Armani v. Northwestern Mutual Life Insurance Co.

840 F.3d 1159, 2016 U.S. App. LEXIS 19925, 2016 WL 6543523
CourtCourt of Appeals for the Ninth Circuit
DecidedNovember 4, 2016
Docket14-56866
StatusPublished
Cited by46 cases

This text of 840 F.3d 1159 (Armani v. Northwestern Mutual Life Insurance Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Armani v. Northwestern Mutual Life Insurance Co., 840 F.3d 1159, 2016 U.S. App. LEXIS 19925, 2016 WL 6543523 (9th Cir. 2016).

Opinion

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 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 *1159 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]n-able 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, 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 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. -Hárt’s report, Northwestern Mutual’s vocational case manager assessed Armani’s ability to per *1160 form “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 “any occupation” 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.

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.’ ”

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840 F.3d 1159, 2016 U.S. App. LEXIS 19925, 2016 WL 6543523, Counsel Stack Legal Research, https://law.counselstack.com/opinion/armani-v-northwestern-mutual-life-insurance-co-ca9-2016.