Insurance – Long-Term Disability – ERISA – Reasoned Decision-making – Labor & Employment

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The defendant-insurer acknowledged plaintiff’s history of heart problems, but noted his improved test results, the fact that he was walking three miles a day, and the fact that his job was entirely sedentary. Although plaintiff’s treating physician considered him totally disabled, the insurer obtained a peer review analysis from Dr. Sims, who concluded that plaintiff could work with certain physical restrictions. The insurer applied a reasoned and principled decision-making process, and its denial of long-term disability benefits was supported by substantial evidence.
We affirm the district court’s decision that the insurer did not abuse its discretion in denying plaintiff’s application for long-term disability benefits.
Even though plaintiff’s particular job as a writer/editor for CBS News in New York was very stressful, CBS’s long-term disability plan explains that the insurer “will look at [the employee’s] occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.” While plaintiff argues that the insurer should have performed a vocational review or consulted the Department of Labor’s Dictionary of Vocational Titles, the plan made it plaintiff’s burden – not the insurer’s – to provide written proof of his claim for disability benefits. The insurer did not abuse its discretion by not obtaining additional vocational evidence.
Plaintiff also argues that Zurich failed to consider the amount of stress involved in his job and how that stress might impact his cardiac conditions. But nowhere in the records did any physician opine that plaintiff cannot perform the duties of his prior job because of the stress associated with doing so.
Geiger v. Zurich American Insurance Co. (Lawyers Weekly No. 001-078-23, 12 pp.) (Marvin Quattlebaum, J.) No. 22-1519. Appealed from USDC at Greenville, S.C. (Joseph Dawson, J.) Nathaniel Bax for appellant; Irma Teresa Reboso Solares and Foster Haselden for appellee. United States Court of Appeals for the Fourth Circuit