Judges Salvador Mendoza and Roopali Desai, nominated by President Biden to the Ninth Circuit court of appeals, cast the deciding vote in a 2-1 ruling that reversed a lower court and permitted a nurse’s claim for long-term disability benefits from an insurance company to go forward. Trump judge Daniel Collins dissented. The January 2024 decision was in Flores v Life Ins. Co. of North America.

 

What happened in this case?

 Kayle Flores, a registered nurse, worked at St. Joseph’s hospital in California. She developed chronic Cushing’s Disease, which caused her severe fatigue, headaches, vertigo, muscle pain, tachycardia, and other problems that disabled her from working. She had hoped to return to work and so initially applied for short-term disability benefits from the hospital’s insurance company, Life Insurance Co. of North America (LINA). The insurer refused her claim and she had to file a lawsuit.

As the lawsuit continued, Flores decided she would not be able to return to work and also needed long-term disability benefits under the policy and the Employee Retirement Income Security Act (ERISA) and so notified  the insurer and the court. She did not formally apply for long-term benefits since it was clear that LINA would simply deny them. The district court declined to grant  those benefits because she had not formally filed for them but  did grant short-term benefits as she initially requested.

After the court entered final judgment in the short-term case, Flores applied for long-term disability benefits from LINA, which the insurance company denied, as she had anticipated it would. She then filed suit for long-term benefits under the insurance policy and under ERISA. But the district court ruled that because the long-term benefit issue came up in the first case and Flores lost, she was precluded from raising the issue in a later case. She appealed to the Ninth Circuit.

 

How Did Judges Mendoza and Desai and the Ninth Circuit Rule and Why is it Important?

Judges Mendoza and Desai cast the deciding votes in a 2-1 ruling that reversed the lower court and sent the case back to give Flores the opportunity to go forward with her claim for long-term disability benefits. They acknowledged the complexity of the issue but explained that the judicial doctrine of claim preclusion “does not apply” because the long-term disability claim did not formally exist until after the first case was over and Flores’ application for long-term benefits had been filed and denied. The decision in the first case not to award long-term benefits because no claim for them had been filed, they went on, cannot be used to preclude someone like Flores from filing such a claim in the first place and pursuing it in court.

The deciding votes of Judges Mendoza and Desai were obviously important to Kayle Flores’ efforts to obtain long-term disability benefits due to her inability to work because of Cushing’s Disease.  It also stands as an important precedent in the Ninth Circuit, which includes California, Washington, Oregon, Alaska, Nevada, Arizona, Hawaii, Idaho, and Montana, to limit the use of the claim preclusion doctrine against people like Flores who apply for disability benefits. In addition, the ruling is an example of the importance of promptly confirming fair-minded Biden nominees like Judges Mendoza and Desai to our federal courts.