Cannot impose “accommodation” requirement for disability, if it isn’t stated in the plan.
Arturo Aguirre vs. Steelcase, Inc., CV-95-5894 GHK
Mr. Aguirre was in his mid-50s, when he became disabled. He had worked for Steelcase his entire adult life, some 29 years, with an almost perfect attendance record, working his way up from a custodial worker to a maintenance mechanic. He had a long history of polio in his right leg, but was able to work, in spite of that problem. But in 1987 he sustained multiple fractures of his left leg (i.e. his only "good" leg), as the result of a car crash. The medical reports established that, as a direct result of the 1987 accident, he suffered post-traumatic arthritis in his left leg, which was progressive and degenerative. After the 1987 accident, Mr. Aguirre was disabled and off work for ten months. He returned to work at Steelcase, but was never the same physically as before. He worked the next four and a half years in constant and increasing pain. But one day, while walking across a parking lot on his way to work, his left leg finally gave out and he collapsed. He was not able to return to work after that.
Mr. Aguirre was covered under his employer’s self-funded ERISA plan, administered by CIGNA. He received Short Term Disability benefits for a period of six months, but then Steelcase denied his Long Term Disability (LTD) claim, contending that he did not meet the “any occupation” standard of the Plan definition of "total disability". Steelcase’s position was based entirely upon the fact that Mr. Aguirre admitted he could perform the duties of a hypothetical job that would “accommodate” his disability. Steelcase further contended that his LTD claim was "defective", because Steelcase was allegedly denied an opportunity to make a timely "accommodation" for him. There was no requirement in Mr. Aguirre’s LTD plan that he perform duties of any accommodation job.
Result: A lawsuit was filed. The case was resolved satisfactorily.