No. 16-2085
JANE DOE,
Plaintiff, Appellant,
v.
Defendant, Appellee.
Before
in 2012: the insurer has paid Doe the benefits owed using a January
2012 onset date, but not the benefits owed if the onset date is in
$100,000 in payments.
lawyer." Yet when the insurer assessed whether and when Doe became
I.
A. Background
and for many years she was an equity partner. In August 2011, Doe
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became a non-equity partner and remained employed in that capacity
for about six months thereafter. Over the course of 2011, Doe
plan ("the Plan") offered by Doe's law firm to its employees. The
Plan was insured by an LTD policy ("the Policy"), which was also
years' experience that "[their] Own Occupation [is] the one legal
modified or omitted."
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The monthly benefit amount depends on the claimant's
turn on the claimant's income during the "prior tax year" -- that
is, the calendar year before the year of disability onset. Doe's
income in 2011 was only one-third of what it had been in 2010, and
life," among other symptoms. Dr. Petersen suspected that Doe was
On December 9, 2011, Doe met for the first time with Dr.
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that same month, Dr. White observed that Doe "was having continuing
discussed Doe's condition with Dr. White earlier that day. In her
imminent suicide risk, but that Doe was "severely depressed." When
2012, Dr. White and Dr. Petersen continued to observe that Doe was
physician, Dr. Donna Conkling, for the first time since April 2011.
work." Doe's last day of logging hours of work at the firm was
B. Doe's Claim
22, 2012." She reported that "she had suffered depression for
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October 2011." As symptoms stemming from her "mental health [and]
lawyer. Standard had requested the description from the law firm
two days earlier, along with Doe's payroll history and timesheets.
The firm also sent Doe's biography, which outlined Doe's career
incomplete or inadequate.
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descriptions and requirements, formerly published by the U.S.
See McDonough v. Aetna Life Ins. Co., 783 F.3d 374, 38081 (1st
Cir. 2015); see also, e.g., Armani v. Nw. Mut. Life Ins. Co., 840
F.3d 1159, 1162 (9th Cir. 2016). There is no separate DOT job
On April 23, 2012, Cottrell responded that Doe did not meet the
18, 2012 onward but not disabled beyond the Policy's "90 day
Benefit Waiting Period." On January 25, 2013, Doe took her first
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formal appeal and submitted additional information from Dr. White
approve her claim and that it would use January 28, 2012 as the
disability onset date. On May 14, 2013, Doe took her second appeal
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"[al]though [Doe] was not performing her own specialty area of
other areas of expertise to the extent that they would differ from
subject matter area are the same as that of [the] DOT occupation
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decision to use a general "lawyer" standard, perhaps because there
date. The Final Decision observed that Doe had performed "non-
and committees and pro bono work." "Therefore," the Final Decision
went on, "while we acknowledge that your client did cease work in
any time prior to January 28, 2012." The Final Decision further
explained that "while we recognize that your client found her work
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on August 29, 2014. She submitted sworn statements from herself,
Dr. Petersen, and Dr. White. In a letter dated September 16, 2014,
entitled."
II.
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is reasonable and supported by substantial evidence on the record
as a whole." Id.; see also Metro. Life Ins. Co. v. Glenn, 554
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to undercut that coverage by failing to ascertain and consider the
Co. of Bos., 454 F.3d 69, 78 (1st Cir. 2006)), that is not the
See id.; Miller v. Am. Airlines, Inc., 632 F.3d 837, 855 (3d Cir.
in a different position."). The fact that the DOT does not have
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Environmental law is a distinct specialty, and the expertise
-division.
Doe did not actually practice "in her own specialty area of
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expertise . . . after November 2011." And Standard's own
around November 2011 and that "[Doe] was not working in her own
basis from 8/1/11 [to] 11/30/11." Its choice of January 28, 2012
Prudential Ins. Co. of Am., 426 F.3d 20, 3132 (1st Cir. 2005);
Glista v. Unum Life Ins. Co. of Am., 378 F.3d 113, 13032 (1st
Cir. 2004) ("In [the ERISA] context, no single answer fits all
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cases."). In light of Standard's failure to apply the Own
It is now 2017, and the dispute concerns events in 2011 and 2012.
Life Assurance Co. of Bos., 320 F.3d 11, 2324 (1st Cir. 2003)
III.
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on a disability onset date of no later than 2011. Doe's request
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