defendant-Appellant Reliance Standard Life Insurance Company (“Reliance”). After paying Dr. Patrick long-term disability benefits for a decade based on her inability to work as a Gastroenterologist, Reliance terminated her benefits after concluding that her “regular occupation” was that of an Internal Medicine Specialist—an occupation she did not perform—and that she could physically perform the attendant duties. On de novo review, the court found Reliance’s decision to terminate benefits to be arbitrary and capricious, and affirmed the judgment and award of attorneys’ fees to Dr. Patrick.

Dr. Patrick was working as a board-certified Gastroenterologist when she lost partial use of her right shoulder after surgery and could no longer perform her duties as a Gastroenterologist. Specifically, she did not have the physical or cognitive endurance to perform colonoscopy and gastroscopy. Dr. Patrick was a participant in an ERISA-governed long-term disability plan insured by Reliance. She was entitled to benefits if she was no longer able to perform her “Regular Occupation,” defined as “the occupation the Insured is routinely performing when Total Disability begins. [Reliance] will look at the insured’s occupation as it is normally performed in the national economy, and not the unique duties performed for a specific employer or in a specific locale.” At the end of 2018, when Dr. Patrick submitted her disability claim to Reliance, its vocational expert concluded that her regular occupation under the Department of Labor’s Dictionary of Occupational Titles (“DOT”) was an Internal Medicine Specialist. Reliance also obtained job description information from Dr. Patrick’s employer, who explained she was a full-time Gastroenterologist. In 2009, Reliance approved Dr. Patrick’s claim and began paying benefits because her “major problem was she lacks endurance to perform colonoscopy and gastroscopy.”

Reliance continued to pay Dr. Patrick for about ten years when a medical review conducted in December 2018 resulted in a termination of benefits. Dr. Patrick’s current doctor, Dr. Jobin, returned an Attending Physician’s Statement stating that he was treating Dr. Patrick’s left shoulder and that she could return to work with no restrictions. Dr. Patrick appealed Reliance’s decision and included a sworn declaration from Dr. Jobin wherein he confirmed that he was only considering her left shoulder when he completed the APS form and that he agreed with the prior diagnosis that Dr. Patrick could no longer perform GI procedures full-time. Notwithstanding this declaration, Reliance continued to uphold the termination of benefits on the basis that she was qualified to perform the duties of her regular occupation of an Internal Medicine Specialist. The district court granted summary judgment to Dr. Patrick because Reliance’s determination of Dr. Patrick’s regular occupation is contrary to the plan’s plain language.

On appeal, as explained by the court, “Reliance’s argument, at its core, is as follows: Reliance reasonably interpreted ‘Regular Occupation’ to mean only occupations found in the DOT, as those are the only occupations that exist in the national economy. Reliance argues that because Gastroenterologist is not a listing in the DOT, it was reasonable for Reliance to assign Dr. Patrick the ‘Regular Occupation’ of Internal Medicine Specialist, even though she is neither practicing as an Internal Medicine Specialist nor is she even board certified to practice internal medicine.” And, because Dr. Patrick’s injury only affects her ability to perform GI procedures, she could perform the tasks required of an Internal Medicine Specialist. Thus, she is not disabled.

The Third Circuit found Reliance’s arguments “ridiculous.”  Though the DOT is a valuable tool when evaluating disability claims, it does not function as an exclusive list of jobs that exist in the national economy. Reliance cannot refuse to consider Gastroenterologist as an occupation simply because it is not in the DOT. The court found that the district court properly relied on the plain language of the disability policy and evidence in the record. Reliance did not challenge the district court’s award of fees and costs. Since the Third Circuit agreed with the district court that summary judgment in favor of Dr. Patrick was proper, it also affirmed the fees and costs award.