Agneta Dobos v. Voluntary Plan Administrators, Inc., et al
California Court of Appeal 2nd Appellate District
September 03 2008;
B199870 (Los Angeles County Super. Ct. No. BC104313)

Comply with Long Term Disability “Qualifying Period” Requirement for Eligibility

This case arose from the employee’s denial of her application for benefits under the long-term disability benefit plan provided by her former employer, the County of Los Angeles.

The employee was Agneta Dobos, the petitioner in this case. She worked for the County as a temporary student nurse. Eventually, she was hired as a temporary staff nurse and promoted to a full-time permanent staff nurse not long after. Agneta worked at the University of Southern California Medical Center, Women’s Hospital.

At one time during her employment, Agneta allegedly incurred disabling injury at work. During the same time, the County suspended her due to on going investigation of misconduct allegations. Thereafter, Agneta no longer returned to work. Following the County’s investigation, she was terminated from employment.

Around 5 months after Agneta’s employment ended, she filed an application for long-term disability benefits under the County’s Long Term Disability and Survivor Benefit Plan. The third party administrator, Voluntary Plan Administrators, Inc., denied her application for benefits on the ground that there was insufficient medical information to support her alleged disability. The denial was affirmed upon appeal.

Thereafter, Agneta applied for Supplemental Security Income (SSI) disability benefits through the SSA. After several additional applications and appeals, the ALJ ultimately found that she was totally disabled and entitled to SSI Disability Benefits. The ALJ also found that Agneta has been disabled since the time she was still under the employ of the County.

Approximately 13 years later, Agneta filed a second application for long-term disability benefits. She now alleged that her disability was the direct result of an injury that arose out of the performance of her duties for the County.

Her second application was also denied. The third party administrator ruled that she failed to satisfy the Plan’s eligibility requirement for a long-term disability benefits. It found that Agneta did not complete the six-month qualifying period during which an eligible employee must be totally and continuously disabled because her employment with the County terminated before the expiration of her qualifying period.

Agneta again appealed the denial. But the denial was again affirmed. The Hearing Officer concluded that she was not eligible for long term disability benefits because she was not employed by the County at the expiration of the qualifying period.

Agneta then filed an amended petition for writ of administrative mandate in Los Angeles County Superior Court. She challenged the administrative decision of the denial of her application for benefits.

The trial court denied the writ petition. In concluded that the relevant provisions of the Los Angeles County Code required that to be eligible for long term disability benefits, Agneta:

• had to be an employee when she became totally disabled


• had to remain an employee absent from work due to a total disability for a period of sixth months and


• had to be an employee on the first day following the expiration of the qualifying period.

Agneta appealed.

The Court of Appeal of the State of California ruled unfavorably of Agneta. The Court held that under the plain language of the Los Angeles County Code, she was not eligible for long-term disability benefits.

Based on the plain language of the law, the Court concluded that an applicant for long-term disability benefits under the Country’s Plan must be an employee of the County at the expiration of the sixth-month qualifying period to be eligible for benefits.

The Court said that the term “qualifying period” requires that an “eligible employee” be totally disabled for a continuous period of six months, commencing with the first day on which the eligible employee is “absent from work due to a total disability.” An “eligible employee” is not entitled to any long-term disability benefits unless and until that employee has satisfied the qualifying period.

Moreover, under the law, an applicant for long term disability benefits must not only be an “employee” of the County at the time he or she becomes totally disabled and unable to work but also must remain an “employee” of the county for the duration of the six-month qualifying period to be eligible for benefits.