Persons who become disabled from work, and make a disability claim, are often faced with an issue with respect to whether they are capable of returning to work. If an insured can return to work, either in their own occupation or another occupation, that fact will often result in a denial of disability insurance benefits. A frequent insurance company claim is that the insureds medical condition does not prevent them from returning to sedentary work. A recent Ninth Circuit Court of Appeal decision under ERISA provides significant support for insureds claiming they are disabled from even sedentary work.
On November 4, 2016, in Armani v. Northwestern Mutual Life Insurance Co. (9th Cir. 2016) 840 F.3d 1159, The Ninth Circuit addressed a disability claim under ERISA where the insured had injured his back, and could not sit “continuously without the ability to change position.” (Id. at 1160.) The insured was examined by multiple doctors and chiropractors, and each of them “determined that he could not sit for more than four hours a day.” (Id. at 1163.)
The insureds worked as a controller for an insurance agency, and the work was described as primarily “sedentary.” (Id. at 1160-61.) After initially paying disability benefits, the insurer changed its position, and concluded that the insured did not qualify for disability benefits because he could perform a job “at a ‘sedentary’ level.” (Id. at 1162.)
The Ninth Circuit in Armani rejected the insurance company’s position. Conducting a de novo review of the denial of the disability claim, the Armani Court noted that the “logical conclusion” is that a person who cannot sit for more than four hours a day cannot perform “an occupation that requires sitting ‘most of the time.’” (Id. at 1163.) Armani concluded that “an employee who cannot sit for more than four hours in an eight-hour workday cannot perform work classified as ‘sedentary.’” (Id. at 1163.)
In so holding, the Armani Court provided support for using the criteria and definitions from Social Security disability claims in analyzing disability claims under ERISA. Thus, the Armani Court noted that the trial court had rejected the insureds “proposed definition of ‘sedentary’ work” because it was a definition from the “Social Security context.” (Id. at 1163.) Armani held the trial court’s ruling rejecting the definition of sedentary work because it was from the Social Security context was “error” which led to the conclusion Armani was not disabled from returning to work. (Id. at 1164.) Based on the insureds inability to sit for more than four hours out of an eight hour work day, Armani held the insured was in fact disabled from any sedentary work.
Armani is an important ruling for insureds who are unable to sit for the majority of the workday, but are denied disability benefits on the grounds they can do sedentary work. It also provides support for the use of Social Security criteria and definitions in evaluating disability claims under ERISA.