A disability review may focus on whether someone can sit, stand, or lift. But treatment for a physical condition can also affect concentration and memory. In Demer v. IBM Corp. LTD Plan, the Ninth Circuit examined whether an insurer adequately considered reported cognitive effects of medication when evaluating long-term disability benefits.
Daniel Demer had serious spinal problems, chronic pain, and depression. MetLife initially approved benefits under the plan’s own-occupation standard. When the claim was evaluated under the later any-occupation standard, MetLife denied continued benefits. The district court ruled for the plan and MetLife; the Ninth Circuit reversed and sent the claim back for reevaluation.
Pain treatment and mental demands
Demer reported fatigue, difficulty concentrating, and problems communicating that he attributed to medications. His treating physicians and a person familiar with him provided supporting observations. The court also noted evidence that his medications were necessary for chronic pain and could affect mental functioning.
MetLife relied on consultants who reviewed the records without examining Demer. The court concluded that their rejection of cognitive limitations effectively discounted his reported symptoms without adequately explaining a credibility determination. A paper review is not automatically improper, but the reasoning supporting a conclusion matters.
The court also considered whether isolated activities, including driving and taking online courses, necessarily showed an ability to perform a gainful occupation under Demer’s plan. The jobs at issue could require sustained concentration and memory. The court declined to rely on a credibility rationale that MetLife had not given during the administrative process.
Reviewing the evidence together
The majority considered the consultants’ substantial paid work for MetLife as a reason for some skepticism in the circumstances. Judge Bybee agreed with the result but dissented from that conflict analysis. The court’s ruling did not establish that a paid reviewer is necessarily biased or that every medication side effect is disabling.
The remedy was also specific: the court ordered a remand for MetLife to reevaluate the claim, rather than ordering payment of benefits. The case illustrates why a decision should connect the medical and functional evidence to the work the plan requires the claimant to be able to perform.
Preparing a response
A claimant’s records may be more useful when they describe the frequency and practical effect of symptoms: for example, difficulty following instructions, maintaining attention, or recovering after tasks. Treating providers can explain how their observations relate to treatment and work demands. The plan’s wording, available occupations, and the complete administrative record remain central.
Source: Demer v. IBM Corp. LTD Plan, 835 F.3d 893 (U.S. Court of Appeals for the Ninth Circuit, 2016-08-26).
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