Social Security and LTD Lawyers: OC, Riverside & San Bernardino
Sedentary Work Under SSDI and ERISA
The “Own Occ” and “Any Occ” Standards
For the first two years, most ERISA-governed group long-term disability (LTD) policies provide disability benefits under an own occupation (“own occ”) standard. What this means is that if you are unable to perform the essential duties of your own occupation, then you will qualify for benefits. However, after the first two years of disability, most policies require a showing of disability under an any gainful occupation standard (“any occ”). This is a more rigorous standard that requires not being able to perform any occupation in the national economy after considering age, education and work experience.
The “any occ” standard under an ERISA-governed plan is similar to Step 5 in the Social Security Administration's (SSA) 5-Step Sequential Evaluation Process for Disability Claims, which determines whether a claimant, given his disability, can perform “sedentary” work, in the national economy considering age, education and work experience. If a claimant's work capacity is determined to be “less than sedentary,” this generally means the claimant is disabled from any gainful occupation and entitled to benefits. C.F.R. §404.1520.
Definition of “Sedentary” Physical Exertional Capability
In evaluating a claimant's physical exertional capability, the U.S. Department of Labor (DOL) has adopted specific categories that include “sedentary,” “light,” “medium” and “heavy” work. In its claims processing, the SSA follows DOL's terminology.
The definition of “sedentary” physical exertional capability under Appendix C to the Dictionary of Occupational Titles (4th ed. 1991) is as follows:
“Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to one-third of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from one-third to two-thirds of the time) to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking or standing are required only occasionally and all other sedentary criteria are met.”
The SSA expanded the DOL's definition of “sedentary” in SSA Ruling 83-10 as follows:
“[S]edentary work [involves] lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers and small tools. Although sitting is involved, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met … ‘Occasionally' means occurring from very little up to one-third of the time. Since being on one's feet is required ‘occasionally' at the sedentary level of exertion, periods of standing or walking should generally total no more than about two hours of an eight-hour workday, and sitting should generally total approximately six hours of an eight-hour workday. Work processes in specific jobs will dictate how often and how long a person will need to be on his or her feet to obtain or return small articles.”
Are Private Disability Insurers Required to Use the Same Definition of “Sedentary” Work?
The question often arises as to whether SSA's definition of “sedentary” physical exertional capability applies to ERISA-governed disability policies. Case law has been evolving on this important issue, and while there is no explicit determination that the SSA definition of “sedentary” is necessarily applicable, there is growing support for the use of Social Security criteria and definitions in evaluating disability claims under ERISA.
In Armani v. Northwestern Mutual Life Insurance Co., 840 F.3d 1159, 1163 (9th Cir. 2016), the court held that a claimant who can sit for a maximum of only four hours during a workday is incapable of performing sedentary work. (Sedentary work “reflect[s] the logical conclusion that an employee who is unable to sit for more than half of the workday, cannot consistently perform an occupation that requires sitting for most of the time.”)
In Connors v. Connecticut General Life Ins. Co., 272 F.3d 127, 136 n.5 (2d Cir. 2001), the court held that “the ability to sit for a total of four hours does not generally satisfy the standard for sedentary work.”
In Robertson v. Standard Ins. Co., 139 F. Supp. 3d 1190, 1209 (D. Or. 2015), the court held that “since sedentary work, as defined by the DOL's [Department of Labor] Dictionary of Occupational Titles, ‘involves sitting most of the time' ... courts have concluded that even four-hour sitting tolerance is insufficient to render one capable of performing sedentary work.”
Therefore, in an ERISA disability claim, if a claimant is unable to sit for more than four hours in an 8-hour workday, that claimant will be considered unable to sit long enough to perform his/her essential occupational duties. The claimant's physical exertional capability is “less than sedentary,” and under an “any occ” standard, the claimant is disabled.
Note that if a claimant's occupation is “mostly sitting,” the sitting tolerance limitation for disability claims under Social Security is six hours and for claims under ERISA, it is four hours.
Social Security Rulings Are Instructive
Courts have held that SSA disability cases provide helpful guidance and are “instructive” in the adjudication of private disability claims under ERISA. Halpin v. W.W. Grainger, Inc., 962 F.2d 685, 695 n.11 (7th Cir. 1992); Helms v. Monsanto Co., 728 F.2d 1416 (11th Cir. 1984).
There are important differences and similarities between Social Security Disability (SSDI) claims and disability claims under ERISA.
At Law Med, we are experienced and knowledgeable in both SSDI and ERISA long-term disability claims.