The First Circuit Court of Appeals found the Standard Insurance Company (“the Standard”) used the wrong occupational standard when determining a Maine environmental lawyer’s disability onset date. Reversing the district court’s ruling in favor of the insurance company, the Court concluded that because the policy was specific to the lawyer’s “own occupation,” The Standard’s evaluation of the disability onset date based on the duties of a general lawyer was unreasonable. The difference in the onset date amounted to over $100,000.00 in payments.
Background
The plaintiff/appellant, “Jane Doe”, worked at a Maine law firm for more than 25 years. After being an equity partner for many years, Dow became a non-equity partner in August 2011 and remained employed in that capacity for approximately six months billing far fewer hours than in prior years. Doe was covered under a group disability policy through her firm and underwritten by the Standard. The policy was a more expensive “own occupation” policy and promised lawyers with at least five years’ experience that their “own occupation” was the area of law in which they specialized if they had earned a majority of their fee income in that area during the 24 months prior to disability onset. There was no dispute that Doe met the criteria for the speciality coverage under the policy.
As early as November 2011, Doe’s medical records showed she was suffering from chronic depression. That month, Doe’s gynecologist doubled her prescription for antidepressants which she had been taking for about four years; the following month Doe met with a clinical psychologist who diagnosed her with major depressive disorder and noted symptoms to include suicidal ideation, diminished concentration, poor concentration, and poor memory. Doe’s last day of logging hours of work at her firm, however, was not until January 2012. The Standard’s Review of the Claim
Doe filed a claim for long term disability benefits in March 2012, noting she was unable to do her occupation in October 2011. Doe’s physicians unanimously agreed she suffered from severe depression and recommended she stop working.
The Standard requested and received from Doe’s employer a job description of her specific occupation, environmental lawyers. The firm also sent Doe’s biography, which detailed her career accomplishments and her expertise in the specific area of law. When Standard’s vocational reviewer evaluated Doe’s claim for disability, her occupation was identified as “lawyer” and not “environmental lawyer” from the Department of Labor’s (DOL) Dictionary of Occupational Titles (DOT). There is no separate DOT job for environmental lawyer and Standard did not look elsewhere.
Standard denied Doe’s claim. After Doe appealed, Standard approved the claim but based on the generic lawyer occupation, determining she was disabled as of January 2012 and not October 2011. Doe challenged Standard’s chosen date of disability by appealing again.
During its review of Doe’s second appeal, Standard had another vocational review performed. The reviewer concluded that Doe was not working in her specialty or area of expertise as of August 2011, but was working as a lawyer before ceasing to work completely. When asked by the appeal specialist if the demands and aptitudes of an environmental lawyer was different from a general lawyer, the vocational specialist concluded “no.” Standard then upheld its decision that Doe’s onset date of disability was January 2012.
The Court’s Review
Reversing the lower court’s decision in favor of Standard, the First Circuit Court of Appeals noted that Standard’s reliance on the DOT’s job description of a generic lawyer instead of Doe’s speciality of environmental lawyer was unreasonable. The Court reasoned that because Standard charged a higher premium for specialty coverage, it could not undercut that coverage by failing to obtain and consider the specific requirements of Doe’s occupation. In short, the policy required Standard to assess whether and to what extent Doe’s impairments compromised her ability to perform the specialized duties of an environmental lawyer. Moreover, Standard received from Doe’s employer (1) a job description outlining the duties and responsibilities of the specialized area of practice and (2) her resume and biography confirming expertise in the area of environmental law.
With this specialty occupation in mind, the Court found that Doe could not perform her speciality occupation as of November 2011. Thus, the Court ordered Standard to pay Doe retroactive benefits going back to 2011.
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