Chung v. Provident Life and Casualty Insurance Company

Background

Edward J. Chung sued Provident Life and Casualty Insurance Company under the Employee Retirement Income Security Act of 1974 (ERISA), seeking disability benefits under a Supplemental Plan and attorney’s fees. The parties agreed to resolve the benefits dispute through a bench trial—a trial decided by a judge rather than a jury—based on a stipulated administrative record.

Chung had worked as a mergers-and-acquisitions partner at Simpson, Thacher & Bartlett, LLP, until December 31, 2018. He had experienced worsening neck and upper-extremity symptoms, including pain, numbness, tingling, weakness, reduced range of motion, fatigue, and decreased dexterity. His doctors diagnosed cervical-spine conditions, and imaging and electrical nerve testing showed progressive abnormalities.

The Supplemental Plan defined total disability as being unable, because of injury or sickness, to perform the material and substantial duties of the insured’s occupation, while receiving medical care or meeting the plan’s alternative requirements. The plan defined the occupation based on how it is performed in the national economy, rather than for a particular employer or location. The plan’s elimination period was 365 days.

Provident initially paid Chung residual-disability benefits of $20,000 per month. After reviewing his continued eligibility, Provident denied additional benefits effective September 21, 2020, concluding that Chung could perform his occupation part time and that residual benefits were unavailable because he had retired. Provident upheld that decision after Chung appealed.

Court’s Review and Findings

The parties stipulated to de novo review, meaning that the court independently evaluated the plan terms and evidence without deferring to Provident’s decision. Chung had to prove his claim by a preponderance of the evidence, meaning that his evidence had to show that his position was more likely true than not.

The court determined that Chung’s occupation under the plan was “attorney.” It relied on national occupational resources but also considered updated requirements identified by Chung’s vocational expert because the main occupational reference source had not been updated since 1991. The court accepted as general attorney requirements substantial computer use, prolonged neck positioning, typing, document review, detailed analysis, multitasking, and sustained concentration. It disregarded requirements tied specifically to Chung’s former employer or his particular role as a partner at a major international law firm.

The court found that Chung could not perform the material and substantial duties of an attorney, even part time. The evidence showed that he could not sit at a desk or in meetings for prolonged periods, keep his neck in a fixed position while viewing a computer screen, or type for extended periods. The evidence also showed that pain and fatigue interfered with his attention, concentration, and ability to perform complex legal work.

The court relied on abnormal cervical-spine imaging, abnormal nerve testing, clinical findings, treating-physician opinions, and two functional capacity evaluations. Dr. Marc Levinson concluded that Chung needed frequent position changes and extended periods of reclining rest, had severely limited hand use, and could not return to work with accommodations. Dr. Igor Stiler concluded that Chung was totally and permanently disabled from practicing as an attorney and could not perform sedentary work or work requiring prolonged computer use. The functional capacity evaluations concluded that Chung could not tolerate an eight-hour workday or even a half-day because of positional intolerance, fatigue, deteriorating performance, and poor endurance.

Provident relied in part on an examination by Dr. Daniel Rosenberg, who concluded that Chung could work with accommodations, including brief hourly movement breaks and limited computer use. The court found that Rosenberg’s short examination and conclusions were difficult to reconcile with the findings of the other examining physicians, functional capacity evaluations, and diagnostic evidence. The court also gave particular weight to the treating physicians’ opinions based on their relationships with Chung, their expertise, and the consistency of their opinions with the other evidence. The court stated that Chung did not need to prove a particular diagnosis; he needed to show that his condition caused enough pain and limitation to prevent him from performing his regular job duties.

Ruling

Judge Alvin K. Hellerstein found that Chung had been totally disabled under the Supplemental Plan since September 21, 2020. The court granted judgment in favor of Chung and awarded total-disability benefits from September 21, 2020, through the date of judgment. Chung was also entitled to benefits after judgment, subject to the Supplemental Plan’s terms and conditions.

The court held Provident liable for Chung’s attorney’s fees and costs under 29 U.S.C. § 1132(g)(1). The parties were directed to propose a schedule for determining the amount of those fees and costs. The clerk was directed to terminate any open motions.