Ninth Circuit Affirms Dearborn Insurance Company’s Denial of Life Insurance Waiver of Premium Benefits

In Wilcox v. Dearborn Insurance Company; Amgen, Inc. Life Insurance Plan, No. 23-55484, 2024 WL 2130598 (9th Cir. May 13, 2024), an unpublished opinion, the Ninth Circuit affirmed the district court’s judgment in favor of Dearborn Insurance Company on Plaintiff’s ERISA claim for life insurance waiver of premium (LWOP) benefits. The court found that the district court’s view that a likely exacerbation of depression did not establish a total inability to work in any occupation was plausible and thus not clearly erroneous. The court also found that the district court’s decision was based on reasons articulated by Dearborn during the ERISA appeals process, thus, Plaintiff was not “sandbagged” by new arguments in litigation.

Plaintiff-Appellant Kevin Wilcox sought LWOP benefits provided to participants in his company-sponsored life insurance plan who are unable to work in “any occupation” for which they are qualified. On appeal, Wilcox argued that Dearborn and the district court erred by requiring that he show “persistent symptomatology” of his depression, where in his case, his total disability was based on the risk of his depression relapsing if he returned to work. The Ninth Circuit disagreed and found that the district court’s decision was based on the absence of ongoing symptoms and the lack of evidence showing that Wilcox could not work in any occupation. Though his psychiatrist stated that Wilcox’s depressive disorders were likely to exacerbate in the context of work-related stress, the view of a “likely exacerbation of depression” does not establish total disability from any occupation.

Wilcox also argued that the district court improperly considered reasons that Dearborn did not provide in its appeal denial. The Ninth Circuit disagreed. Dearborn articulated the basis for its denial, including that the “evidence showed that Wilcox’s depression was improving, and the evidence after July 2019 suggested only that returning to work would likely ‘exacerbate’ his depressive disorders.” The court found that Dearborn cited enough evidence to ensure a meaningful review under ERISA. The district court expanded Dearborn’s conclusions in greater detail, but it did not adopt new rationales. Judgment affirmed.