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First Circuit Reversed the Standard on Arbitrary and Capricious Onset Date

The Standard denied benefits to an insured, Doe, whose own occupation was an environmental lawyer. The Standard determined she was able to perform the essential duties of the occupation “lawyer” and did not take into account the difference in job duties between “lawyer” and the “environmental lawyer” specialty. Doe had paid for an “own occupation” policy from The Standard which required them to determine disability based on the duties of an environmental lawyer. The Standard approved her for benefits with an onset date from early 2012 even though Doe claimed that she was disabled from November 2011, which made an astronomical difference in benefit payments due to the pre-disability earnings used to base off her monthly benefits. The First Circuit reversed finding The Standard’s use of the 2012 onset date was arbitrary and capricious since Doe had not been working in her occupation as an environmental lawyer since November 2011. The court also found the use of the wrong occupation description of “lawyer” rather than her actual own occupation of environmental lawyer also arbitrary and capricious.