In Margueritte Kibel v. Aetna Life Insurance Company, the U.S. Court of Appeals for the Ninth Circuit, in a unanimous opinion, ruled that Margueritte Kibel had met her burden of proof and was entitled to long-term disability benefits. It remanded to the District Court with instructions to enter an award of benefits to her.

Kibel’s problems started in 2011 when she collapsed two separate times at work. Once in a meeting with a supervisor, and another time while entertaining clients. In January 2012, she was diagnosed with multiple sclerosis. Even so, she returned to work in March 2012, but after only a month, she had to quit. She made several other attempts to work before finally quitting in November 2013 and applying for long-term disability benefits. Aetna denied her claim.

After exhausting her administrative appeals, Kibel filed an ERISA lawsuit in the District Court. The District Court agreed with Aetna, and ruled Kibel was not entitled to benefits, and she appealed to the higher court.

The U.S. Court of Appeals for the Ninth Circuit reversed the District Court’s denial of benefits and specifically concluded that “Kibel has sustained her burden to prove that her multiple sclerosis (“MS”) prevented her from performing with reasonable continuity the substantial and material acts required by her job as a Relationship Manager at City National Bank on or before February 20, 2013.”

Aetna and the District Court Ignored Legal Precedent and Relevant Doctor’s Reports

The district court held that Kibel had not met her burden of proof that “MS prevented her from doing her ‘own occupation’ because the ‘most credible’ evidence in the administrative record “[did] not suggest sufficient physical impairment.” Kibel’s job as a Relationship Manager at a bank required her to spend 35 percent of her time managing a portfolio of business and personal relationships. The other 65 percent of her time was spent entertaining potential clients as she tried to find, identify, and develop new clients for the bank.

The record showed that she suffered from “mild fatigue” and “depression.” But, the Ninth Circuit noted that it was clear from the administrative record that fatigue in MS patients is different than fatigue experienced by healthy people. Fatigue is described by many MS patients as their “most debilitating symptom.”

Aetna and the district court also both speculated that Kibel’s fatigue “was the product of her depression, not MS.” This was also a wrong conclusion, based on evidence in the administrative record concerning depression in MS patients. Additionally, Ninth Circuit precedent established that courts abuse their discretion when they discount subjective reports of pain, as the lower court did here in discounting Kibel’s subjective reports of fatigue and depression.

The Appellate Court concluded, “With this administrative record, Kibel has established by a preponderance of the evidence that she was totally disabled under the terms of Aetna’s long-term disability plan.”

The Remedy

The Court also concluded that “Aetna was obligated to pay benefits.” Therefore, it reversed the district court decision and remanded “with instructions to the district court to direct an award of benefits to Kibel.”

This case was not handled by our firm, but if you have experienced a similar issue with your insurer or a court, or any other issue concerning your disability claim, contact us at Dell & Schaefer for a free consultation.