At first glance, it did not seem like a strong claim for disability benefits. The claimant, a technician, applied for short-term disability benefits claiming that he was disabled as a result of severe spinal and hip disorders. He filed his claim after his employer fired him for repeated acts of insubordination. Under the terms of his ERISA policy, no individual could qualify for disability benefits if the period of disability began when he or she was no longer an employee of the company. Solely due to this provision, the plan administrator (“Plan”) denied the claim for disability benefits.
In his lawsuit seeking to overturn the Plan’s decision to deny him disability benefits, the claimant argued that his period of disability began more than six months before his termination.
His case is Hipple v. Matrix Absence Mgmt., Inc., (E.D. Mich. June 13, 2014), and it is a decision of considerable importance for disability claimants. In Hipple, the claimant’s argument, on the surface at least, could seem flawed. How could you be disabled during a period in which you were still working? In Hipple, the court denied the Plan’s motion for summary judgment, faulting the Plan’s assumption that, because the claimant continued to show up to work until the day he was fired, “he was not disabled before that date.”
The ruling in Hipple is critical: A disability plan administrator cannot turn down a claim for disability benefits solely because the claimant continued to work after he or she began experiencing the onset of the disabling condition.
Hipple is not an anomaly, but, in fact, expanded on precedent. In the case of Rochow v. Life Ins. Co. of N. Am., 482 F.3d 860 (6th Cir. 2007), the Sixth Circuit held that a plan administrator could not deny an employee’s claim for disability benefits “solely because the employee was present at work on or after the alleged disability onset date.” In Rochow¸ the Sixth Circuit also determined that the plaintiff, whose employment was terminated before he sought disability benefits, had been disabled under the terms of his policy before he was terminated. As the court noted: “[T]here is no logical incompatibility between working full-time and being disabled from working full-time.”
The Rochow court’s point seems counterintuitive, until you give it a closer look. Basically, in Rochow, the court recognized the familiar scenario of an ailing employee who continues to work every day, even though he or she can no longer complete the physical and mental demands of the job. Many of these individuals cannot afford to be out of a job and try, admirably, to work through their disabilities. In some cases, an employer may take a while to recognize that an employee is not completing his or her job duties. Nevertheless, what the court said in Rochow is that individuals who show up to their jobs each day may still be disabled under the terms of their disability policies, if they can point to medical evidence in support of their conditions.
Hipple, in some ways, is a more useful case for many disability claimants than Rochow. In Rochow, the claimant was fired because his degenerative neurological disease prevented him from meeting the demands of his occupation. His firing was, if anything, compelling evidence of his disability. The Hipple case is different. In Hipple, the claimant was fired because he was repeatedly insubordinate, and not because of his health. Whatever disability resulted from the claimant’s spine and hip disorders was not a reason for his dismissal.
What the Hipple court said, however, is that, regardless of the circumstances of the claimant’s dismissal, the Plan still had an obligation to evaluate his medical evidence. The Plan could have cited his ability to work after the onset of his disability as one of the reasons for why it was denying his disability claim. However, it could deny his disability claim for that reason alone.
In a perfect world, individuals with disability policies would apply for benefits when their medical condition prevent them from not fully performing their job duties. In reality though, that is often not how it works. There is not always a clear line between struggling, but making it, from one day to the next–and not being able to perform your job duties as effectively and consistently as you could without a disabling condition. Rochow and Hipple are important cases because they allow former employees to apply for disability benefits after they have been fired, provided they have medical evidence in support of their claims. Just as importantly, these cases prevent insurance companies and plan administrators from relying solely on circumstantial evidence to deny claims for short or long-term disability benefits.
Disability cases are almost always complex. If you believe you have been unfairly denied long-term disability benefits, you should contact an experienced Tennessee disability law firm.