Abuse of Discretion to Rely on Employer's Accommodation that Materially Altered Participant's Job Duties

Garrison v. Aetna Life Ins. Co., 558 F. Supp. 2d 995 (C.D. Cal. 2008)

This case addressed the issue of an employer’s accommodation of an employee’s disability, and how the claim administrator considered that factor when assessing disability. Here, a Boeing employee submitted a claim for benefits under the “own occupation” definition of disability. At the time of her disability, her position was described as “light,” requiring 12-hour shifts and a great deal of travel. In response to the onset of the employee’s disability, Boeing attempted to make accommodations by eliminating the travel requirement and reducing the number of hours worked. Based on the accommodations, the claim administrator reclassified the participant’s occupation from “light” to “sedentary,” and finding that she was capable of sedentary work, denied her claim.

When justifying their decision in front of the District Court, the claim administrator relied on Ross v. Indiana State Teacher's Association Insurance Trust, in which the Seventh Circuit found no abuse of discretion when the administrator’s accounted for the employer’s accommodations in the claim decision. However, the district court rejected this argument, distinguishing Ross by noting that the accommodations in that case were relatively minor, while here, travel was a major component of the participant’s job. Further, the Court ruled that when accommodations are offered in direct response to the Plaintiff's disability symptoms, absent Plan language stating otherwise, an administrator should not be able to reclassify or redefine a claimant’s occupation based on her capabilities while suffering from the condition that led to her disability leave. The Court also noted that the Aetna, without justification, assumed the Plaintiff could perform her job in an eight-hour work day, when she was previously working 12-14 hours a day.

Based on these findings, the District Court found that the claim administrator abused its discretion by relying on the employer’s accommodation when terminating LTD benefits and awarded benefits though the 30-month own occupation period.