Case Result

Nothing Stops Donahue & Horrow LLP From Relentlessly Pursuing Justice – Doubling Down and Going All the Way to the 9th Circuit U.S. Court of Appeals to Win 

SUMMARY:

THE JUDGE RULED PARTIALLY IN FAVOR OF OUR CLIENT AT THE TRIAL COURT LEVEL AWARDING LIMITED PAYMENT OF LONG TERM DISABILITY (LTD) BENEFITS. HOWEVER, THAT WAS NOT AN ACCEPTABLE OUTCOME AS OUR CLIENT SHOULD HAVE RECEIVED FULL PAYMENT. MOST LAWYERS DO NOT APPEAL TO THE HIGHER COURTS ON ERISA CASES.  THIS IS WHERE DONAHUE & HORROW LLP MAKES THE DIFFERENCE.  WHEN A CLIENT DESERVES MORE BENEFITS, MICHAEL HORROW AND HIS TEAM TAKE THE RISK, FILE AN APPEAL IN THE 9^th CIRCUIT U.S. COURT OF APPEALS, AND WORK TWICE AS HARD – AGGRESSIVELY PURSUING JUSTICE FOR OUR CLIENTS.  WE INVEST IN CASES EVEN WHEN THERE IS NO GUARANTEE OF PAYMENT (100% OF OUR PAYMENT IS SUBJECT TO WINNING THE CASE).  OUR COMMITMENT AS A FIRM IS TO RELENTLESSLY FIGHT ON BEHALF OF OUR CLIENTS.   

In this case, our client was a long-time hospital employee, who, through hard work and dedication to his job, rose to the job of Administrative Director of Diagnostic Services.  Unfortunately, over time, he also developed disabling cardiac problems which eventually led to his hospitalization and forced him to stop working.  Luckily, so he thought, his employer provided long-term disability insurance to cover this exact situation.  Unfortunately for our client, the insurance company, Sun Life Assurance Company of Canada, refused to honor its contract and as a result, wrongfully denied his claim for disability insurance benefits.

After Sun Life denied his claim and the administrative appeal, our client contacted Donahue & Horrow LLP.  After the administrative appeal was denied, we filed an ERISA lawsuit in the Central District of California.  We demanded that our client be placed on claim and awarded his disability insurance benefits.

After the parties submitted the trial briefs, the U.S. District Court Judge conducted a bench trial.  Michael Horrow appeared on behalf of our client, arguing that our client’s cardiac impairment, exacerbated by work stress, and other orthopedic problems, including severe and disabling back pain, made him disabled under the terms of the Sun Life disability insurance policy.  Sun Life asserted that our client was never disabled (despite previously approving his claim for short-term benefits for six months) and not entitled to long term disability benefits.

Following the trial, the Judge issued a ruling which granted our client disability benefits, but only for a limited period of time.  She agreed that our client was disabled due to a combination of cardiac problems and occupational stress, but only through January 29, 2020. The Court found that after that date, our client recovered for about six weeks, before becoming disabled again due to a cardiac event on March 10, 2020.  However, due to the finding of no disability as of January 29, 2020, our client was no longer eligible to recover long term disability benefits.

After reviewing the Judge’s Order, Donahue & Horrow LLP believed that it was incorrectly decided, and appealed that decision to the 9th U.S. Court of Appeals.  At the 9th Circuit, Michael Horrow and his team at Donahue & Horrow LLP made two primary arguments.  

First, the firm argued that our client, a man with a serious history of cardiac problems could not have meaningfully recovered during that six-week period such that he was able to return to work.  As further evidence of this, we noted that our client’s physician has been pushing him to retire, due to his disabling cardiac condition, for months prior to January 2020, and thus he must have been disabled after that date.

Second, Donahue & Horrow LLP argued that the Court ignored our client’s spinal injuries, which also rendered him disabled before and after January 29, 2020.  The medical records made it clear that his diagnoses of “degenerative arthritis of the spine” and “lumbar disc problems” made him disabled as well, and yet the Court’s Order did not address these medical problems at all in its decision.

After the parties submitted briefing to the Ninth Circuit, the three-judge panel reviewed the briefing, and decided that the issues were clear and that no oral argument was necessary.  Shortly thereafter, the panel issued a ruling in our client’s favor, holding that the medical evidence showed that our client could not have recovered from his cardiac condition during the six weeks between January 29, 2020 and March 10, 2020.  The panel also stated that the Trial Court failed to properly consider the extent to which our client’s back problems further prevented a return to work.  The 9^th Circuit Court of Appeals explained that it was reversing the ruling, and remanding the matter back to the District Court for further consideration.

If you believe your disability insurance, life insurance, long-term care or AD&D insurance claim was improperly denied by your insurance company, call Donahue & Horrow LLP at (877) 664-5407 for a free consultation.  We are ready to help you get the benefits you deserve.