Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca9-14-56866/USCOURTS-ca9-14-56866-0/pdf.json

Parties Involved:
Avery Armani
Appellant
Northwestern Mutual Life Insurance Company
Appellee

Document Text:

FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

AVERY ARMANI,

Plaintiff-Appellant,

v.

NORTHWESTERN MUTUAL LIFE

INSURANCE COMPANY, a

corporation,

Defendant-Appellee.

No. 14-56866

D.C. No.

2:13-cv-07058-

RSWL-RZ

OPINION

Appeal from the United States District Court

for the Central District of California

Ronald S.W. Lew, Senior District Judge, Presiding

Argued and Submitted October 3, 2016

Pasadena, California

Filed November 4, 2016

Before: Dorothy W. Nelson and Richard A. Paez, Circuit

Judges, and Elaine E. Bucklo,* Senior District Judge.

Opinion by Judge D.W. Nelson

*The Honorable ElaineE.Bucklo, Senior United States District Judge

for the Northern District of Illinois, sitting by designation.

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2 ARMANI V. NORTHWESTERN MUTUAL

SUMMARY**

Employee Retirement Income Security Act

The panel vacated in part the district court’s judgment in

favor of the defendant in part in plaintiff’s action under the

Employee Retirement Income Security Act, challenging a

denial of benefits under a long term disability insurance

policy.

The administrative record showed that the plaintiff could

not sit for more than four hours a day. The district court,

reviewing de novo, nonetheless upheld the insurer’s

determination that the plaintiff could performsedentarywork. 

The panel held that the district court erred by rejecting the

plaintiff’s proposed definition of “sedentary” work on the

basis that it was drawn from the Social Security context. 

Agreeing with other circuits, the panel held that an employee

who cannot sit for more than four hours in an eight-hour

workday cannot perform “sedentary” work that requires

“sitting most of the time.”

The panel vacated the part of the district court’s judgment

denying the plaintiff his long term disability benefits and

remanded for further proceedings.

** This summary constitutes no part of the opinion of the court. It has

been prepared by court staff for the convenience of the reader.

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ARMANI V. NORTHWESTERN MUTUAL 3

COUNSEL

Charles Fleishman (argued) and Paul A. Fleishman, The

Fleishman Law Firm, Woodland Hills, California, for

Plaintiff-Appellant.

Linda M. Lawson (argued) and Charles K. Chineduh,

Meserve Mumper & Hughes LLP, Los Angeles, California,

for Defendant-Appellee.

OPINION

D.W. NELSON, Senior Circuit Judge:

Avery Armani (Armani) appeals the district court’s

judgment denying him benefits under his long term disability

policy sponsored by his employer and issued by Appellee

Northwestern Mutual Life Insurance Company(Northwestern

Mutual). We have jurisdiction pursuant to 28 U.S.C. § 1291,

and we VACATE the part of the judgment denying Armani

benefits and REMAND the case for further proceedings

consistent with this opinion.

BACKGROUND

Armani worked as a full-time controller for the

Renaissance Insurance Agency (Renaissance) from

November 3, 2008 to May 18, 2011. On January 6, 2011,

during the normal course of his employment, Armani injured

his back while lifting a heavy backup power supply. A

family practitioner treated Armani on January 26, 2011, and

diagnosed a lumbar region sprain, muscle spasms, and

sciatica. A chiropractor, Dr. Brian Padveen, later treated

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4 ARMANI V. NORTHWESTERN MUTUAL

Armani, restricted him to modified work effective April 13,

2011, and instructed Armani not to sit continuously without

the ability to change position. On April 19, 2011, an MRI

revealed minor disc desiccation as well as disc bulge and

annular tear. Armani stopped working on May 18, 2011 as a

result of his increasing back pain. Dr. Padveen determined

the next day that Armani was unable to work and that he

should be re-evaluated on June 22, 2011. Armani saw a

different chiropractor on June 22, 2011, who also determined

that Armani was unable to work and that he should be reevaluated again at a later date.

As a Renaissance employee, Armani was insured under a

group long-term disability policy (the LTD Plan) issued by

Northwestern Mutual. Under the terms of the LTD Plan, the

definition of disability changes after benefits are paid for 24

months. For the first 24 months, a claimant is “only required

to be Disabled from [his] own occupation,” which means the

claimant is either “[u]nable to perform with reasonable

continuity the material duties of [his] own occupation” or

“[u]nable to earn more than 80% of [his] Indexed

Predisability Earnings while working in [his] own

occupation.” To receive benefits after 24 months of disability

payments, the claimant must then “be Disabled from all

occupations.” This requires the claimant to demonstrate that

he is “[u]nable to perform with reasonable continuity the

material duties of any gainful occupation for which [he is]

reasonably fitted by education, training, and experience” or

“[u]nable to earn more than 80% of [his] Indexed

Predisability Earnings while working in [his] own or any

other occupation.”

