Opinion ID: 183519
Heading Depth: 4
Heading Rank: 5

Heading: Job Requirements

Text: Although we have not previously so held, various courts have determined that an administrator's proper consideration of the claimant's ability to perform his or her job requirements in light of the relevant diagnosis is a significant factor to evaluate on arbitrary and capricious review. See, e.g., Elliott v. Metro. Life Ins. Co., 473 F.3d 613, 619 (6th Cir.2006) (determining that plan administrator's decision could not be considered reasoned when there was no discussion of claimant's duties or her ability to complete them in light of diagnoses); Kalish, 419 F.3d at 507 (finding that administrator's conclusion that claimant might be capable of sedentary work cannot be a rational basis for finding that he was not disabled, given that his former occupation required him to walk, stand, and reach for several hours a day); Lamanna v. Special Agents Mut. Benefits Ass'n, 546 F.Supp.2d 261, 296-97 (W.D.Pa.2008). In Elliott, the Sixth Circuit expressed skepticism of the insurance company's conclusion that the claimant was not disabled when it did not consider the specific requirements of her position. See 473 F.3d at 619. The court observed that the administrator's denial letter simply recited the diagnoses of the claimant's condition, but did not provide any explanation of how the claimant could be expected to perform the functions of her job in light of these ailments. See id. Therefore, the court determined, the administrator cannot be said to have given a reasoned denial of [the] claim. Id. (emphasis in original). We find this analysis persuasive because it is essential that any rational decision to terminate disability benefits under an own-occupation plan consider whether the claimant can actually perform the specific job requirements of a position. The District Court did not consider whether American adequately addressed Miller's ability to fulfill his job requirements. Miller contends that neither the termination letter nor the WME report provided any explanation of how he could perform the essential duties of his position as a pilot. American did not address Miller's ability to function as a pilot in the termination letter; however, the WME report canvasses the extent to which it considered the actual job requirements Miller had to fulfill. American included a job description and a list of essential functions that a pilot must perform when it ordered the WME report. Therefore, we consider whether the WME report adequately addressed Miller's ability to function as a pilot. Even though the WME evaluators determined that Miller was not disabled, they arrived at this conclusion without considering whether he could actually perform his duties as a pilot in light of his diagnoses. According to American's job description, a pilot must, among other things, be able to work varying hours of the day or night, possess [c]apability of decision-making under stress, as well as [t]he ability to adapt to diversified flight schedules, situations, or scenarios. (App. at 303-05.) In addition, because the Plan provides own occupation disability benefits, it is essential to consider whether a pilot is capable of working in that capacity, regardless of his ability to function in a different position. Although Dr. Crain concluded that Miller was not disabled from his occupation as a Pilot, he also recognized that Miller was at risk of having another psychotic episode if he was exposed to physical fatigue, sleep deprivation, and emotional stress. ( Id. at 311.) As such, there is a striking incongruity between Dr. Crain's conclusion that Miller could return to work as a pilot  having to operate under considerable stress  and his recognition that stress, fatigue, and sleep deprivation could prompt another psychotic episode. Moreover, Dr. Crain did not address how the fact that Dr. Gonzalez had diagnosed Miller with anxiety would be compatible with his ability to work under stress as a pilot. On the whole, we believe that Dr. Crain's conclusion that Miller could perform as a pilot, without explaining how his claimed anxiety and latent risk of psychosis would be compatible with this uniquely stressful position, is perfunctory. Accordingly, American's failure to address the specific demands that Miller would face as a pilot suggests that the termination decision was not reasoned and based on an individualized assessment of Miller's ability. Thus, this is a significant oversight that suggests the decision was arbitrary and capricious. See Elliott, 473 F.3d at 619; Kalish, 419 F.3d at 507.