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Any Occupation Demands – W.D. Wash.

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  • Any Occupation Demands – W.D. Wash.

    Here’s a new case out of the Western District of Washington entitled Adasha Turner v. Life Insurance Company of North America. In this matter, the court looks at LINA’s conclusion that the plaintiff can perform “all of the material duties” of occupations identified by a TSA. The court concludes that LINA’s conclusion was incorrect.

    In response, LINA cites numerous cases for the proposition that the “any occupation” standard is “not demanding” and encompasses part-time, as well as full-time, work. See McKenzie v. Gen. Tel. Co. of Cal., 41 F.3d 1310, 1317 (9th Cir. 1994), overruled on other grounds by Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955 (9th Cir. 2006), as recognized in Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863, 872 n.2 (9th Cir. 2008); Arnold v. Life Ins. Co. of N. Am., 650 F. Supp. 2d 500 (W.D. Va. 2009). Contrary to LINA’s suggestion, however, the clause “any occupation” does not itself indicate how much or how often an employee must be able to work to be deemed not disabled. Rather, as plaintiff contends, in the policy at issue, the phrase “material duties” serves such function. In other words, to the extent that a material duty of an occupation is to perform for eight hours a day, five days a week, if a claimant cannot do so, then the claimant is “unable to perform all the material duties” of such occupation. See Halley v. Aetna Life Ins. Co., 141 F. Supp. 3d 855, 870-73 (N.D. Ill. 2015) (ruling that a person who was medically restricted to 40 hours of work per week could not perform any of the occupations identified in the TSA, which all required more than 40 hours per week (citing McFarland v. Gen. Am. Life Ins. Co., 149 F.3d 583, 588 (7th Cir. 1998) (observing that an individual can experience a qualitative and/or quantitative reduction in his or her abilities as a result of an injury or illness, using as an example of a qualitative reduction a baseball shortstop’s inability to throw, one of the essential skills for such position, but explaining that a quantitative reduction occurs when a person can still perform the required task, but not as often or as long as necessary to continue working))).

    Plaintiff’s reading of the definition of “Disabled,” set forth in the WOP provision of the policy, is both fair and reasonable. The language is not ambiguous, but even if it were, it would be construed against LINA, as the drafter. The Court concludes that LINA was required to, but did not, make a showing that the occupations identified in CRC Wilson’s TSAs did not involve, as a material duty, working full-time. Thus, the Court cannot affirm LINA’s denial of WOP benefits, and LINA’s motion for summary judgment is DENIED.

    With respect to plaintiff’s motion, the Court must accept LINA’s evidence as true and draw all “justifiable inferences” in LINA’s favor. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986). To the extent that, as LINA’s reviewers have indicated, plaintiff was able to perform some work tasks for a meaningful portion of the work day, the Court cannot say, as a matter of law, that plaintiff was, during the timeframe at issue, “unable to perform all the material duties of any occupation” for which she is or might reasonably become qualified. The Court can, however, and does conclude that the TSAs authored by CRC Wilson, and thus the current Administrative Record, do not support LINA’s denial of WOP benefits. LINA’s decision is therefore VACATED.
    The opinion is attached below.
    Attached Files