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Elliott v. United of Omaha Life Insurance Co.

United States District Court, W.D. Michigan, Northern Division

March 31, 2017

TASHINA ELLIOTT, Plaintiff,
v.
UNITED OF OMAHA LIFE INSURANCE COMPANY, Defendant.

          OPINION

          GORDON J. QUIST UNITED STATES DISTRICT JUDGE.

         Plaintiff, Tashina Elliott, has sued Defendant, United of Omaha Life Insurance Company, pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq., seeking review of Defendant's decision to discontinue Plaintiff's long-term disability benefits. (ECF No. 1-1 at PageID.8.) Defendant has filed the Administrative Record and the parties have filed cross-motions for judgment on the Administrative Record in accordance with the procedures set forth in Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609 (6th Cir. 1998). For the foregoing reason, the Court will affirm Defendant's decision.

         Facts

         Defendant issued a long-term disability insurance policy to the Bay Mills Indian Community. Plaintiff is an employee of Bay Mills and is covered by the policy which provides, in relevant part:

Disability and Disabled means that because of an Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred in which You are:
(a) prevented from performing at least one of the Material Duties of Your Regular Occupation on a part-time or full-time basis; and
(b) unable to generate Current Earnings which exceed 80% of Your Basic Monthly Earnings due to that same Injury or Sickness.
After a Monthly Benefit has been paid for 3 years, Disability and Disabled mean You are unable to perform all of the Material Duties of any Gainful Occupation. Disability is determined relative to Your ability or inability to work. It is not determined by the availability of a suitable position with Your employer. …
Material Duties means the essential tasks, functions, and operations relating to an occupation that cannot be reasonably omitted or modified. In no event will We consider working an average of more than 40 hours per week in itself to be a part of material duties. One of the material duties of Your Regular Occupation is the ability to work for an employer on a full-time basis.
Regular Occupation means the occupation You are routinely performing when Your Disability begins. Your regular occupation is not limited to the specific position You held with the Policyholder, but will instead be considered to be a similar position or activity based on job descriptions included in the most current edition of the U.S. Department of Labor Dictionary of Occupational Titles (DOT). We have the right to substitute or replace the DOT with a service or other information that We determine of comparable purpose, with or without notice. To determine Your regular occupation, We will look at Your occupation as it is normally performed in the national economy, instead of how work tasks are performed for a specific employer, at a specific location, or in a specific area or region.

(ECF No. 13-1 at PageID.90-92.)

         Plaintiff worked as a receptionist at Bay Mills. The record describes her occupation as follows:

ESSENTIAL FUNCTIONS:
1. Schedules appointments, gives information to callers, takes dictation, and otherwise relieves accounting department of clerical work and minor ...

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