United States District Court, E.D. Virginia, Alexandria Division
O'Grady, United Stales District Judge
dispute arose when Plaintiff Mark Sapp sued Liberty Life
Assurance Company of Boston ("Liberty") under the
Employee Retirement Income Security Act of 1974
("ERISA") seeking long-term disability (LTD)
benefits due to him under the terms of his employee benefit
plan. Because Liberty did not reasonably consider and
evaluate the evidence of Mr. Sapp's job description in
its determination of Mr. Sapp's "Own
Occupation" and its subsequent denial of Mr. Sapp's
LTD benefits, Liberty's abused its discretion under the
Policy. Therefore, for the reasons that follow, Mr.
Sapp's motion for summary judgment is granted and
Liberty's cross-motion for summary judgment is denied.
Sapp was employed with Republic National Distributing Company
("Republic") as a wine salesman. Republic
categorized Mr. Sapp's position as "Sales
Representative-Retail" with a focus on the tasks of
merchandizing and servicing stores. Mr. Sapp's job
responsibilities included making deliveries, filling shelves,
creating store displays, and carrying and moving boxes of
wine in excess of twenty pounds. In performing his duties, he
also drove more than 24, 000 miles a year.
February 25, 2014, Mr. Sapp hurt his back on the job while
lifting boxes of wine. He received surgery for this injury.
After the operation and subsequent physical therapy, his
doctors determined he could not lift more than 10 pounds,
bend, twist, stoop, or sit for longer than 45 minutes.
Defendants have not produced any contradictory medical
evidence and do not otherwise contest these medical
Sapp's employer, Republic National Distributing Company,
maintains an employee benefit plan through Liberty that
sponsors a LTD policy, GF-3 890-455090-01, ("the
Policy"), for its employees. In general, the Policy
provides LTD benefits for employees who become disabled while
in active employment with Republic.
Policy defines the terms necessary for its LTD benefits
determinations. A "Disabled" employee is someone
who, "as a result of injury or sickness, is unable to
perform the Material and Substantial Duties of his Own
Occupation." In addition, "Material and Substantial
Duties" are defined as "responsibilities that are
normally required to perform the Covered Person's Own
Occupation, or any other occupation, and cannot be reasonable
eliminated or modified." In turn, "Own
Occupation" is defined as "the Covered Person's
occupation that he was performing when his Disability or
Partial Disability began. For the purposes of determining
Disability under this policy, Liberty will consider the
Covered Person's occupation as it is normally performed
in the national economy."
is responsible for administering the plan and making any
benefits determinations under the plan. Specifically, Liberty
was granted "sole discretion [ ] to construe the terms
of the policy and to determine benefit eligibility."
his injury, Liberty informed Mr. Sapp that it would evaluate
his claims for LTD under the Policy on August 4, 2014.
Liberty referred the claim to a vocational expert, who was an
employee of Cascade Disability Management, a Liberty
affiliate. The vocational expert reviewed the electronic
claim file as well as "standard vocational resources
(e.g., Dictionary of Occupational Titles ("DOT"),
Occupational Outlook Handbook ("OOH"), Occupational
Information Network ("0*NET")/Standard Occupational
Classification ("SOC") coding system, etc.), and
Internet job boards" in making her determination. In the
claim file, Mr. Sapp's employer listed his position as
"Sales Representative - Retail, " and the
vocational expert found that there was no appropriate DOT
description for a general sales representative in the
Vocational Expert compared Mr. Sapp's job to two 0*NET
occupational classifications: "Sales Representatives,
Services, All Other"; and "Sales Representatives,
Wholesale and Manufacturing, Except Technical and Scientific
Products." The vocational expert took these
classifications and her additional research and issued a
report that concluded: "the occupation of Sales
Representative is not performed in one definitive manner in
the national economy. Rather, taking into consideration the
nature of the work in the SOC/0*NET and OOH descriptions, the
occupation is most often performed at the sedentary and light
levels of physical demand based on the Department of Labor
descriptions found in the DOT, with sufficient opportunity at
both levels." Relying on this report, Liberty denied
coverage on August 8, 2014. Liberty asserted that Mr.
Sapp's "Own Occupation, " as defined by the
policy, was "41-4012.00-Outside Sales Representative,
" which is categorized as a "light work"
position under Department of Labor ("DOL")
occupations. As a result, Liberty determined that the
post-surgery restrictions placed on Mr. Sapp by his doctors
would not interfere with a "light work" position
and therefore he did not qualify as disabled. Liberty
informed Mr. Sapp of his right to appeal within 180 days.
August 28, 2014, Mr. Sapp appealed and incorporated
additional information regarding his duties as a wine
salesman. These included: driving more than 24, 000 miles per
year; filling shelves; lifting cases of wine that weigh an
average of 45 pounds; and bending, kneeling, and reaching for
wine bottles on store shelves. He also provided medical notes
requested by Liberty. On October 21, 2014, Liberty denied the
appeal and affirmed the denial of benefits.
February 1, 2016, Mr. Sapp filed this action to recover
benefits due under 29 U.S.C. § 1132(a)(1)(B). He now
moves for summary judgment, arguing that: (1) Liberty's
denial of benefits was not reasonable because it ignored
important evidence of in defining Mr. Sapp's Own
Occupation, including information provided by Mr. Sapp on
appeal; and (2) Liberty failed to consider the more
appropriate occupational title of 53.3021.00-Driver/Sales
Worker, " which is a "medium work" position.
Liberty filed a cross-motion for summary judgment, arguing
that the denial of benefits was within its discretion under
reviewing a plan administrator's decision to deny
benefits in the ERISA context, courts must first look to the
policy's language to decide whether the administrator has
been granted discretion to determine benefit eligibility
under the terms of the plan. Firestone Tire &Rubber Co. v. Bruch,489 U.S. 101, 115 (1989);
Gallagher v. Reliance Standard Life Ins. Co., 305
F.3d 264, 268 (4th Cir. 2002). Where the plan confers
discretionary authority on the plan administrator, courts
apply an abuse ...