Armani completed a Group Disability Claim Employee

Statement for Northwestern Mutual on July 15, 2011,

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ARMANI V. NORTHWESTERN MUTUAL 5

reporting that his back injury prevented him “from sitting,

standing, walking, driving, and concentrating for prolonged

period of time without experiencing a lot of pain &/or

difficulty.” Northwestern Mutual also received a description

of Armani’s “working conditions” as “sedentary the majority

of the time in a quiet office environment.” Armani indicated

that his job required him to sit for approximately seven hours

a day and stand or walk for one hour a day. On July 25,

2011, Northwestern Mutual received an Attending Physician

Statement indicating that Armani was limited to sitting for

four hours, standing for two hours, and walking for two hours

during an eight-hour workday. Northwestern Mutual’s

vocational case manager later confirmed that Armani’s

occupation was classified as sedentary, and Armani’s

disability claim was approved under the “own occupation”

test effective July 18, 2011.

Between September 2011 and January 2012, Armani

continued to visit chiropractors, pain specialists, and

physicians, all of whom confirmed that Armani’s disability

precluded him from working. On January 16, 2012, another

chiropractor indicated that Armani was limited to sitting for

four hours a day and to standing and walking for two hours a

day, but believed that Armani’s condition would improve and

that he could return to work on July 6, 2012. Based solely on

these medical records, Northwestern Mutual’s reviewing

physician, Dr. John Hart, determined that Armani was

capable of working in a sedentary position.

On February 11, 2013, Armani returned to Dr. Padveen,

who determined that Armani was still limited to sitting for

four hours a day and to standing and walking for two hours a

day. In a follow-up visit on April 15, 2013, Dr. Padveen

again stated that Armani could sit for between two and four

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6 ARMANI V. NORTHWESTERN MUTUAL

hours a day and must alternate between sitting and standing

to relieve pain every 30 minutes.

Dr. Hart was asked again by Northwestern Mutual to

review Armani’s medical records and on April 18, 2013,

wrote that Armani was “capable of doing a sedentary-level

occupation without limitations or restrictions.” Using Dr.

Hart’s report, Northwestern Mutual’s vocational case

manager assessed Armani’s ability to perform “any

occupation” given his functional capacity, work history,

skills, and training. On June 12, 2013, the case manager

identified three positions in addition to Armani’s own

position that he could perform at a “sedentary” level. She

based her assessment on the Dictionary of Occupational

Titles (DOT), published by the United States Department of

Labor, which states that “[s]edentary work involves sitting

most of the time, but may involve walking or standing for

brief periods of time.” (emphasis added).

By letter dated July 9, 2013, Northwestern Mutual

informed Armani that his LTD claim was being closed

because his records did not support a disability under the

“own occupation” or “anyoccupation” test. Armani appealed

the decision and asked for review by a second doctor. After

being assigned to review Armani’s records, Dr. Hans Carlson

also found that the records “[did] not support that [Armani]

would be precluded from sedentary-level work.” Dr. Carlson

further elaborated that “[i]t would be reasonable that

[Armani] would have the ability to reposition from sitting to

standing occasionally as needed.” On September 11, 2013,

Northwestern Mutual informed Armani that it was upholding

its claim decision.

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ARMANI V. NORTHWESTERN MUTUAL 7

On September 16, 2013, Armani filed a lawsuit pursuant

to the Employee Retirement Income Security Act (ERISA)

seeking judicial review of Northwestern Mutual’s claim

decision.1 Following a bench trial, during which the district

court reviewed de novo Northwestern Mutual’s

determination, the court awarded Armani benefits for the

remainder of the first 24 months of disability under the Plan,

finding that “there was no change in circumstances sufficient

to warrant denying [Armani] the nine days of benefits at the

end of the ‘own occupation period.’”

However, the district court also held that Armani failed to

show by a preponderance of the evidence that he was disabled

from “all occupations” after July 18, 2013, reasoning that

“[t]he Administrative Record contain[ed] scant information

regarding [Armani’s] condition during this period.” Although

Armani argued that he was “unable to perform any

occupation classified as ‘sedentary,’ because, by definition,

‘sedentary’ requires an ability to sit for six hours,” the court

held that Northwestern Mutual was not bound by this

definition, and that Armani had failed to demonstrate how his

disability prevented him from performing any of the

sedentary occupations identified by the vocational case

manager.

The district court also excluded four exhibits from outside

the administrative record that Armani attempted to introduce

with his ReplyTrial Brief, finding that the documents “[were]

1 The beneficiary of a disability insurance plan may bring a civil

action under ERISA “to recover benefits due to him under the terms of his

plan, to enforce his rights under the terms of the plan, or to clarify his

rights to future benefits under the terms of the plan.” 29 U.S.C.

§ 1132(a)(1)(B).

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8 ARMANI V. NORTHWESTERN MUTUAL

not necessary to adequately conduct [the court’s] review.” 

