Virginia Lawyers Weekly VA Lawyers Weekly
Where an insurer denied a man’s application for long-term disability benefits, but it failed to consider the risk of future harm that he would suffer were he to return to his high stress work environment, it abused its discretion.
Background
This action under the Employee Retirement Income Security Act, or ERISA, arises from Reliance Standard Life Insurance Company’s denial of Michael Aisenberg’s application for long-term disability benefits. The magistrate judge issued a report and recommendation, or R&R, which recommended granting plaintiff’s motion for summary judgment and denying defendant’s motion for summary judgment. Defendant filed objections to the R&R.
Analysis
Defendant first objects to the R&R’s conclusion that defendant improperly failed to consider and assess plaintiff’s risk of future harm in returning to work and the magistrate judge’s rejection of defendant’s argument that plaintiff failed to prove the risk of future harm. This objection must be overruled because the R&R correctly concluded that defendant abused its discretion in failing to consider the risk of future harm that plaintiff would suffer were he to return to his high stress work environment.
The R&R also correctly concluded that defendant cannot now raise the argument that, even if risk of future harm does qualify as a disability, plaintiff failed to provide sufficient evidence of a risk of future harm. As the Fourth Circuit has explained, an ERISA defendant is limited to the justifications for denial of benefits that the defendant provided in the administrative process. Here, defendant did not raise plaintiff’s lack of sufficient evidence of a risk of future harm in defendant’s denial letters.
Defendant next objects that the R&R incorrectly applied a burden-shifting framework, even though the Fourth Circuit has made clear that in a denial of benefits case, the plaintiff has the burden of proving disability. However, the R&R’s citation of the burden shifting analysis does not affect the result reached and is not material to the magistrate judge’s ultimate conclusion — which is now adopted here — that in making the disability determination, defendant improperly failed to consider plaintiff’s risk of future harm if plaintiff returned to his high stress position. Thus, defendant’s objection in this regard is overruled.
Defendant also objects to the conclusion in the R&R that defendant 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. Defendant’s objection must be sustained because under the terms of the policy at issue, defendant has discretion to interpret the terms and provisions of the policy. It is evident that defendant’s interpretation of “regular occupation” was reasonable, and the R&R erred in failing to defer to defendant’s interpretation.
This does not end the analysis, however, because although defendant concluded that plaintiff’s “regular occupation” encompassed other “less stressful” attorney positions, defendant did not analyze whether such positions indeed exist in the national economy. For that reason, it is appropriate to remand for further consideration of whether there exist other “less stressful” attorney positions that plaintiff could perform.
Defendant’s next objection is that the R&R incorrectly relied on a case involving de novo review of an ERISA claim even though the review in this matter is under an abuse of discretion standard. Defendant is correct. Because the citation of the case was not material to the analysis or conclusion of the R&R, however, defendant’s objection is overruled.
Defendant also includes a broad objection “to the Report’s conclusion that the denial of benefits was an abuse of discretion, as that conclusion is contrary to the facts contained in the administrative record, the language in the policy, and the applicable law.” This blanket objection is improper as it objects to the R&R’s conclusion as a whole and attempts to relitigate issues squarely presented in the extensive summary judgment briefing before the magistrate judge.
Finally, defendant also argues that the R&R improperly “questioned” why defendant concluded that even though plaintiff met the requirements for total disability on Jan. 12, 2021, defendant then determined that plaintiff was not totally disabled after Jan. 13, 2021. Defendant objects to this portion of the R&R, arguing that the magistrate judge “in practice” applied an estoppel or waiver theory to defendant’s denial of ERISA benefits. Defendant’s final objection must be rejected because the magistrate judge did not apply an estoppel theory to this ERISA dispute.
Plaintiff’s motion for summary judgment granted in part, denied in part. Defendant’s motion for summary judgment granted in part, denied in part.
Aisenberg v. Reliance Standard Life Insurance Company, Case No. 1:22-cv-125, Feb. 21, 2023. EDVA at Alexandria (Ellis). VLW 023-3-084. 17 pp.
