from the U.S. Fifth Circuit Court of Appeals
out of New Orleans, Robinson v. Aetna Life Insurance Co.
Alton Robinson was a sales rep. When his eyesight began to fail he realized he could no longer drive the distances required by his job, 800 – 1000 miles a week. It is quite evident that the ability to safely drive long distrances for Mr. Robinson was a pretty important component of that work. But fortunately, Alton had a disability policy that paid him disability benefits when he was not able to perform the material duties of his own occupation.
Unfortunately, he had to deal with an unsympathetic insurer. Although Aetna initially paid the claim for about 18 months, the insurer cut Alton off because his physician stated that Alton had no restrictions on his activities of daily living. Alton’s response? “Sure, I can care for myself at home. But everyone agrees I can’t drive any meaningful distance. The criteria for disability is whether I can perform my job, not whether I can care for myself.”
Alas, this cogent analysis failed to reverse the denial because Aetna simply switched over to another reason to deny the claim. Rather than asserting that he could drive, Aetna claimed that driving was not a material duty of Alton’s own occupation!
Fortunately for Alton, the court of appeals was not as obtuse as Aetna. It reversed the denial and granted Alton his benefits.
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