Ninth Circuit Affirms United of Omaha’s Denial of Disability Insurance Benefits

In Gray v. United of Omaha Life Insurance Company, No. 24-700, 2024 WL 5001915 (9th Cir. Dec. 6, 2024), Plaintiff-Appellant Kandice Gray appealed the district court’s judgment in favor of Defendant-Appellee United of Omaha Life Insurance Company in her lawsuit seeking additional short-term disability (“STD”) and long-term disability (“LTD”) benefits under an employer-sponsored disability plan governed by ERISA. In an unpublished opinion, the Ninth Circuit affirmed the decision of the district court because the court determined that Gray did not meet her burden of proving by a preponderance of the evidence that she was disabled under the terms of the plan.

Gray worked as a supervisor and mental health therapist before symptoms related to lumbar radiculopathy caused her to be unable to perform her “light” strength demand job. (“Light” means “20 pounds maximum lifting with frequent lift/carry up to 10 pounds” and either “significant walking/standing” or “mostly sitting” with “push/pull on arm or leg controls.”) Gray’s disability claim was supported by two physicians who submitted Attending Physician Statements noting that Gray cannot lift, push, pull, or carry greater than 5 pounds and cannot sit or stand without pain and spasms. Her treatment plan included medication, ice, heat, and rest. One of her doctors noted that he expected an improvement within four months.

United approved and paid STD benefits for about 5 weeks before it determined that the clinical findings did not support ongoing disability. Gray appealed United’s denial of STD benefits, and at the same time submitted a claim for LTD benefits. United denied the STD appeal and LTD claim. Gray submitted a second appeal, which United denied. The present lawsuit followed.

Following a bench trial, the district court issued a judgment holding that Gray was not entitled to further disability benefits. Reviewing the district court’s findings of fact under the clearly erroneous standard, and conclusions of law de novo, the Ninth Circuit determined that Gray did not meet her burden of proving disability. The administrative record contained only records from four doctors’ appointments with two doctors. “There was no showing that these two doctors had specialties relevant to the diagnosis of lumbar radiculopathy such as an orthopedic, neurology, or pain management specialty. The medical findings are too thin and dependent on Gray’s subjective reporting to be given substantial weight.” United relied on reports from orthopedic surgeons it retained to review Gray’s medical file. They opined that she was not disabled. The court found that they provided detailed reports which substantiated their opinions. Lastly, the court did not consider a doctor’s letter summarizing an MRI report because it was sent to United after it had already decided Gray’s administrative appeals and the record was closed. “Gray had many opportunities to submit additional medical records while her claims were still under review with United, and there are no exceptional circumstances that necessitate considering Dr. Guidry’s letter now.”