N.D. Cal. Reinstates ERISA Disability Benefits Despite Normal Cognitive Test Scores

In O’Connor v. Metropolitan Life Insurance Company, No. 4:24-cv-08723-YGR, 2026 WL 2220173 (N.D. Cal. July 29, 2026), Chief United States District Judge Yvonne Gonzalez Rogers granted Plaintiff’s motion for judgment under Federal Rule of Civil Procedure 52 and denied Defendant’s cross-motion, finding that Plaintiff was disabled under her ERISA-governed long-term disability plan’s “any occupation” standard at the time MetLife terminated her benefits. The court found that cognitive difficulties associated with Plaintiff’s asymmetric hearing loss precluded her from performing an executive-level sales management position, even though her formal neuropsychological testing produced average and above-average scores.

What ERISA standard of review applied, and who carried the burden?

The parties agreed that de novo review governed, so the court gave no deference to MetLife’s decision and determined in the first instance whether Plaintiff had established disability. Applying Muniz v. Amec Construction Management, Inc. and Armani v. Northwestern Mutual Life Insurance Co., the court placed the burden on Plaintiff to prove by a preponderance of the evidence that she was disabled under the Plan, and noted that the burden remained on the claimant even though her benefits had been terminated after an initial grant. Resolving the matter under Rule 52, the court conducted what amounts to a bench trial on the record, weighing the persuasiveness of the conflicting evidence.

Could Plaintiff supplement the administrative record with her Social Security award?

Yes. Plaintiff moved to supplement the record with a Social Security Disability decision issued on March 17, 2026, after the administrative process closed. The court applied the restrictive rule of Mongeluzo and Opeta, which permits a court conducting de novo review to admit additional evidence when circumstances clearly establish that it is necessary for an adequate review. The court found the award necessary for two reasons: it was relevant to whether Plaintiff met the Plan’s disability standard when her benefits were terminated, and it could not have been presented during the administrative process because it issued well after that process closed. The court granted the motion, noting under Salomaa v. Honda Long Term Disability Plan that Social Security awards are evidence of disability even though they do not bind plan administrators.

How did the court define the relevant “any occupation” for someone earning over $324,000 per year?

The court agreed with Plaintiff that the relevant inquiry was whether she could engage with reasonable continuity in an executive-level sales management position or a comparable position. The court reached that conclusion for three reasons. First, such positions were ones Plaintiff could reasonably be expected to perform satisfactorily given her decades of experience in marketing, business development, and client management, culminating in her Senior Director role at Salesforce. Second, MetLife had represented to Plaintiff during the administrative process, on multiple occasions, that the “any occupation” standard looked to an occupation paying 100% of her pre-disability wages or more, and Plaintiff had earned at least $324,000 per year. Third, MetLife identified no other occupation Plaintiff could reasonably perform that would pay a comparable wage. MetLife did not respond to Plaintiff’s arguments on this point.

Why did average neuropsychological test scores not defeat the claim?

The court credited the opinions of Plaintiff’s treating otolaryngologist, Dr. Kari, who explained that Plaintiff’s cochlear implant had not fully restored her hearing and that her brain worked harder to process information, producing cognitive fatigue and difficulties that impaired her ability to process information accurately and quickly. The court also credited Dr. Rothke, a clinical neuropsychologist who examined Plaintiff in person and explained why her intact test results did not reflect her real-world capacity. Dr. Rothke reasoned that the testing occurred in a controlled, distraction-free environment with an examiner directing Plaintiff’s attention, supports unavailable in high-level positions where an individual must supply structure independently and process far more complex information. The court found that the test results did not establish, or even indicate, the absence of disabling cognitive impairment.

Why did the court discount MetLife’s reviewing physicians?

The court accorded minimal weight to MetLife’s neurology and neuropsychology reviewers because none personally examined Plaintiff and because they relied on her test scores without accounting for Dr. Rothke’s explanation of why those scores did not indicate work capacity. Citing Montour v. Hartford Life & Accident Insurance Co., the court noted that reliance on a paper review can raise questions about the thoroughness of a benefits determination, particularly where the impairments are cognitive and arise partly from self-reported symptoms. The court gave minimal weight to MetLife’s otolaryngology reviewers because each acknowledged Plaintiff’s cognitive deficits but declined to opine on them as outside the scope of their reviews, leaving their conclusions with little relevance to the cognitive question that decided the case. The court also rejected MetLife’s litigation argument that the standard permitted consideration of reasonable accommodations, holding under Collier v. Lincoln Life Assurance Co. of Boston that MetLife could not raise a rationale it had not cited in its denial letters, and that nothing in the Plan supported reading an accommodation requirement into the definition.

What did the court order?

The court found that Plaintiff established disability under the “any occupation” standard, granted her motion for judgment, and denied MetLife’s cross-motion. The court directed the parties to meet and confer within twenty-one days to resolve the amount of benefits due and to submit a proposed form of judgment.