Jones v. Mountaire Corp. Long Term Disability Plan

542 F.3d 234, 2008 U.S. App. LEXIS 19288, 2008 WL 4163498
CourtCourt of Appeals for the Eighth Circuit
DecidedSeptember 11, 2008
Docket07-3118
StatusPublished
Cited by8 cases

This text of 542 F.3d 234 (Jones v. Mountaire Corp. Long Term Disability Plan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jones v. Mountaire Corp. Long Term Disability Plan, 542 F.3d 234, 2008 U.S. App. LEXIS 19288, 2008 WL 4163498 (8th Cir. 2008).

Opinion

MELLOY, Circuit Judge.

Plaintiff Larry G. Jones was a participant in a long-term disability plan (the “plan”) provided by Mountaire Corporation (“Mountaire”) and established pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. Mountaire’s plan was insured by Prudential Insurance Company of America (“Prudential”), which was also the claims administrator. Jones filed for benefits under the plan. Prudential denied the claim, and Jones lost his two subsequent appeals. Jones then filed this action in the district court, which awarded him long term disability benefits. Moun-taire and Prudential appeal, arguing that the district court erred by (1) raising the issue of a different job database, the Occupational Information Network (“O’Net”), 1 for the first time in its order; (2) determining that Prudential inappropriately used the Dictionary of Occupational Titles (the “DOT”) 2 to evaluate Jones’s regular occupation under the plan; (3) reviewing de novo Prudential’s decision; and (4) awarding benefits under the plan. We remand to the district court.

I. Background

A. The Long Term Disability Plan

Under the plan, a beneficiary is disabled and qualifies for benefits if Prudential determines that the beneficiary is unable to perform the material and substantial duties of his regular occupation due to sickness or injury. The plan defines regular occupation as the occupation the beneficiary routinely performed when his disability began. Prudential looks at the “occupation as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location.” As the claims administrator, Prudential has discretion to determine benefits eligibility under the plan.

B. Jones’s Medical History

Jones has had a myriad of health problems. In 1998, Jones had a triple by-pass, and in 2004, a stent was placed in his right coronary artery. In June 2005, Jones saw his primary care physician, Dr. Ransom (the “physician”), regarding chest pain. His chest x-ray showed bullous 3 emphysema. In July 2005, Jones underwent a hernia surgery. In September 2005, Jones visited his cardiologist, Dr. Henderson (the “cardiologist”), who noted in a report to the physician that Jones’s heart was doing *236 well and that its rhythm was regular. A September 2005 CT scan showed extensive emphysema throughout both lungs. In October 2005, a thoracic surgeon, Dr. Aguinaga (the “surgeon”), performed a cervical mediastinoscopy, bronchoscopy, thoracoscopy, and right upper lobe resection. The surgeon discovered severe bul-lous emphysema throughout Jones’s right lung. A suspicious lesion in the right lung was benign.

C. Prudential’s Review for Disability Benefits

Jones worked for Mountaire as a sales representative, selling animal feed products. He promoted sales to dealers and feeders within a five-state region. His job included traveling frequently, attending trade shows, setting up displays for dealers, and conducting quarterly inventories. He also recommended proper feeds for animals, visited farms, and occasionally worked with large animals. His job required him to spend long hours on his feet, stoop, and lift and move inventory — up to fifty-pound bags of feed — in a dusty, dirty environment. Jones’s last day at Moun-taire was on September 30, 2005.

Jones filed a claim for long term disability benefits on November 2, 2005, and indicated his job was sedentary. Jones stated that he was unable to work because he had emphysema and could no longer work around dust and chemicals. Mountaire completed an employer statement, which also stated that Jones’s job was sedentary.

In November 2005, the physician and surgeon filled out forms, certifying that Jones could not return to work. The physician stated that stress and physical exertion would increase Jones’s breathing problems and that Jones was incapacitated and would likely worsen in the future. He diagnosed Jones with progressive chronic emphysema and coronary artery disease. The physician noted, however, that Jones had the functional ability to do sedentary work. The surgeon stated that due to progressive lung disease, Jones should not do physical labor or be exposed to chemical agents.

Prudential denied Jones’s claim on December 20, 2005 based on the opinion of its nurse, Nurse Gillis, who reviewed Jones’s medical records and found that the alleged disability lacked support. The nurse noted the lack of recent chest x-rays or pulmonary function tests to support the physician’s assertion that breathing problems rendered Jones disabled and noted Jones was stable from a cardiac standpoint. Prudential explained that the medical records indicated no sudden worsening of his condition at the date of disability and that Jones previously had worked despite his condition.

Jones appealed the denial and submitted additional medical records. Jones’s three treating doctors wrote letters stating that because of the combined effects of coronary artery disease and emphysema, Jones was incapable of returning to work. The cardiologist opined “that Mr. Jones is totally disabled for performing anything more than the most sedentary type occupation.” The physician stated “that Mr. Jones is totally and permanently disabled to hold gainful employment.” The physician also placed restrictions on Jones relating to standing, walking, lifting, climbing, balancing, kneeling, crawling, and reaching overhead, as well as restrictions relating to exposure to gas, dust, fumes, or changes in temperature. The surgeon opined that Jones “is presently incapacitated and likely will remain so in the future.”

Jones also submitted a job description showing that his job was not sedentary. The description indicated that Jones’s duties included lifting up to fifty-pound bags of feed. Mountaire also added duties *237 to the job description: visiting farms, handling large animals, and participating in quarterly inventories, which require standing, stooping, lifting, and moving inventory for hours in a dusty and dirty environment.

Prudential’s rehabilitation specialist, Mr. Chretien, reviewed Jones’s job description and determined his regular occupation as defined by the plan. The rehabilitation specialist concluded that it was “Sales Representative, Animal-Feed Products” 4 under the DOT. The DOT classified the job as light, which means the job includes the ability to exert up to twenty pounds of force occasionally and up to ten pounds of force frequently and to walk and stand for periods of time.

Prudential Medical Director Dr. Kowal-ski reviewed Jones’s medical records and concluded that his medical history did not prevent Jones from doing a light-duty job. Prudential contacted Jones and asked if there was any supplemental information. In response, the surgeon submitted an office visit note dated November 2005.

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Bluebook (online)
542 F.3d 234, 2008 U.S. App. LEXIS 19288, 2008 WL 4163498, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jones-v-mountaire-corp-long-term-disability-plan-ca8-2008.