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Compliance April 6, 2006
Court Upholds Benefits Denial Based on Job Description
April 6, 2006 (PLANSPONSOR.com) - The US District
Court for the Eastern District of New York has ruled that a
disability benefit plan administrator acted reasonably by
depending on an employer's job description to terminate
disability benefits.
Reported by Rebecca Moore
Granting the administrator’s motion for judgment on the administrative record, the court said the administrator did not act arbitrarily when it terminated the employee’s benefits despite her claim that she regularly lifted packages weighing over 20 pounds, BNA reports.
The court also said the administrator could reasonably have been suspicious that the employee had not objected to her job description until late in the appeals process.
Debra Greenberg worked at Wolters Kluwer and participated in its disability benefit plan that was administered by UNUM Life Insurance Co. of America. She became disabled because of a sprained back and pinched nerve together with a viral infection, according to the court opinion. When Greenberg initially applied for benefits, her claim was approved, however, in October 2001, UNUM reviewed Greenberg’s current medical records and terminated her benefits.
According to UNUM’s letter to Greenberg, her complaints of pain were disproportionate to the medical findings and the administrator cited its reliance on Wolters Kluwer’s description that Greenberg’s job was sedentary. Wolters Kluwer described Greenberg’s job as a collection specialist, a sedentary position almost exclusively conducted while seated and which involved carrying one to two pound packages at most.
The case is Greenberg v. UNUM Life Insurance Co. of America, E.D.N.Y., No. CV-03-1396 (CPS), 3/27/06.