A federal district court in Illinois has ruled that a partner at an international law firm in Chicago who suffered from eye disease was entitled to receive long term disability benefits, reversing the insurance company’s decision.
Mary C. Fontaine was a partner at the law firm of Mayer Brown in Chicago, where she practiced in the firm’s structured finance group for 30 years. In 1997, Ms. Fontaine began having problems with her vision, complaining of seeing floaters and flashes in her eyes and having trouble focusing. Her doctors diagnosed her with myopic macular degeneration, a condition that results in a loss of vision in the center of the visual field. Over the next several years, Ms. Fontaine’s condition deteriorated and, in 2011, she decided that her vision had become so impaired that she could no longer perform her material job duties. She then filed a claim for disability benefits with MetLife under two policies she had with MetLife: a long term disability policy and an individual disability policy.
In support of her claim, Ms. Fontaine provided her medical records, a list of her treating physicians, and a nine page employee statement explaining why she believed that her eye disease prevented her from performing the material duties of her job.
In the employee statement, Ms. Fontaine described the nature of her work as a structured finance partner. She stated that she “designed, documented, negotiated and closed complex financial transactions (including securitizations, CLOs and derivatives) that were funded in global capital markets.” She stated that the structured finance partner’s role in these transactions was to “break portfolios of financial assets and related risks into different categories and to allocate each category of risk, as well as cash flow from the financial assets, among a number of different parties.” She described her practice as “requir[ing] the ability to master and manipulate large concepts and simultaneously insure the accuracy of minute detail spread across thousands of pages of interlocking contracts.” She noted that a typical contract went through several rounds of revision, and, as the lead partner on a transaction, she ultimately was responsible for making sure that the final draft incorporated all of the comments from the various parties. She noted that “[h]undreds of millions, or even billions, of dollars change hands in these transactions” and that “[t]here is no margin for error.”
Ms. Fontaine described her typical day, which she said began at 6:15 when she woke up to catch the 7:16 train downtown. She stated that, while she was on the train, she would read and respond to Blackberry messages that came in overnight. She arrived at the office around 8:00 a.m. She stated that, throughout the day, she would draft and edit documents, read laws and regulations relevant to her transactions, field written and telephone questions from clients and associates, work through term sheets and diagrams for potential new transactions, and participate in business development activities. She stated that she would read and respond to between 150 and 300 emails per day. She would leave the office between 8:00 p.m. and 1:00 a.m, and she regularly worked during the weekend. In addition to her typical working days, she traveled to other cities several times per year to make client pitches and attend conferences.
Ms. Fontaine listed several reasons her eye disease prevented her from doing her job. She stated that she had difficulty “reading and digesting complex cash flow formulas that go on for pages and often involve footnotes in tiny type,” “reading numbers and accurately noting where the decimal point is placed,” and “discerning the subtle differences between similar contract provisions during contract negotiations conducted in concentrated time frames.” She stated that she could not “generate timely issue summaries for clients, or lead them through a line-by-line review of lengthy contracts.” She could not correct the work of attorneys whom she supervised and “misplaced words in documents in a way that change[d] the[ir] legal meaning.” She stated that she could not “read fast enough to get through the volume of work on [her] desk each day.” She also stated that she could “no longer effectively generate new business” because she could not read materials to prepare for meetings with a potential client and had difficulty reading name tags and business cards.
Ms. Fontaine concluded by noting that, although she had not yet made a mistake that was catastrophic to one of her clients, she did not believe she could “justify subjecting my clients or my firm to the risk that I will make such a mistake.”
MetLife denied Ms. Fontaine’s claim for disability benefits. MetLife concluded that the medical information she provided did “not support any restrictions or limitations that would prevent her from performing her occupation.”
Ms. Fontaine appealed MetLife’s denial of her claim, but MetLife upheld its decision.
Ms. Fontaine brought suit to challenge MetLife’s denial of her claim under Section 502(a)(1)(B) of the Employee Retirement Income Security Act, 29 U.S.C. § 1132 (“ERISA”). She sought $33,500 per month (plus accrued cost-of-living adjustments), less $2,444 per month, representing the amount of Social Security disability benefits she had been awarded.
The parties filed cross-motions for entry of judgment.
The long term disability policy defined disabled as:
Disabled or Disability means that, due to Sickness or as a direct result of accidental injury:
• You are receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and
• You are unable to earn:
• more than 80 percent of Your Predisability Earnings at Your Own Occupation from any employer in Your Local Economy; and
• unable to perform each of the material duties of Your Own Occupation.
The policy defined own occupation as:
the specialty in the practice of law in which You were practicing just prior to the date Disability started.
The individual disability policy provided coverage if an employee became “totally disabled,” which the policy defined as:
Total Disability or Totally Disabled means that due solely to impairment caused by Injury or Sickness, You are …
a. Prevented from performing the material and substantial duties of Your Regular Occupation;
b. Not Gainfully Employed; and
c. Receiving appropriate care from a Physician who is appropriate to treat the condition causing the Impairment.
The policy defined regular occupation as:
Your usual occupation (or occupations, if more than one) in which You are Gainfully Employed at the time You become Disabled.
The court’s decision
The court granted judgment in favor of Ms. Fontaine.
In its decision, the court first found that it would review MetLife’s decision under the de novo standard. It acknowledged that MetLife’s long term disability plan contained language that ordinarily would be sufficient to trigger a deferential standard of review, but it found that a regulation of the Illinois Department of the Insurance Director required that it use the de novo standard and it decided that the regulation was enforceable under Illinois law and not preempted by ERISA.
Then, the court decided that because the long term disability policy defined “disability” as the inability to perform “each of the material duties of your own occupation,” Ms. Fontaine had to show that she was unable to perform all of the material duties of a structured finance partner.
The court next found that Ms. Fontaine’s symptoms prevented her from being able to perform each of her material job duties, rejecting the insurer’s principal argument that Ms. Fontaine was able to perform these duties because of her good visual acuity. As the court explained, Ms. Fontaine “never suggested that she was disabled because of poor visual acuity” but that she was disabled because she could not “see and read well enough to perform her occupation.” It decided that by 2011, her eye disease had progressed to the point where she was unable to read at the level that was required of a structured finance partner.
The court said that it detected “no hint of malingering” and that, to the contrary, the record suggested that Ms. Fontaine “genuinely loved her work and would have continued to work were it not for her disability.” Accordingly, it found that Ms. Fontaine had shown by a preponderance of the evidence that she was unable to perform each of the material and substantial duties of her job. Therefore, the court concluded, she was entitled to benefits under both MetLife policies.