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9th Cir. – LTD Denial Upheld

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  • 9th Cir. – LTD Denial Upheld

    Here’s a new case out of the Ninth Circuit, Kelly Demko v. Unum Life Insurance Company of America. This is an LTD case where the head of human resources at Dream Works filed a claim under the Unum plan. It is very short opinion clocking in at 3 paragraphs. Below, find the two that are relevant. I don’t have much to comment on this one. The opinion is attached below.

    To prevail on her claim, Demko needed to prove that she was “unable to perform with reasonable continuity the substantial and material acts necessary to pursue [her] usual occupation in the usual and customary way” during the coverage period. See id. The district court did not clearly err in finding that Demko, who was the head of human resources at Dreamworks, was able to perform her job normally until she was terminated for non-medical reasons. Demko’s employer presented evidence that she did not significantly change her hours, job duties, or performance during the period of claimed disability. Treatment records from Demko’s doctor showed that her fibromyalgia condition was improving during that period, and her doctor first opined that she was disabled months after the coverage period ended. See id. at 1296-98 (district court did not clearly err in denying ERISA claim where doctor’s opinion was inconsistent with accompanying medical records); Boyd v. Bert Bell/Pete Rozelle NFL Players Ret. Plan, 410 F.3d 1173, 1178-79 (9th Cir. 2005) (upholding denial of ERISA claim where medical evidence could reasonably support either party).

    Demko’s objections to the district court’s evaluation of the evidence are unavailing. First, although the district court was not required to defer to the opinions of Demko’s doctor, Black & Decker Disability Plan v. Nord, 538 U.S. 822, 834 (2003), it nevertheless accorded them the “greatest weight” and did not rely heavily on the opinions offered by Unum’s doctors. Second, an independent medical examination was not required, particularly when Demko proffered insufficient evidence to establish disability. Third, the record does not support Demko’s contention that, to deny coverage, Unum belatedly raised the circumstances of her termination and whether she reduced her work schedule. Fourth, the district court reasonably determined that Demko failed to show that she could not satisfy the cognitive functions of her job. Fifth, the district court addressed Demko’s ability to work the required hours, finding that she had not reduced her work schedule. And finally, the district court duly considered Demko’s subjective complaints, and reasonably concluded that they did not establish the requisite level of disability.
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