Disability insurance policies provide benefits if you cannot perform the duties of your occupation. How does this apply to nurses working in a specialty? The insurer may categorize nurses as a registered nurse and overlook the demands of the medical specialty. A neonatal nurse or emergency room nurse needs mobility and exemplary multitasking skills to engage in their specialized nursing field. By categorizing these nurses as general RN’s the insurer erroneously disregards the special skill set required of these nurses.
In the recent case of Samper v. Providence St. Vincent Med. Ctr., 675 F.3d 1233 (9th Cir. 2012) the Ninth Circuit Court of Appeals offered some commentary on this issue. Samper, although focused on the Americans with Disabilities Act (ADA) and not specifically on long term disability insurance, dealt with a neonatal nurse who worked in the NICU of a hospital. The issue was the denial of Samper’s request for additional accommodations under the ADA. The court notes that the patient population that a neonatal nurse interacts with “cries out for constant vigilance, team coordination and continuity.” Id. at 1238. It is further acknowledged by the court that “NICU nurses must have specialized training, and it is very difficult to find replacements.” Id.
In Peck v. Aetna Life Ins. Co., 495 F. Supp. 2d 271, 274 (D. Conn. 2007) Aetna applied a generalized RN job description to the claimant who was an operating room nurse at a hospital. Aetna chose to freely interpret “own occupation” since no definition was contained within the policy but the court stated that when “own occupation” is not defined, it “shall be a position of the same general character as the insured’s previous job, requiring similar skills and training, and involving comparable duties.” Considering Peck to be a generalized RN was arbitrary and capricious because her role required a different skill set and her duties included “10-hour shifts, spending nearly all of her time on her feet, and assisting everyone in a particular operating room,” vastly different than the responsibilities of a general RN.
Schofield v. Metro. Life Ins. Co., 297 Fed. Appx. 697 (9th Cir. Cal. 2008), Schofield was a Certified Registered Nurse Anesthetist but in their analysis, Met Life determined that she was capable of performing “more-sedentary nursing duties.” The court found this analysis flawed because the policy was an own occupation policy and the analysis was if Schofield could perform her job as a Certified Registered Nurse Anesthetist.
While an insurer may try to classify a specialized nurse as an RN that is rarely acceptable as the positions are different. While a specialized nurse certainly could perform the duties of a generalized registered nurse that is not the occupation that the specialized nurse engages in. Additionally, the skill set required of the specialized nurse while rooted in the same skills required of an RN, necessitates additional specialized skills and potential training. If covered under an own occupation definition in a policy it is patently unfair for the insurer to generally categorize a specialized nurse as an RN because while trained as an RN that is not the nurses occupation.
We at Bonny G. Rafel have experience handling a variety of issues with “own occupation” terms of disability policies. If you have been denied due to an “own occupation” issue or need help interpreting the terms of your policy contact our office so we can put that experience to use in helping you receive the benefits that you deserve.
–By Alexander C. Schaffel, Esq. and Bonny G. Rafel, Esq.