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Sapp v. Liberty Life Assurance Co. of Boston

United States District Court, E.D. Virginia, Alexandria Division

September 28, 2016

MARK SAPP, Plaintiff,
v.
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON, Defendant.

          MEMORANDUM OPINION

          Liam O'Grady, United Stales District Judge

         This 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.

         I. BACKGROUND

         Mr. 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.

         On 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 determinations.

         A. The Policy

         Mr. 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.

         The 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."

         Liberty 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."

         B. Administrative History

         Following 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 Dictionary.

         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.

         On 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.

         On 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 the Policy.

         II. DISCUSSION

         A. Legal Standard

         When 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 ...


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