An Ohio federal court ruled that Reliance Standard Life Insurance Company (“Reliance Standard”) owed a cardiopulmonary assistant long-term disability benefits after wrongly defining her “regular occupation” to deny her claim.
Background
Ms. Ebert worked as a cardiopulmonary assistant at Barnesville Hospital. The hospital described her job duties and tasks involved continuous standing and occasional pushing, pulling, carrying, and lifting of the equipment.
Ms. Ebert suffered a back injury which required surgery. She eventually returned to work but stopped working less than a year later because of the back injury. Unable to continue working, Ms. Ebert filed a claim for total disability with Reliance Standard.
Ms. Ebert’s Claim for Total Disability
Reliance Standard’s policy provided for total disability benefits. The policy defined “total disability” to mean that the insured could not perform the material duties of his/her own “regular occupation.”
Reliance Standard denied Ms. Ebert’s claim, deciding she did not meet the definition of total disability because Ms. Ebert could perform sedentary to light duties and her regular occupation involved sedentary to light duties.
Court’s Review of Ms. Ebert’s Claim
The issue before the court was defining Ms. Ebert’s “regular occupation.”
Reliance Standard argued that a cardiopulmonary assistant was like a cardiopulmonary technologist. It used the Dictionary of Occupational Titles (“DOT”) to define the duties of a cardiopulmonary technologist, which described the job duties as light. Since Ms. Ebert could perform light duties, she could perform the material duties of her regular occupation.
The court disagreed with Reliance Standard. It compared the duties and tasks of the two jobs and found that they were not similar.
Importantly, the court stated that the policy’s definition of a “regular occupation” did not mean a similar DOT specified occupation. Reliance had to use the hospital’s definition of Ms. Ebert’s “regular occupation” as the hospital was free to outline the duties and tasks required of its employees.
Help from an Attorney with Expertise in Disability Insurance
Disability insurance law is complicated. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get help from a lawyer with expertise in disability law.
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