Benefits & ERISA Law

Disabled by AIDS in 1994 Does Not Mean Still Disabled in 2006 According to 7th Circuit

By Suzanne Wynn

If a condition is grave enough to warrant disability in 1994, why isn’t it sufficient to warrant disability in 2006? The 7th Circuit Court of Appeals addressed this question in Jenkins v. Price Waterhouse Long Term Disability Plan, No. 06 C 603 (May 4, 2009).

In 1994, Charles Jenkins started receiving long-term disability benefits under Price Waterhouse’s plan. In 1988, he had tested positive for HIV. In 1989, when he was 27 years old, he started working for Price Waterhouse. By the end of 1993, he was no longer able to work due to serious health problem. In 1994, the plan defined disability as the inability to perform one’s own occupation. In 1999, that definition became unable to perform any occupation within one’ qualifications. There is no dispute that in 1994, Mr. Jenkins met the plan’s definition of disability and started receiving long-term disability benefits. There is also no dispute that in 1999, when the definition changed to the stricter definition of unable to perform any occupation, Mr. Jenkins met that stricter definition and thus continued to receive benefits under the plan.

In 2006, Mr. Jenkins’ benefits under the plan were terminated, and Mr. Jenkins appealed that decision. The 7th Circuit upheld the decision of the district court, which found in favor of Price Waterhouse, stating that the difference between 1994 and 2006 were a change in Mr. Jenkins’ overall condition due to improved treatment for treating AIDS. Specifically, the 7th Circuit found:

“But Jenkins fails to recognize what CGLIC (and the general population, it seems) thought HIV and AIDS meant in the early 1990s. That impression was that HIV (and certainly AIDS) brought rapid death. Thankfully, the prognosis has changed - in large measure due to new drugs - both for Jenkins and countless others. It was not ‘downright unreasonable’ for CGLIC to shift its position along with that change when the medical evidence supported it.”

The “downright unreasonable” standard applied by the Court is from Davis v. Unum Life Ins. Co. of Am., 444 F.3d 569, 576 (7th Cir.). It states that court cannot reverse the district court’s decision unless the decision is “downright unreasonable”. Finding that the plan administrator’s decision to terminate Mr. Jenkins’ benefits had “rational support in the record” as it was supported by opinions from 4 medical professionals, the 7th Circuit determined that it had little choice but to affirm the district court’s decision finding for Price Waterhouse and the plan administrator.

pension protection act, ppa, AIDS, disability, Price Waterhouse, Unum, 7th Circuit, ERISA

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Full post as published by Pension Protection Act Blog on May 07, 2009 (boomark / email).