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Any Occupation Standard: D.D.C.

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  • Any Occupation Standard: D.D.C.

    In a recent, and very straightforward, decision from the District of Columbia, the court touches on the high burden of the "Any Occ" standard. The court's decision is summarized below:

    In short, Reliance is entitled to summary judgment because there is no genuine dispute that Ms. Kemathe failed to prove that she was totally disabled. To qualify for a monthly benefit under her policy, Ms. Kemathe had to submit “satisfactory proof of Total Disability” to Reliance. A.R. 21. Because Reliance had paid her monthly benefits for two years, her policy required her to prove that she could not “perform the material duties of Any Occupation.” A.R. 14. Reliance correctly determined that Ms. Kemathe did not do so.
    First, Ms. Kemathe’s condition seems to have improved over time. For example, in October 2014, Dr. Luis G. Ruiz explained that Ms. Kemathe’s asthma “remains controlled” with “no recent exacerbations.” A.R. 452. He advised that Ms. Kemathe could “consider working again” if her work environment did not have triggers such as chemicals or dust. Id. And in September 2016, Dr. Ajeet G. Vinayak noted that Ms. Kemathe “had been doing pretty well from a respiratory perspective.” A.R. 1152. He noted that her “[c]ough exacerbation has resolved,” and she had no shortness of breath, no wheezing, and minimal coughing. Id. In January 2017, after reviewing her medical records and conducting a personal examination, Dr. Myerson concluded that “her pulmonary complaints have been minimal over the recent past.” A.R. 1586.
    There is also no genuine dispute that Ms. Kemathe can perform other jobs—even if she cannot return to her work at the hospital.
    Accordingly, thew court granted the Defendant's motion for summary judgment. The full opinion is attached below.
    Attached Files
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