A Washington District Court ordered Reliance Standard to pay a nurse’s disability benefits, finding the insurance company was wrong when it concluded she was not disabled from her own occupation.
The plaintiff, Sue Ray, worked as a visiting nurse in Seattle prior to becoming disabled. Ms. Ray suffered from severe irritable bowel syndrome (IBS) with diarrhea symptoms. The lawsuit alleged Reliance Standard misclassified her occupation when making its adverse benefits determination.
In Ray v. Reliance Standard, the insurance company labeled Ms. Ray’s job as a “private duty nurse” but her position was in fact a “visiting nurse.” The latter occupation required her travel to patients in a home setting to provide her skilled nursing care. One vital job duty was the requirement to frequently - or 34%-65% of the time - operate a motor vehicle to go from one location to another. When she suffered symptoms of her IBS, she had to divert from or leave work to attend to her hygiene. The “private duty nurse” occupation Reliance Standard used when determining if she was disabled from her own occupation did not require travel as part of a material duty of the position.
Another important issue in the Ray case is that both parties agreed that the de novo, and not the arbitrary and capricious, standard of review applied to the case. This was because the parties acknowledged that the LTD policy did not confer discretion on the plan administrator, Reliance Standard, to determine eligibility for disability benefits or to construe the terms of the plan. In short, Ms. Ray simply had to prove she was disabled from her own occupation.
The court ultimately ruled Ms. Ray was disabled from her occupation as a “visiting nurse” and and ordered the parties to come to an agreement on the amount of benefits owed to Ms. Ray, as well as attorneys’ fees.
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