United States: California Plaintiff Fails To Satisfy Burden Of Proof In Long-Term Disability Case

The U.S. District Court for the Central District of California, applying de novo review due to California's discretionary clause ban, ruled that an employee of Apple, Inc. was not entitled to long-term disability benefits because he did not satisfy the burden of proving that he was disabled. McCool v. Life Insurance Company of North America, et al., No. 17-cv-07766 (November 9, 2018).


Gabe McCool, an Apple Genius Bar technician, sued Life Insurance Company of North America (LINA) and Apple after LINA denied his request for long-term disability benefits. Under Apple's long-term disability policy, for the first 12 months "an employee is considered 'disabled' if, because of an injury, he is 'unable to perform all the material duties of his or her Regular Occupation or a Qualified Alternative.'" After an employee has received benefits for 12 months, the employee will continue to be considered disabled only if he or she is "unable to perform all the material duties for any occupation for which he or she is, or may reasonably become, qualified based on education, training, or experience."

LINA initially paid McCool disability benefits because the insurance company determined, based on a peer review of McCool's medical records, that he could only sit and stand occasionally and was, therefore, precluded from performing his job. Under the policy, the claimant was required to provide satisfactory proof of his disability on an ongoing basis. After one year, LINA terminated his benefits. LINA determined that he no longer met the definition of disabled because he was not precluded from performing the duties of any occupation. In reaching its decision, LINA relied on McCool's file, including medical records from McCool's doctor; peer reviews of his medical records; surveillance footage showing him walking, entering and exiting a vehicle, driving, and carrying items without difficulty; and two transferrable skills analyses (TSA), which identified three suitable sedentary jobs for McCool. LINA's TSAs resulted in a finding that McCool could reasonably perform a sedentary or a light job considering his ability to sit "frequently."

The Court's Analysis

The court discussed whether McCool could reasonably perform a sedentary or a light job considering his ability to sit "frequently"—a fact that both parties agreed was supported by the medical evidence. "Frequently" was defined as between 2.5 to 5.5 hours in an 8-hour workday. And although a single treating physician found that he could only sit "occasionally," or for fewer than 2.5 hours a day, 3 separate medical practitioners later found that this physician's findings were unsupported by the medical records. Repeated requests for clarification from the treating physician who had supported the restriction were ignored. As a result, LINA relied on the most recent findings of three separate doctors to determine that McCool could handle "frequent" sitting.

The court then reviewed case authority in the Ninth Circuit Court of Appeals, holding that an employee who cannot sit for more than four hours in an eight-hour workday cannot perform sedentary work. According to at least one Ninth Circuit case, light work is more active than sedentary work and requires standing or walking for up to two-thirds of the workday.

The medical evidence presented to LINA from several doctors indicated that McCool could sit between 2.5 and 5.5 hours per day. This range, however, presented a problem for the court. McCool suggested that because his capacity might fall below the four-hour-per-day limit, he could not perform sedentary or light work. Light work, the court found, requires that about 2/3 of an 8-hour day are spent standing, or about 5.3 hours. The evidence, therefore, weighed against the likelihood that McCool could perform light work, since he could stand, at most, 5.5 hours a day. Since the doctors disagreed about whether he fell in the "occasional" or "frequent" category, the court concluded that it was unlikely that he fell on the farthest end of the "frequent" continuum.

However, the court noted that McCool bore the burden of proving by a preponderance of the evidence that he could sit only between 2.5 and 4 hours a day, precluding him from performing sedentary work. After appeal extensions and numerous unanswered requests for clarification from his supporting treating physician or other medical providers, the court concluded that McCool had failed to present sufficient evidence to prove that he could not sit for four hours a day.


The court, in ruling for LINA, determined that McCool could perform two sedentary jobs based on numerous doctors' evaluations and peer reviews of his treating physician's evaluations. Ultimately, the court found that McCool had failed to establish by a preponderance of the evidence that he could not perform either of the sedentary jobs identified in his TSAs. He also had not established that the TSAs were based on unreliable or unsupportable medical evidence or presented other medical evidence that LINA failed to consider that would necessitate a change in diagnosis. Because the evidence indicated that there were jobs that McCool could perform within his limitations, the court upheld the decision that he did not qualify for continued long-term disability benefits under LINA's policy.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

In association with
Related Topics
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Mondaq Free Registration
Gain access to Mondaq global archive of over 375,000 articles covering 200 countries with a personalised News Alert and automatic login on this device.
Mondaq News Alert (some suggested topics and region)
Select Topics
Registration (please scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions