Third Circuit: “Own Occupation” and “Regular Occupation” Interchangeable

Apr 10, 2019 | Blog |

Christopher Patterson v. Aetna Life Insurance Company, No. 17-3566 (3d Cir. 2019)

By: Stephen A. Jackson

Patterson became disabled after back surgery and Aetna began paying benefits under a group long-term disability plan in 2007.  In 2014, Aetna terminated those benefits after concluding Patterson was no longer disabled because he could fulfill the material duties of his “own occupation” as performed “in the national economy.”  The term “own occupation” was not defined in the policy.

Aetna determined Patterson’s “own occupation” “in the national economy” was sedentary and that while he could not do a job in a “heavier category” he could perform sedentary work.  After denying internal appeal Patterson brought this ERISA claim. On cross motions for summary judgment the District Court determined that Aetna’s “national economy” interpretation of “own occupation” was contrary to the plain language of the policy in light of Lasser v. Reliance Standard Life Insurance Co., 344 F.3d 381 (3d Cir. 2003).  In Lasser “own occupation” must involve consideration of Patterson’s actual duties as performed before he became disabled, thus Aetna’s decision to terminate benefits was arbitrary and capricious because Aetna did not consider whether Patterson could perform his actual job duties and, even if had done so, Patterson could not perform those duties.

On appeal, Aetna argues it was allowed to construe “own occupation” to mean Patterson’s occupation as performed in the national economy. Aetna argued Lasser is not controlling because the policy in Lasser used the term “regular occupation” whereas the policy here used the term “own occupation.”  The Court was not persuaded noting other courts have recognized the distinction between “own occupation” with “regular occupation” is one without a legal difference.  The Court further noted that Aetna itself subscribed to the same view as in Peck v. Aetna Life Insurance Co., 495 F. Supp. 2d 271 (D.Conn. 2007) where Aetna successfully argued that the terms “own occupation” and “regular occupation” are interchangeable.  Accordingly, the term “own occupation” in the policy required Aetna to consider Patterson’s actual job duties and that its “national economy” interpretation was unsupportable.

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