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Court Decisions



Luu v. First Unum Life Insurance Company, 2019 U.S. Dist. LEXIS 2019416 (C.D. CA, November 14, 2019) The District Court (Judge Selna) reversed Unum's denial of Mr. Luu's long-term disability claim, holding that he established that he was disabled at the time he left work.  The court specifically rejected Unum's argument that he stopped working to job-specific problems rather than from a medical impairment, and found that the medical evidence supported his disability from his own occupation as a software engineer.  The court had previously ruled in Mr. Luu's favor on a pret-trial motion to allow additional medical evidence to be part of the administrative record due to Unum's violation of the ERISA regulations requiring that a claimant be notified of the information necessary to perfect the claim on administrative appeal.

Laventure v. Prudential Insurance Company of America, 237 F.3d 1042 (9th Cir. 2001)   The Ninth Circuit Court of Appeals held that a disability insurance policy purchased by a family-owned company to cover only the owners of the company but none of the other employees is not an “employee benefit plan” under ERISA, such that a lawsuit for benefits was not preempted by ERISA, but instead was governed under state law.

The Ninth Circuit Court of Appeals held “notice-prejudice” rule of insurance law, requiring an insurance company to prove that it was actually prejudiced by the insured’s submitting a claim beyond the time set forth in the policy is a law “regulating insurance,” saved from preemption, and thus, applicable to claims brought under ERISA. This decision was essentially upheld by the United States Supreme Court in the sister case of Unum Life Insurance Company v. Ward, 526 U.S. 358 (1999).
The Ninth Circuit Court of Appeals held that language in our client’s long-term disability insurance policy requiring “satisfactory proof” of her disability did not unequivocally delegate discretion to determine eligibility for benefits to the insurance company, such that the applicable standard of review was de novo.  

McCormick v. United of Omaha Insurance Company, U.S. Dist. Ct., Central District of California, #12-01924.  The District Court (Judge Carney) reversed United of Omaha's denial of Ms. McCormick's long-term disability claim.  The court held, that upon de novo review, shemet her burden of establishing that her condition of mild cognitive impairment (dementia) prevented her from being able to perform the essential function (material and substantial duties) of her occupation as a sales manager.  Ms. McCormick has continued to receive benefits after the definition of disability changed to "any occupation."

Lacy v. Met Life Insurance Company, U.S. Dist. Ct., So. Dist. CA, #10-0830 (July 3, 2012) The Court held that Met Life abused its discretion in terminating our client's benefits for, first, failing to consider "the well-documented and considerable evidence by Lacy's treating physicians that he suffered, both subjectively and objectively, significant and debilitating pain," and second, for failing to consider Lacy's occupational duties as a territory sales manager, though "there is not a scintilla of evidence in the adminsitrative record that Lacy is capable of performing at the high functional level demanded of a territory sales manager position."  Benefits were awarded "at least" through the date of the judgment.