Gordon v. Northwest Airlines, Inc. Longterm Disability Income Plan

606 F. Supp. 2d 1017, 2009 U.S. Dist. LEXIS 22217, 2009 WL 749828
CourtDistrict Court, D. Minnesota
DecidedMarch 18, 2009
DocketCase 07-CV-4172 (PJS/RLE)
StatusPublished
Cited by5 cases

This text of 606 F. Supp. 2d 1017 (Gordon v. Northwest Airlines, Inc. Longterm Disability Income Plan) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gordon v. Northwest Airlines, Inc. Longterm Disability Income Plan, 606 F. Supp. 2d 1017, 2009 U.S. Dist. LEXIS 22217, 2009 WL 749828 (mnd 2009).

Opinion

MEMORANDUM OPINION AND ORDER

PATRICK J. SCHILTZ, District Judge.

Plaintiff Dale W. Gordon worked for Northwest Airlines as a machinist for about five years. Gordon was covered under a long-term disability insurance policy issued to Northwest Airlines by defendant Life Insurance Company of North America (“LINA”). 1 LINA also administered the policy.

*1019 Gordon began experiencing serious knee problems in 2002 and, as a result of those problems, stopped working in February 2003. LINA granted Gordon long-term disability benefits from May 2003 through May 2006, when the applicable definition of disability changed. LINA decided that Gordon was not disabled under the new definition and discontinued his benefits in June 2006.

Gordon now sues for benefits under 29 U.S.C. § 1132(a)(1)(b), the section of the Employee Retirement Income Security Act (“ERISA”) that authorizes such suits. LINA and Gordon cross-move for summary judgment. For the reasons that follow, the Court grants Gordon’s motion and denies LINA’s.

I. BACKGROUND

A Policy Terms

Under the long-term disability insurance policy at issue in this case, if an insured such as Gordon becomes “Disabled” for purposes of the policy, LINA must pay the insured a “Disability Benefit.” Tab 56 at 215. 2 The benefit equals two-thirds of the employee’s pre-disability earnings, less other benefits received by the employee (such as Social Security Disability Insurance (“SSDI”) benefits), and less a portion of the employee’s post-disability earnings (if any). 3 Id. at 215-16, 226-27.

The policy defines “Disability” in two ways. Id. at 215. The first definition, which applies during the first thirty-six months that an employee receives benefits, covers what is known as “own-occupation” disability. The second definition, which applies after an employee has received benefits for thirty-six months, covers what is known as “any-occupation” disability.

Own-occupation disability is defined this way:

An Employee is Disabled if, because of Injury or Sickness, ... he or she is unable to perform all the material duties of his or her regular occupation....

Id. Any-occupation disability is defined this way:

An Employee is Disabled if, because of Injury or Sickness, ... he or she is unable to perform all the material duties of any occupation for which he or she may reasonably become qualified based on education, training or experience.

Id.

The any-occupation definition of disability is thus more restrictive than the own-occupation definition. If an employee cannot do his own occupation, he is entitled to disability benefits for thirty-six months. But he is not entitled to benefits after that thirty-six-month period unless he cannot do any occupation “for which he ... may reasonably become qualified based on education, training or experience.” Id.

The policy also includes a “Work Incentive Benefit” that allows an employee to work while he is receiving disability benefits and to retain a portion of his earnings. *1020 Put differently, the “Work Incentive Benefit” gives the employee an incentive to work by not reducing the disability benefit by one dollar for every dollar the employee earns. In its generally applicable provisions, the policy provides:

If an Employee is covered for Work Incentive Benefits, he or she may return to work while Disabled and Disability Benefits will continue. The conditions under which an Employee may return to work and the amount of this benefit are shown in the Schedule of Benefits.

Id. at 226 (emphasis added). And in the specific “Schedule of Benefits” applicable to workers such as Gordon, a provision titled “Work Incentive Benefits” says:

For the first 36 months the Employee is eligible for a Disability Benefit, the Disability Benefit is as figured above [i.e., it is 2/3 of the employee’s salary, less certain offsets]. If for any month during this period, the sum of the Employee’s Disability Benefit, current earnings and any additional Other Income Benefits exceeds 100% of his or her Indexed Covered Earnings, the Disability Benefit will be reduced by the excess amount. After the first 36 months, the Disability benefit is as figured above, reduced by 50% of his or her current earnings received during any month he or she returns to work. If the sum of the Employee’s Disability Benefit, current earnings and any additional Other Income Benefits exceeds 80% of his or her monthly Indexed Covered Earnings, the Disability Benefit will be reduced by the excess amount figured above. Current Earnings include any wage or salary for work performed while Disability Benefits are payable....

Id. at 216.

Translated into plain (or at least plainer) English, the work-incentive benefit provision operates as follows: During the own-occupation period (i.e., the first thirty-six months), if a disabled employee works at some other job and earns under one-third of his pre-disability earnings, he can keep all of his earnings. But anything he earns over that amount will not increase his overall income, because his disability benefit will be reduced dollar-for-dollar by any earnings that exceed one-third of his predisability earnings. 4 His overall income (benefits plus earnings) is thus capped at the total amount of his pre-disability income.

In the any-oceupation period (i.e., the thirty-seventh month on), the calculations become slightly more complicated because no matter how little the employee earns, his earnings reduce his benefit payment. The employee may keep half of a portion of his earnings — specifically, the portion up to 26 percent of his pre-disability income. But the employee may keep none of the remainder; any earnings over 26 percent of his pre-disability income reduce his disability benefit dollar-for-dollar. So for every $10 that the employee earns, $5 or less of it goes in his pocket. Further, the employee’s total income is capped at 80 percent of his pre-disability income. As a result, if the employee earns 80 percent of his pre-disability income, his disability benefit completely disappears. Thus, the mathematics of the work-incentive benefit *1021 provision effectively render the employee non-disabled — that is, not entitled to disability benefits — when he earns 80 percent of his pre-disability income. 5

Finally, the policy provides that disability benefits will end on the earliest of the following four dates:

1.

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Cite This Page — Counsel Stack

Bluebook (online)
606 F. Supp. 2d 1017, 2009 U.S. Dist. LEXIS 22217, 2009 WL 749828, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gordon-v-northwest-airlines-inc-longterm-disability-income-plan-mnd-2009.