One such exhibit included an August 7, 2013 medical

evaluation stating that Armani was still limited to sitting for

two to four hours a day. Armani timely appealed.

STANDARD OF REVIEW

We review the district court’s findings of fact for clear

error and its conclusions of law de novo. United States v.

Bell, 602 F.3d 1074, 1079 (9th Cir. 2010).

ANALYSIS

When a district court reviews de novo a plan

administrator’s determination of a claimant’s right to recover

long term disability benefits, the claimant has the burden of

proving by a preponderance of the evidence that he was

disabled under the terms of the plan. Muniz v. Amec Const.

Mgmt., Inc., 623 F.3d 1290, 1294 (9th Cir. 2010).

The administrative record available to the district court

plainly showed that, between July 25, 2011, and April 15,

2013, every physician and chiropractor who treated Armani

determined that he could not sit for more than four hours a

day. Nonetheless, the district court upheld Northwestern

Mutual’s determination that Armani could perform work at

the “sedentary” level as of April 18, 2013. The district court

rejectedArmani’s proposed definition of “sedentary” work on

the basis that it was drawn from the Social Security context. 

Citing “the vast differences in both form and function

between Social Security law and ERISA law,” the district

court concluded, without further discussion or analysis, that

“the federal criteria for Social Security claims are not

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ARMANI V. NORTHWESTERN MUTUAL 9

transferable to ERISA cases.” This conclusion was

erroneous.

Indeed, while this Court has yet to address the question,

other courts evaluating ERISA claims and interpreting the

DOT have consistently held that an employee who cannot sit

for more than four hours in an eight-hour workday cannot

perform work classified as “sedentary.” See, e.g., Connors v.

Connecticut General Life Ins. Co., 272 F.3d 127, 136 n.5 (2d

Cir. 2001) (“The ability to sit for a total of four hours does

not generally satisfy the standard for sedentary work.”);

Brooking v. Hartford Life &Accident Ins. Co.,167 Fed. Appx.

544, 548–49 (6th Cir. 2006); Robertson v. Standard Ins. Co.,

139 F. Supp. 3d 1190, 1209 (D. Or. 2015) (“Since sedentary

work, as defined by the DOL’s Dictionary of Occupational

Titles, ‘involves sitting most of the time,’ . . . courts have

concluded that even a four-hour sitting tolerance is

insufficient to render one capable of performing sedentary

work.”) (internal citations omitted). Some of these courts

have further noted that “sedentary work” generally requires

the ability to sit for at least six hours. See LaVertu v. Unum

Life Ins. Co. of Am., 2014 WL 1224736, at *13 (C.D. Cal.

Mar. 25, 2014) (“Sedentarywork requires the ability to sit for

at least six hours of an eight-hour workday.”); Wykstra v. Life

Ins. Co. of N. Am., 849 F. Supp. 2d 285, 295 (N.D.N.Y. 2012)

(“[T]he generally recognized definition of sedentary work is

work that ‘involves up to two hours of standing or walking

and six hours of sitting in an eight-hour work day.’”); Alfano

v. CIGNA Life Ins. Co. of New York, 2009 WL222351, at *18

(S.D.N.Y. Jan. 30, 2009) (noting that “6 hours per day [is]

generally recognized as the minimum [sitting] tolerance

required for sedentary work”); Mead v. ReliaStar Life Ins.

Co., 2008 WL 850675, at *2 n.4 (D. Vt. Mar. 27, 2008) (“A

generally recognized standard for sedentary work ‘involves

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10 ARMANI V. NORTHWESTERN MUTUAL

up to two hours of standing or walking and six hours of sitting

in an eight-hour work day.’”). Accordingly, these cases

reflect 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.” We agree with this commonsense conclusion and hold

that an employee who cannot sit for more than four hours in

an eight-hour workday cannot perform “sedentary” work that

requires “sitting most of the time.”

Rather than consider whether the preponderance of the

evidence established that Armani was unable to perform “any

occupation” while restricted to sitting for no more than four

hours a day, the district court rejected Armani’s proposed

definition of “sedentary” work on the erroneous basis that the

definition was limited to the Social Security context. That

error led the court to conclude that Armani had not

established that he was unable to perform the four positions

Northwestern Mutual had identified based on his functional

capacity as of April 18, 2013, despite the fact that all four

positions were classified as “sedentary,” and despite

undisputed evidence that, as of that date, Armani was unable

to sit for more than four hours a day.

Accordingly, we hold that the district court erred in

denying Armani his long term disability benefits under the

Plan. Because we vacate the district court’s judgment on

these grounds, we need not decide whether the district court

properly excluded extra-record evidence submitted by

Armani.

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ARMANI V. NORTHWESTERN MUTUAL 11

CONCLUSION

We VACATE the part of the district court’s judgment

denying Armani his long term disability benefits and

REMAND the case for further proceedings consistent with

this opinion.

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