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Ninth Circuit Affirms Sun Life’s Denial of Doctor’s Long-Term Disability Benefit Claim

In Amoroso v. Sun Life Assurance Company of Canada, No. 21-35801, 2022 WL 2115117 (9th Cir. June 13, 2022), the Ninth Circuit considered whether Plaintiff-Appellant Dr. Paul Amoroso was entitled long-term disability benefits under an ERISA-governed disability plan insured by Defendant-Appellee Sun Life Assurance Company. Dr. Amoroso worked as a Physician Executive at the MultiCare Health System. On December 14, 2018, he took FMLA leave due to his mental health conditions which he believed was interfering with his ability to work. He returned to work after eighty days, on March 4, 2019, and worked full-time for about fifty days before he resigned. He informed his “treating psychiatrist that his cognitive functioning difficulties impaired his work, but his supervisor and others thought he performed adequately.” He applied for LTD benefits with Sun Life and Sun Life denied his claim because he did not meet his burden of proving that he was disabled for 90 consecutive days while he was insured or that he was unable to perform the material and substantial aspects of his position.

On de novo review, the district court found in favor of Sun Life because Dr. Amoroso did not meet the requirement of being disabled for the entire 90-day elimination period. He returned to work just ten days shy of the elimination period and worked full-time until he resigned. The Ninth Circuit affirmed the district court. Dr. Amoroso needed to meet three requirements to receive benefits: (1) provide proof of disability; (2) be insured under the policy at the time of disability; and (3) complete the elimination period. Because Dr. Amoroso did not meet the third requirement, Sun Life was not obligated to pay him benefits.


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