Ninth Circuit weighs the impact of an ambiguous insurance policy, and more!

This last Tuesday, Joe Creitz argued to the Ninth Circuit on behalf of Nurse Diana Anderson, a disabled former operating room nurse to whom Sun Life denied disability benefits because, it asserted, when her employer gave her a temporary accommodated job at full pay to see if she could recover from her injuries, she somehow mutated into a receptionist. Insurer Sun Life argued that its policy rendered Nurse Anderson a receptionist. Nurse Anderson argued that the policy is ambiguous and must, therefore, be construed in her favor You can listen to the Anderson v. Sun Life oral argument here if you are interested: http://www.ca9.uscourts.gov/media/view_video.php?pk_vid=0000009256

Also pending this week before the Ninth Circuit was Upadhyay v. Aetna, which the court deemed submitted on the briefs. This issues raised there are two (1) when an employee executes a settlement and release with her employer that arguably extends to her ERISA claims, but in good faith provides it to the insurer during the administrative process and the insurer never raises it, can the insurer invoke it for the first time during the litigation? (2) Can an ERISA-regulated disability insurer invoke in litigation a contractual limitations period that it never discussed in its denial letters?

In the briefs, we argued that the answer to both those questions is "no". The first is resolved by the Ninth Circuit's holdings in Mitchell v. CB Richard Ellis, Harlick v. Blue Shield, and Spinedex v. United.

The Ninth Circuit has not addressed the second issue, but three other circuits have and all have come down on the side of the claimants: Moyer v. MetLife, 762 F.3d 503, 505-507 (6th Cir. 2014); Mirza v. Ins. Adm’r of America, Inc., 800 F.3d 129, 137 (3rd Cir. 2015; Santana-Díaz v. MetLife, --- F.3d ----, No. 15-1273, 2016 WL 963830 (1st Cir. March 14, 2016).

We are optimistic about our prospects in both appeals. Tune in for updates, and don't hesitate to contact us if you have questions.