Juanita Nichols worked as a Hazard Analysis Critical Control Point (HACCP) Coordinator at Peco Foods, Inc, a chicken processing plant in Sebastopol, Mississippi. As part of her job, she was regularly exposed to cold temperatures as chicken processing plants are required by federal law to operate much of their facilities under a certain temperature for food safety reasons.

In late 2015 and early 2016, Nichols was diagnosed with Raynaud’s phenomenon, a circulatory disorder. The condition meant that Nichols could develop gangrene if she continued to work in colder temperatures. On January 28, 2016, Nichols stopped working due to her limitations with working in the cold.

She applied for long term disability benefits through Reliance Standard Life Insurance Company (Reliance), the company that provided her employer’s ERISA plan. However, her application was denied, and she appealed that decision by filing a lawsuit with the Federal District Court in Mississppi.

Defining Total Disability and Regular Occupation in the Reliance Plan

The ERISA plan through Reliance required that she be considered “Totally Disabled” to get benefits. That means that she “cannot perform the material duties of [her] Regular Occupation” as of the date that the total disability began. The claimant’s “Regular Occupation” under the disability insurance policy is the way that the applicant’s job is “normally performed in the national economy.” The definition also specifically states that the occupation is not the way that the job is “performed for a specific employer or in a specific locale.” In this case, Nichols’ limitation exclusively dealt with her ability to work in the cold. She was not limited in any other way. As a result, the question became whether working the cold was a requirement based on her “Regular Occupation.”

Reliance’s Initial Evaluation and Denial

In their evaluation of the claim, Reliance obtained a copy of the job description for Nichols’ role as HACCP Coordinator. The information they obtained also include Sanitation Standard Operating Procedures and Good Manufacturing Practices Procedures for the plant. The job list and description did not include any indication that Nichols was required to work in the cold.

When Reliance compared Nichols’ duties to the Department of Labor’s Dictionary of Occupational Titles (DOT), it concluded that her regular occupation matched that of “Sanitarian.” The material duties of a Sanitarian did not include working in a poultry processing facility or exposure to the cold, however.

Reliance denied Nichols’ required for LTD because it concluded that she “retain[ed] the ability to perform the material duties of [her] occupation.” However, they also acknowledged that she could be exposed to cold temperatures and that her job required her to work in cold areas. Nonetheless, Reliance noted that working in the cold was specific to her particular job and employer but was not required in a Sanitarian position based on the “national economy.”

Nichols’ Appeal Focuses on the Reality of Her Position

Nichols appealed Reliance’s initial determination, noting that her condition prohibited her from working in cold environments and that any poultry plant across the United States was going to be below a certain temperature. Federal law required these lower temperatures, which meant that if she wanted to work in the poultry industry, she would have to be exposed to that type of environment.

The lower court agreed with Nichols, noting that her meat inspection and meat packaging duties would require her to work in the cold no matter where she worked. The Court stated that Reliance used the wrong DOT classification, concluding that it should have used “Cooler Room Worker (Meat Products)” rather than “Sanitarian.” The court also went on to note that Reliance has a history of denying reasonable claims and that the court should carefully scrutinize claims that are denied.

The United States Court of Appeals for the Fifth Circuit Reverses the Lower Court

Although Nichols won at the lower court, the U.S. Court of Appeals for the Fifth Circuit reversed the lower court’s decision and denied LTD benefits for Nichols in May 2019. In reaching its conclusion, the Court of Appeals focused on the environmental factors at a particular employer and compared them to working in the industry in general.

Specifically, the Court of Appeals noted that there was no way that Reliance could possibly guess what every person in every occupation does to determine what their material job duties are. They rely heavily on job descriptions from employers, vocational reports, and experts to determine what tasks a worker must actually complete in their particular industry, job, and position. The Court also emphasized the deference that it should give to the insurance company as part of its initial review of the claim.

The Court of Appeals took issue with the lower court’s decision, in part, because it classified Nichols under a different definition in the DOT on its own. Nichols did not argue that she should be considered a “Cooler Room Worker,” when she appealed Reliance’s denial. If she had made that type of argument, there is a real possibility that the Court of Appeals’ decision would have been very different.

This case highlights the importance of having the right information and arguments, even at the very first level of your long-term disability application. If Nichols has provided further explanation of what she did in her role as HACCP Coordinator, specifically the fact that she was required to work in the cold, the Court may have reached a different conclusion at the last level of appeal.

Dell & Schaefer did not handle this case, but the lessons that it teaches us are very important to virtually every disability benefits claim. If you need assistance with your long term disability application or appeal, contact the attorneys in our office to learn how we can help.