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The appellate court affirmed the district court's ruling that Sun Life should have awarded disability benefits to Gross, finding that surveillance evidence did not undermine medical evidence of total disability. The court vacated and remanded only on prejudgment interest calculations and partially on attorney's fees.
What Happened
Patricia Gross worked for Sun Life Assurance and applied for disability benefits when she became unable to work due to her medical condition. Sun Life denied her claim, arguing that surveillance footage showed she could still perform work activities. Gross sued the company, claiming they wrongfully terminated her benefits and broke their contract with her.
What the Court Decided
The court ruled in favor of Gross. The appeals court agreed with a lower court's decision that Sun Life should have approved her disability benefits. The judges found that the surveillance evidence Sun Life used was not strong enough to override the medical evidence proving Gross was totally disabled and unable to work. The court sent the case back only to recalculate interest payments and attorney fees.
Why This Matters for Workers
This ruling reinforces that insurance companies cannot simply rely on surveillance footage to deny legitimate disability claims when there is solid medical evidence supporting a worker's inability to work. It shows that courts will protect employees when insurance companies try to avoid paying valid disability benefits, giving workers more confidence that their medical documentation will be taken seriously in disputes.
This summary was generated to explain the ruling in plain English and is not legal advice.
Other orders and opinions in Gross from the same court.
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