Aug 20, 2017
The Eighth Circuit Court of Appeals issued a ruling this week, Seitz v. Metropolitan Life, that decisively shoots down a disability insurer’s argument that I’ve seen surface occasionally. It’s one of those arguments that may have some appeal the first time you hear it. But when you digest it and really think it through, you realize its not just wrong but nasty. It’s the type of argument that gives insurers a bad name.
The language of the disability policy in Seitz stated that in order to get benefits you must be "unable to perform all material aspects of your occupation." What does this mean? MetLife argued that Seitz was not disabled under this definition because he could do some of the material aspects of his job. Alternatively, it argued that Seitz was not disabled because he could do all of the material aspects of his job, albeit it to a limited degree. For example, his job required that he sit for five to six hours in a workday. Seitz’s doctors stated that during an eight hour period he could sit for no more than two hours.
The Eighth Circuit rejected both these arguments with little hesitation. The three judges who decided the case recognized that to adopt MetLife’s argument would make disability benefits pretty much impossible to get. Here’s why.
Let’s say you have a job as an office manager. The list of the material aspects of your job is long, 20 different components, including such things as supervising and training the office clerical staff, meeting with peers and superiors on a regular basis to discuss and solve problems as they occur in the office, and acting as the decision-maker on personnel issues such as hiring and firing. Also among the 20 material aspects of your office manager job are these three:
--Be able to lift and carry for short distances files and office equipment of up to 25 lbs. on an occasional basis
--Be able to sit for five to six hours a day
--Show up by 8:00 a.m. and don’t leave before 5:00 p.m. Monday through Friday
Walking to work one day a tree branch falls on your head and leaves you with a serious, permanent brain injury. You lose a good deal of mental capacity and end up with a functional IQ of 75. Physically you are in pretty good shape. But can you do your job? Under MetLife’s definition, you bet. You can perform some of the material aspects of your occupation. The most fundamental ones in many ways. You can show up. You can stay at the job 40 hours a week. You can carry out the physical demands of the job. But would you or your family really think you are not disabled from your occupation as an office manager?
Fortunately, the judges who decided Seitz saw through MetLife’s charade.
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