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  • Failure to Consider Travel Requirements of Nurse’s Job...

    Failure to Consider Travel Requirements of Nurse’s Job is an Abuse of Discretion – W.D. Wa.

    Attached is a case out of the Western District of Washington, Ray v. Reliance Standard Life Insurance Company. In this case, plaintiff seeks ERISA governed long term disability benefits. Defendant concluded that plaintiff’s regular occupation was a private duty nurse and determined that she was not disabled from that regular occupation. Plaintiff argued that she was not a private duty nurse but, rather, was a visiting nurse. Her job as a visiting nurse required extensive travel which defendant did not take into consideration. The court found that defendant’s failure to properly consider the duties of plaintiff’s job was an abuse of discretion.

    In deeming plaintiff a “Private Duty Nurse,” Reliance did not properly define the scope of plaintiff’s “material duties” as a “Visiting Nurse.” Plaintiff’s doctor, Thomas E. Byrne, M.D., and Reliance’s peer reviewer, Dr. Liebermann, agreed that, because plaintiff has “recurrent unpredictable episodes of bowel incontinence,” she must have “ready access to restroom facilities.” AR 231 & 265. The material duties of plaintiff’s “Regular Occupation” as a “Visiting Nurse” include frequent travel via motor vehicle to, from, and between patients’ homes, AR 78 & 81, which necessarily places her out of close range to a restroom for substantial periods of the workday. See also AR 79 (listing a Washington State driver’s license and proof of insurance as essential qualifications for the position of “Visiting Nurse”). The occupational data for “Private Duty Nurse” do not include any driving or travel requirements, AR 95, and Reliance did not properly perform an analysis of whether plaintiff could perform the “material duties” of her “Regular Occupation.”

    The Court finds and concludes that, because of her IBS with bowel incontinence, plaintiff could not, as of August 17, 2015, perform the “material duties” of her “Regular Occupation.” The Court further finds and concludes that plaintiff submitted “satisfactory proof” of “Total Disability” and that Reliance’s own reviewer’s opinion supports deeming plaintiff “Totally Disabled,” as defined for the 24-month period from August 17, 2015, until August 17, 2017. The Court makes no ruling concerning whether plaintiff continued to be “Totally Disabled” under the LTD policy language applicable after August 17, 2017. In light of this ruling, the Court need not and does not reach the other issues raised by the parties.
    Attached Files