MCCOOL v. LIFE INSURANCE COMPANY OF NORTH AMERICA (2021)

United States Court of Appeals, Ninth Circuit.2021-04-02No. No. 18-56529

Summary · law.co

Holding. The court affirmed the district court's judgment in favor of the insurance company, finding no clear error in the lower court's determination that McCool failed to prove he could not sit for four hours a day, which is necessary to establish disability under ERISA.

Gabe McCool appealed a district court decision denying his claim for disability benefits under an employer's ERISA benefit plan. McCool argued he was unable to work due to his physical condition, but the insurance company, Life Insurance Company of North America, contested this claim. The district court found that McCool failed to demonstrate he could not sit for at least four hours during an eight-hour workday, which is the standard threshold for disability under ERISA when a policy lacks a specific definition of disability.

The appellate court reviewed the district court's factual findings for clear error and found none. Medical evidence showed that three doctors opined McCool could sit "frequently," defined as between 2.5 to 5.5 hours in an eight-hour day. Because this range includes the four-hour threshold, the district court properly concluded that McCool did not meet his burden of proving he was disabled under the plan's terms. The court applied established ERISA precedent requiring claimants to prove by a preponderance of the evidence that they cannot perform any occupation.

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Key issues

Whether claimant proved disability when medical evidence showed ability to sit 2.5 to 5.5 hours daily
Proper standard for disability when insurance policy contains no definition of 'sedentary'
Claimant's burden of proof under ERISA for denial of disability benefits
Meaning of 'frequent' sitting capacity in disability determinations

Procedural posture

McCool appealed the district court's judgment following a bench trial ruling in favor of the insurance company on his ERISA disability benefits claim.

Authorities cited

No cited authorities resolved to law.co cases yet.

Opinion · public domain

MEMORANDUM **

Appellant Gabe McCool (McCool) appeals the district courts judgment in favor of Appellee Life Insurance Company of North Americas (LINA) following a bench trial. We have jurisdiction under 28 U.S.C. § 1291, and review the district courts factual findings following a bench trial for clear error. See Stormans, Inc. v. Wiesman, 794 F.3d 1064, 1075 (9th Cir. 2015). The district courts interpretation of the Employee Retirement Security Act (ERISA) and conclusions of law are reviewed de novo. See id.

McCool asserts that LINA wrongfully denied his requested disability benefits under his employers ERISA benefit plan. In the normal course, a court would review the policy to determine the definition of “sedentary” or suggestion of what definition to follow. However, this policy does not contain a definition. Thus, the district court properly applied the standard from Armani v. Northwestern Mut. Life Ins. Co., 840 F.3d 1159 (9th Cir. 2016), which (1) imposes the burden upon the claimant to prove by a preponderance of the evidence “that he was disabled under the terms of the plan”; and (2) adopts the “consistent” interpretation of “ERISA law” that an individual is unable to perform “any occupation” under a disability policy if that individual “cannot sit for more than four hours in an eight-hour workday.” Id. at 1163 (citation omitted).

The district court did not clearly err in finding that McCool failed to meet his burden of proving by a preponderance of the evidence that he could not sit for four hours a day. Three doctors opined that McCool could sit “frequently.” “Frequently is defined as between 2.5 to 5.5 hours in an 8-hour workday.” The district court found that McCool failed to establish that he cannot sit for four hours a day “despite repeated findings that he can sit frequently.” This finding was not clearly erroneous in light of the record evidence, and was consistent with our analysis in Armani.

AFFIRMED.