Northwestern Mutual Must Pay Disability Benefits for Employee Who Cannot Sit for More than Four Hours Per Day Due to Back Injury

A federal appeals court has ruled that Northwestern Mutual must pay disability benefits to an employee who is unable to sit for more than four hours per day due to a back injury. The employee worked as a controller for an insurance agency. He injured his back while lifting a large battery.  MRI results showed he suffered from a bulging disc and tear within his spine.

The employee was insured under a long-term disability plan issued by Northwestern Mutual. To receive long-term disability benefits, the policy required the employee “be disabled from all occupations.” This means the employee cannot perform the duties he was hired to perform.

The employee’s physician concluded that the employee could only sit for four hours, not the eight hours he normally sat in a given work day.  Several doctors who saw the employee, including a pain specialist, chiropractor and his treating physician, concluded his injuries prevented him from working.

A chiropractor who treated the employee concluded in a report that he believed the employee’s condition would improve in the future. Based solely on this information, Northwestern Mutual’s doctor concluded that the employee was capable of working in a sedentary position.  The insurer sent the employee a letter stating his disability benefits were being terminated because his records showed he was no longer disabled. 

The employee eventually filed a lawsuit suing his employer under ERISA. The employee sought review by a federal court of the insurer’s claim denial. The district court agreed with Northwestern, finding that his injuries did not prevent him from doing sedentary work.

The employee appealed the district court’s decision to a federal appeals court.  That court reversed the district court, finding that the district court erred in denying the employee his long term disability benefits. In reversing the lower court, the appellate court recognized case law that concludes that in order to do sedentary work, an employee usually has to be able to sit for six hours per day. Here, the employee suing Northwestern Mutual was only able to sit for four hours per day, not six.

The appellate court’s decision is insightful. The court held “[w]e agree with this commonsense conclusion and hold that an employee who cannot sit for more than four hours in an eight-hour workday cannot perform sedentary work that requires sitting most of the time.” See Armani v. Northwestern Mutual Life Ins. Co., 840 F.3d 1159 (9th Cir. 2016