Shahpazian v. Reliance Standard Life Insurance Company

12 Citing cases

  1. Stiltz v. Metro. Life

    244 F. App'x 260 (11th Cir. 2007)   Cited 28 times
    Distinguishing Shahpazian on same basis

    Unlike the plans reviewed in the decision upon which Stiltz relies, the MetLife plan defines the term "occupation." Cf. Shahpazian v. Reliance Standard Life Ins. Co., 388 F.Supp.2d 1368, 1377 (N.D.Ga. 2005). The clear plan language allowed MetLife to look beyond the requirements of "the specific position" Stiltz held.

  2. Nichols v. Reliance Standard Life Ins. Co.

    No. 3:17-CV-42-CWR-FKB (S.D. Miss. Jun. 29, 2018)   Cited 4 times

    of a long term disability policy and thereby underpaid . . . benefits due under the policy"); O'Bryhim v. Reliance Standard Life Ins. Co., 997 F. Supp. 728, 733 (E.D. Va. 1998), aff'd, 188 F.3d 502 (4th Cir. 1999) (describing "bad faith on the part of Reliance" during benefits determination); Pinto v. Reliance Standard Life Ins. Co., 214 F.3d 377, 393 (3d Cir. 2000), as amended (Jul. 19, 2000) (finding the evidence "support[s] the view that whenever it was at a crossroads, Reliance . . . chose the decision disfavorable to [claimant]"); Weinberger v. Reliance Standard Life Ins. Co., 54 F. App'x 553, 556 (3d Cir. 2002) (criticizing Reliance for "inappropriate" use of the Dictionary of Occupational Titles while ignoring "a job description setting forth the actual requirements of [the claimant's] position"); Lasser v. Reliance Standard Life Ins. Co., 344 F.3d 381, 386 (3d Cir. 2003) (finding it "unreasonable for Reliance to define 'regular occupation' differently from its plain meaning"); Shahpazian v. Reliance Standard Life Ins. Co., 388 F. Supp. 2d 1368, 1379 (N.D. Ga. 2005) (describing Reliance's "extreme" and "unreasonable" occupation determination methodology, which included an "enslaved dependence" on the Dictionary of Occupational Title's occupational descriptions "despite the fact that these descriptions, individually or when blended, did not reflect certain material duties of [claimant's] position. Its rigid reliance on the generic [Dictionary] descriptions, even if multiple descriptions are blended, requires, in circumstances like these, pounding square pegs into round holes"); Hann v. Reliance Standard Life Ins. Co., No. 09-CV-2496, 2011 WL 1344502, at *4 (M.D. Pa. Apr. 8, 2011) (Reliance took "arbitrary and capricious . . . action that was clearly inconsistent with the unambiguous terms of the contract . . . to reduce [disability] benefit amount, which quite clearly worked to [Reliance's] own benefit"); Wilkerson v. Reliance Standard Life Ins. Co., No. CIV. A. 99-4799, 2001 WL 484126, at *1 (E.D. Pa. Mar. 6, 2001) ("In my view . . . [Reliance's]

  3. Green v. Reliance Standard Life Insurance Company

    408CV068 (S.D. Ga. Jul. 7, 2009)   Cited 2 times

    Doc. # 19-2 at 10. In response, Green points out that courts have previously found Reliance Standard's use of the DOT to define a claimant's occupation on a national level to be improper. He cites to Shahpazian v. Reliance Standard Life Ins. Co., 388 F. Supp. 2d 1368 (N.D. Ga. 2005), which found: Reliance Standard seized upon one or more occupation descriptions in the DOT, despite the fact that these descriptions, individually or when blended, did not reflect certain material duties of Plaintiff's position with [his employer] or forensic accountants generally.

  4. Stiltz v. Metropolitan Life Insurance Company

    Civil Action File No. 1:05-CV-3052-TWT (N.D. Ga. Aug. 30, 2006)   Cited 14 times
    In Stiltz the Eleventh Circuit held that an insurer could rely on DOT definitions when the disability plan defined "own occupation" as "not limited to the specific position" held by the plaintiff.

    According to the Plaintiff, his inability to sit for long periods of time, lift and carry his luggage, and walk long distances precludes him from traveling as required by his job. In support of his argument that MetLife was required to consider the actual duties he performed for BearingPoint, especially the travel and associated physical burdens, the Plaintiff relies on Shahpazian v. Reliance Standard Life Insurance Co., 388 F. Supp. 2d 1368 (N.D. Ga. 2005). InShahpazian, the plaintiff sought long-term disability benefits after his left leg was amputated below the knee. In order to receive benefits, the plaintiff was required to show the inability to "perform the material duties of his/her regular occupation."

  5. Tippitt v. Reliance Standard Life Ins. Co.

    457 F.3d 1227 (11th Cir. 2006)   Cited 115 times   2 Legal Analyses
    Holding that requiring proof "satisfactory to [the administrator]" is sufficient to convey discretion

    "[A]mbiguity exists if the policy is susceptible to two or more reasonable interpretations that can fairly be made, and one of these interpretations results in coverage while the other results in exclusion." Shahpazian v. Reliance Standard Life Ins. Co., 388 F.Supp.2d 1368, 1375 (N.D.Ga. 2005); accord Luton v. Prudential Ins. Co. of Am., 88 F.Supp.2d 1364, 1370 (S.D.Fla. 2000). If there is no ambiguity and only "one reasonable construction is possible, the court will enforce the contract as written." Sapp v. State Farm Fire Cas. Co., 226 Ga.App. 200, 486 S.E.2d 71, 73 (Ga.Ct.App. 1997).

