Nov 11, 2016 - Articles by Seltzer & Associates
In a November 4, 2016 ruling, The Ninth Circuit Court of Appeals reversed a Central District of California ruling when it concluded an individual who cannot sit for four hours a day cannot perform sedentary work. In 2011, Avery Armani suffered a back injury while at work. He was covered under a group long-term disability insurance policy issued by Northwestern Mutual provided by his employer. Following his back injury, Mr. Armani sought treatment from chiropractors, pain specialists, and physicians. Each treatment provider confirmed Mr. Armani was not capable of sitting more than four hours per day because of his lumbar region sprain, muscle spasms, sciatica, minor disc desiccation, disc bulge, and annular tear.
Northwestern Mutual confirmed Mr. Armani was not able perform the material duties of his occupation and paid him disability benefits. However, following the first 24 months of disability payments, the definition of disability in Mr. Armani’s policy changed. Following the first 24 months of disability payments, Northwestern Mutual was only required to continue paying disability payments if Mr. Armani was unable to perform the material duties of any gainful occupation for which he is reasonably fitted by education, training, and experience.
As the end of Mr. Armani’s first 24 months of disability payments ended, Northwestern Mutual asked Dr. John Hart to review Mr. Armani’s medical records. Based upon his review, Dr. Hart determined Mr. Armani was capable of performing sedentary work. Mr. Armani submitted additional updated medical records to Northwestern Mutual again stating he could not sit for more than four hours a day. Dr. Hart again reviewed Mr. Armani’s records and determined he was “capable of doing a sedentary-level occupation without limitations or restrictions.” Relying on Dr. Hart’s reports, a Northwestern Mutual vocational case manager determined there were occupations available for Mr. Armani to perform at a sedentary work level, including his own.
Northwestern Mutual then terminated Mr. Armani’s claim, stating his medical records did not support disability in either his own occupation or any occupation. Mr. Armani filed the ERISA-mandated appeal with Northwestern Mutual, and Dr. Hans Carlson also found, on behalf of Northwestern Mutual, that Mr. Armani’s medical records did not support the inability to perform sedentary work. Relying upon Dr. Carlson’s determination, Northwestern Mutual upheld its termination decision.
Mr. Armani filed suit against Northwestern Mutual in the United States District Court for the Central District of California. Following an ERISA-mandated bench trial, the district court found Mr. Armani was entitled to disability benefits for the remainder of the first 24 months of disability benefits, the “own occupation” period, but was not entitled to any additional benefits. The district court reasoned Northwestern Mutual was not bound by the definition that sedentary work requires the ability to sit for six hours, as Mr. Armani argued, and Mr. Armani failed to show how his disability prevented him from performing the occupations Northwestern Mutual had identified for him.
On appeal, the United States Court of Appeals for the Ninth Circuit acknowledged it had never addressed whether the criteria for Social Security claims are transferable to ERISA cases. The court raised this question because Mr. Armani’s argument that sedentary work requires the ability to six for six hours was based upon Social Security’s definition of sedentary work. However, the circuit court acknowledged many other courts have found that the inability to sit for more than four hours in a workday prevents an individual from performing sedentary work or that sedentary work generally requires the ability to sit for at least six hours per day. Agreeing with what the circuit court called commonsense conclusions, it created a brightline rule, holding “that an employee who cannot sit for more than four hours in an eight-hour workday cannot perform “sedentary” work that requires “sitting most of the time.””
The circuit court vacated the district court’s decision and remanded the case back to the district court for further proceedings consisted with its opinion.