Ninth Circuit Overturns District Court's Decision on Union Dockworkers' Health Benefits Claims
In a significant legal development, the U.S. Court of Appeals for the Ninth Circuit recently reversed a lower court's decision regarding the health benefits claims of union dockworkers. This ruling not only revives approximately $4.1 million in disputed medical claims but also reinforces vital principles of ERISA law, emphasizing the importance of substantial evidence in benefit claim determinations.
On January 28, 2026, Kantor & Kantor, LLP announced the reversal following the Ninth Circuit's consideration of an appeal that challenged the denial of health insurance benefits to members of the ILWU-PMA Welfare Plan. The earlier ruling by a California district court had upheld the denial made by the plan’s administrator, who asserted that the outpatient surgical treatment facility utilized by the workers did not qualify as a ‘hospital’ under the plan’s provisions.
However, the Ninth Circuit found this interpretation to lack a reasonable basis under the deferential abuse-of-discretion standard that governs such claims. The court emphasized that the health facility in question was indeed accredited and met the necessary criteria, indicating that the denial of benefits was based on arbitrary distinctions that lacked legal and factual substantiation.
The legal representation for the dockworkers, led by Glenn R. Kantor, highlighted the importance of this decision. "This ruling underscores that plan administrators cannot exercise uncheckable authority to deny claims on questionable grounds. There must be a foundation of reason and evidence that supports any denial of benefits. The Ninth Circuit rightly clarified that this standard was not fulfilled in the original decision," Kantor stated.
This ruling comes at a crucial time for union workers, many of whom rely on the comprehensive health benefits provided by their plans. The healthcare landscape and the regulations surrounding such benefits often lead to disputes that, if unchallenged, can impose overwhelming financial burdens on workers seeking necessary medical care.
Specifically, the appeals court criticized the lower court’s reliance on internal classifications that did not consider the broader regulatory framework. California law governs outpatient surgical facilities mainly through accreditation, rather than barring them from functioning as hospitals. The appellate court found that the benefits should not be denied based on misconstrued interpretations or unsupported premises that contradicted established guidelines.
As the case, Delgado et al. v. ILWU-PMA Welfare Plan, heads back to the district court for further proceedings, this ruling signifies a pivotal moment for the rights of employees under ERISA. It illuminates the necessity for valid reasons to support benefit denials and reinforces the expectations placed on plan administrators when determining claim validity.
Kantor & Kantor, LLP, a leading law firm focused on representing policyholders in ERISA-related disputes, has been at the forefront of advocating for the rights of clients against wrongful claim denials. Their commitment is to help individuals and families navigate the complexities of health insurance, ensuring fair access to the benefits they are owed. With the Ninth Circuit's ruling, workers now have hope for recovering their denied health benefits, bringing to light the essential protections under ERISA that should safeguard them against unjust denial of care.
As this legal process unfolds, it is essential for employees to remain vigilant and informed about their rights regarding health benefits. Kantor & Kantor continues to fight against unfair practices in the insurance industry, advocating for transparency and accountability in benefit adjudication, which is crucial for the well-being of workers nationwide.
On January 28, 2026, Kantor & Kantor, LLP announced the reversal following the Ninth Circuit's consideration of an appeal that challenged the denial of health insurance benefits to members of the ILWU-PMA Welfare Plan. The earlier ruling by a California district court had upheld the denial made by the plan’s administrator, who asserted that the outpatient surgical treatment facility utilized by the workers did not qualify as a ‘hospital’ under the plan’s provisions.
However, the Ninth Circuit found this interpretation to lack a reasonable basis under the deferential abuse-of-discretion standard that governs such claims. The court emphasized that the health facility in question was indeed accredited and met the necessary criteria, indicating that the denial of benefits was based on arbitrary distinctions that lacked legal and factual substantiation.
The legal representation for the dockworkers, led by Glenn R. Kantor, highlighted the importance of this decision. "This ruling underscores that plan administrators cannot exercise uncheckable authority to deny claims on questionable grounds. There must be a foundation of reason and evidence that supports any denial of benefits. The Ninth Circuit rightly clarified that this standard was not fulfilled in the original decision," Kantor stated.
This ruling comes at a crucial time for union workers, many of whom rely on the comprehensive health benefits provided by their plans. The healthcare landscape and the regulations surrounding such benefits often lead to disputes that, if unchallenged, can impose overwhelming financial burdens on workers seeking necessary medical care.
Specifically, the appeals court criticized the lower court’s reliance on internal classifications that did not consider the broader regulatory framework. California law governs outpatient surgical facilities mainly through accreditation, rather than barring them from functioning as hospitals. The appellate court found that the benefits should not be denied based on misconstrued interpretations or unsupported premises that contradicted established guidelines.
As the case, Delgado et al. v. ILWU-PMA Welfare Plan, heads back to the district court for further proceedings, this ruling signifies a pivotal moment for the rights of employees under ERISA. It illuminates the necessity for valid reasons to support benefit denials and reinforces the expectations placed on plan administrators when determining claim validity.
Kantor & Kantor, LLP, a leading law firm focused on representing policyholders in ERISA-related disputes, has been at the forefront of advocating for the rights of clients against wrongful claim denials. Their commitment is to help individuals and families navigate the complexities of health insurance, ensuring fair access to the benefits they are owed. With the Ninth Circuit's ruling, workers now have hope for recovering their denied health benefits, bringing to light the essential protections under ERISA that should safeguard them against unjust denial of care.
As this legal process unfolds, it is essential for employees to remain vigilant and informed about their rights regarding health benefits. Kantor & Kantor continues to fight against unfair practices in the insurance industry, advocating for transparency and accountability in benefit adjudication, which is crucial for the well-being of workers nationwide.
Topics Policy & Public Interest）
【About Using Articles】
You can freely use the title and article content by linking to the page where the article is posted.
※ Images cannot be used.
【About Links】
Links are free to use.