Igor Gunn v. Reliance Standard Life Insuran

399 F. App'x 147
CourtCourt of Appeals for the Ninth Circuit
DecidedAugust 18, 2010
Docket09-55089
StatusUnpublished
Cited by10 cases

This text of 399 F. App'x 147 (Igor Gunn v. Reliance Standard Life Insuran) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Igor Gunn v. Reliance Standard Life Insuran, 399 F. App'x 147 (9th Cir. 2010).

Opinions

MEMORANDUM2

This is an appeal, following remand,3 from an action to recover benefits brought pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B). Defendants-Appellants Paine Webber Long Term Disability Plan (“the Plan”) and Reliance Standard Life Insurance Company (“Reliance”), the issuer of the insurance policy underlying the Plan and the Plan’s claim administrator (collectively “appellants”), appeal from the decision of the district court finding that Reliance’s denial of benefits was an abuse of discretion and awarding long-term disability benefits to plaintiff-appellee Igor Gunn (“Gunn”), a participant in the Plan.

Reliance initially awarded Gunn long-term disability benefits due to multiple sclerosis and severe depression, since the Plan permitted the payment of benefits for long-term disability based on physical and/or mental illness during the first twenty-four months of disability. Reliance later determined that Gunn was not eligible for benefits beyond the initial 24-month period. Citing a policy limitation which precluded an award of benefits beyond the initial 24-month period for total disability “caused by or contributed to by” mental or nervous disorders,4 Reliance found that Gunn failed to show that he was totally disabled as a result of physical illness.5

In reviewing the plan administrator’s decision, the district court applied language included in a booklet prepared by Gunn’s employer, UBS/Paine Webber (“Paine Webber”), which differed from the [149]*149policy language in that it precluded benefits for disability “due to” mental illness. The district court interpreted this language as allowing benefits so long as Gunn’s disability was not due solely to mental illness. Citing Bergt v. Retirement Plan for Pilots Employed by MarkAir, Inc., 293 F.3d 1139, 1145 (9th Cir.2002), the district court applied the booklet definition as being the definition most favorable to Gunn. Id. at 1260-61. The district court reviewed the administrator’s decision, conducted a conflict of interest analysis, and concluded that Reliance’s decision to terminate benefits was an abuse of discretion. See Gunn v. Reliance Standard Life Ins. Co., 592 F.Supp.2d 1251, 1261-62(C.D.Cal.2008) (“Gunn II ”).

I. STANDARD OF REVIEW

We review de novo the district court’s choice and application of the standard of review to decisions by ERISA fiduciaries, as well as its interpretation of ERISA insurance policy language. Abatie, 458 F.3d at 962; Metropolitan Life Ins. Co. v. Parker, 436 F.3d 1109, 1113 (9th Cir.2006). “We review for clear error the underlying findings of fact.” Abatie, 458 F.3d at 962. Because the Plan unambiguously provides discretion to the administrator, the standard of review shifts “from the default of de novo to the more lenient abuse of discretion.” Id. at 963.6

Our abuse of discretion review is “informed by the nature, extent, and effect on the decision-making process of any conflict of interest that may appear in the record.” Abatie, 458 F.3d at 967. Thus, where, as here, a structural conflict exists because the insurance company administrator both funds and administers the Plan, “the court must consider numerous case-specific factors, including the administrator’s conflict of interest, and reach a decision as to whether discretion has been abused by weighing and balancing those factors together.” Montour v. Hartford Life & Acc. Ins. Co., 588 F.3d 623, 630 (9th Cir.2009). Our decisions in Abatie and Montour provide the specific factors that a court should weigh in determining whether an administrator abused its discretion. See Abatie, 458 F.3d at 968-69, 974; Montour, 588 F.3d at 630.

II. DISCUSSION

A. Application of Summary Plan Document

1. Summary as a Plan Document

Appellants first argue that the district court erred in holding that the booklet distributed by Paine Webber was a SPD. The “Disability Plan” booklet does not contain all of the twelve requirements for a SPD, as listed in Pisciotta v. Teledyne Industries, Inc., 91 F.3d 1326, 1329 (9th Cir.1996) (citing 29 U.S.C. § 1022(b)). However, the “Disability Plan” booklet refers employees to a booklet entitled “Legal and Administrative Overview” booklet, also distributed to plan participants, for further information about filing or appealing a claim and their rights as plan participants. This court has held that an ERISA plan may be made up of several booklets and documents. See Horn v. Berdon, Inc. Defined Benefit Pension Plan, 938 F.2d 125, 127 (9th Cir.1991); see also 29 C.F.R. § 2520.102-3(s) (a plan’s claims procedures may be furnished as a separate document). The “Disability Plan” booklet and the “Legal and Administrative Overview” booklet, when read together, substantially comply [150]*150with the requirements for a summary plan description under 29 U.S.C. § 1022(b).

2.Disclaimer Clause

Appellants argue that the district court erred in applying the language of the “Disability Plan” booklet in light of the disclaimer in that booklet. The “Disability Plan” booklet states that the SPD “does not determine rights under the LTD Plan but is intended only to summarize the important provisions of the LTD Plan” and that in the event of any inconsistency between the SPD and the policy, “the terms of the Plan Document will govern.” This court held in Pisciotta that a similar disclaimer which “clearly stated that the contract was the controlling document” and “was available for review by any employee who wished to see it” was enforceable. 91 F.3d at 1331. Enforcement of the disclaimer is not precluded by Bergt, 293 F.3d at 1144-45 (applying language from the plan master document which was more favorable to the employee than the SPD language); since Bergt makes no reference to any disclaimer clause being present in that case, nor does it discuss the holding in Pisciotta regarding the effect of a disclaimer clause, it is not controlling here. The “Legal and Administrative Overview” booklet informed Paine Webber employees that the insurance policy was the controlling document, and also informed them that the insurance policy was available for review by any employee who wished to see it and told them how to find it. Under Pisciotta,

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399 F. App'x 147, Counsel Stack Legal Research, https://law.counselstack.com/opinion/igor-gunn-v-reliance-standard-life-insuran-ca9-2010.