  6. United Ass'n of Journeymen v. Johnson Controls, Inc.

    Civil Action 4:18-cv-182 (S.D. Ga. May. 20, 2022)

    A collective bargaining agreement is ambiguous if, “after applying established rules of interpretation, [it] remains reasonably susceptible to at least two reasonable but conflicting meanings.” See CNH Indus. N.V. v. Reese, 138 S.Ct. 761, 765 (2018) (quoting 11 R. Lord, Williston on Contracts § 30:4, pp. 53-54 (4th ed. 2012)); Shahpazian v. Reliance Standard Life Ins. Co., 388 F.Supp.2d 1368, 1374-75 (N.D.Ga. 2005) (“When construing the terms of an ERISA policy, ambiguity exists if the policy is susceptible to two or more reasonable interpretations that can fairly be made, and one of these interpretations results in coverage while the other results in exclusion.”). “Each provision of the CBA is interpreted ‘consistently with the entire document and the relative positions and purposes of the parties' in order to ‘give full meaning and effect to all [plan documents'] text, avoiding constructions that would render provisions illusory.”

  7. Watkins v. Goodyear Pension Plan

    Case No.: 4:17-CV-461-VEH (N.D. Ala. Apr. 26, 2018)

    " Id. "'[A]mbiguity exists if the policy is susceptible to two or more reasonable interpretations that can fairly be made, and one of these interpretations results in coverage while the other results in exclusion.'" Tippitt v. Reliance Standard Life Ins. Co., 457 F.3d 1227, 1235 (11th Cir. 2006) (quoting Shahpazian v. Reliance Standard Life Ins. Co., 388 F.Supp.2d 1368, 1375 (N.D.Ga.2005)). "[E]quitable estoppel is not available to plaintiffs in cases involving oral amendments to or modifications of employee plans governed by ERISA because ERISA specifically addresses these issues.

  8. Ray v. Sun Life Health Ins. Co.

    CV-09-BE-0238-M (N.D. Ala. Sep. 29, 2010)   Cited 10 times
    Affirming administrator's termination based upon surveillance report showing plaintiff who claimed to a heart condition, on a seven-hour shopping trip and running errands, and driving to three locations on the next day, because the “objective evidence” contradicted his claimed physical limitations

    05) ("When the term `occupation' is undefined, courts properly defer to the DOT definition of the term because insurers issuing disability policies `cannot be expected to anticipate every assignment an employer might place upon an employee outside the usual requirements of his or her occupation'"); Hamall-Desai v. Furtis Benefits Ins. Co., 370 F. Supp. 2d 1283, 1307-08 (N.D. Ga. 2004) (stating that "the Plan's disability definition requires the [Plaintiff] not be able to perform one of the material duties of her regular occupation. It does no require that she be unable to perform one of the material duties of her occupation as altered by her employer); with, on the other hand, cases interpreting that term to mean the employee's particular job duties: Lasser v. Reliance Standard Life Ins. Co., 344 F.3d 381, 386 (3rd Cir. 2003) (stating "it is unreasonable for Reliance to define `regular occupation' [broadly] . . . without explicitly including that different definition in the Policy."); Shahpazian v. Reliance Standard Life Ins. Co., 388 F. Supp. 2d 1368, 1379 (N.D. Ga. 2005) (finding that where the policy did not expressly define "regular occupation," the claims administrator erred in using the definition of the occupation as it is normally performed in the national economy); Freling v. Reliance Standard Life Ins. Co., 315 F. Supp. 2d 1277, 1287-88 (S.D. Fla. 2004) (rejecting use of the DOT's national occupational definitions to define "regular occupation"). Given the lack of consensus and the lack of controlling authority addressing this issue, this court is not prepared to say Sun Life was wrong in defining the term by the national standard; however, the court notes that Sun Life could avoid this issue in the future simply by defining the term in the policy.

  9. White v. Reliance Standard Life Insurance Company

    1:05-cv-2149-WSD (N.D. Ga. Jan. 22, 2007)   Cited 2 times

    The Court notes that it, and many other courts, have found Defendant's interpretation of "regular occupation" to be unreasonable in other cases. See Shahpazian v. Reliance Std. Life Ins. Co., 388 F. Supp. 2d 1368, 1379 (N.D. Ga. 2005) (finding that Reliance's dependence upon the DOT was unreasonable and created a risk of unjust results when it relied solely upon occupation descriptions in the DOT when the descriptions did not reflect certain material duties of Plaintiff's position and noting that "one must ask whether the DOT descriptions are practically or legally viable in a dynamic and diverse labor market such as exists in this urban community or elsewhere"). On April 15, 2004, Defendant interviewed Plaintiff and noted that she performed "small house cleaning, eat, watch TV and rest a lot because she's off balance."

  10. Tookes v. Metropolitan Life Insurance Company

    Civil Action No. 1:04-CV-1957-RWS (N.D. Ga. Mar. 31, 2006)   Cited 4 times
    Holding that employer was not a fiduciary under ERISA when employer delegated all decision making responsibility for claims to the insurance company

    Nevertheless, "[w]here, as here, the parties agree that the administrator both possessed discretion in denying benefits and suffered from a conflict of interest, an abbreviated three-step analysis is appropriate." See Shahpazian v. Reliance Standard Life Ins. Co., 388 F. Supp. 2d 1368, 1373 n. 7 (N.D. Ga. 2005). First, from a de novo perspective, the Court must ascertain whether the decision to deny benefits was "wrong" — that is, whether the Court disagrees with it. Williams v. BellSouth Telecomms., Inc., 373 F.3d 1132, 1138 (11th Cir. 2004). If it is not "wrong," then the defendant prevails.