Seyfarth Synopsis: A recent case from the Western District of North Carolina contains a helpful example of how the standards applicable to an employee’s request for accommodation of a disability differ from those for determining whether the same employee is eligible for benefits under a short-term disability plan. At the same time, it demonstrates the importance of following a deliberate, principled claims handling process, even when the decision appears simple.
In Cannon v. Charter Commc’ns Short Term Disability Plan, No. 3:18-CV-041-DCK, 2019 WL 235325 (W.D.N.C. Jan. 16, 2019), the Plaintiff sought benefits under his employer’s self-insured short-term disability plan (the “Plan”), claiming he was unable to work due to recurrent vertigo, sleep apnea, heart disease, insomnia, and other, related conditions. In support of his claim, he submitted documentation from his sole treating physician, which stated he was unable to perform the essential functions of his position, but identified his only restriction as an inability to “drive in traffic.” To be eligible for benefits under the Plan, Plaintiff needed to demonstrate that he was unable to perform the essential duties of his occupation.
Defendant denied the claim, after determining that Plaintiff’s only documented restriction—an inability to drive—did not impact his ability to perform the essential functions of his “sedentary” job, which consisted of reviewing orders from customers for accuracy, keying those orders into the billing system, and scheduling certain installation services. In making this determination, Defendant relied on reviews conducted by two different intendent, board certified specialists, and the fact that for several years before making his claim for benefits, Plaintiff had been accommodated for his medical conditions with an agreement allowing him to work from home. Accordingly, as driving—the sole activity from which he was restricted from performing—was not an essential function of his job, Plaintiff’s claim was denied. After exhausting his administrative remedies, Plaintiff filed suit, alleging he was wrongfully denied benefits under the Plan.
In granting the employer’s motion for summary judgment the Court credited the administrator for its deliberate, principled review process, and found no abuse of discretion in denying the claim. In doing so the Court apparently accepted that Plaintiff’s sole restriction—his inability to drive—was irrelevant, since it did not impact an essential job function.
More notable for employers, however, is Defendant’s underlying argument that the fact that Plaintiff could perform his job with a reasonable accommodation meant that Plaintiff was not eligible for STD benefits under the Plan, because it demonstrated that (while requiring accommodation) he was not incapable of performing the essential functions of his occupation. In short, this case demonstrates that the fact that an employee has a “disability” for which he receives an accommodation does not mean—depending on the applicable plan language—he is entitled to disability benefits.