Abuse of Discretion Where Insurer Failed to Consider “Similar Income” Requirement

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George v. Reliance Std. Life Ins. Co.
5th Cir., Jan. 15, 2015

In the appeal of an ERISA disability benefits denial, the Fifth Circuit found an abuse of discretion where the insurer failed to consider the “similar income” provision. The insurer had found in its investigation that the claimant was not totally disabled under the policy as there were sedentary jobs for which the insured was able to perform. What the court found lacking, was any discussion of whether the sedentary jobs the insurer found the claimant could engage in would produce a similar income.

The policy language in this case defined “Total Disability” in part as whether the claimant can “perform the material duties of any occupation which provides substantially the same earning capacity.”  The court found that the record showed the insurer attempted to ignore this requirement and further, refused to consider evidence submitted by the claimant. The claimant here had submitted evidence from “Simplyhired.com” showing that the jobs cited by the insurer would produce significantly less income and therefore did not meet the “similar income” requirement.