Kevin Wilcox v. Dearborn Insurance Company

• Court: Court of Appeals for the Ninth Circuit
• Decided: May 13, 2024
• Docket: 23-55484
• Status: Unpublished

Opinion

NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS MAY 13 2024 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT

KEVIN WILCOX, No. 23-55484

Plaintiff-Appellant, D.C. No. 2:21-cv-04605-JLS-JC v.

DEARBORN INSURANCE COMPANY; MEMORANDUM* AMGEN, INC. LIFE INSURANCE PLAN,

Defendants-Appellees.

Appeal from the United States District Court for the Central District of California Josephine L. Staton, District Judge, Presiding

Submitted May 9, 2024** Pasadena, California

Before: TALLMAN, FORREST, and BUMATAY, Circuit Judges.

Plaintiff-Appellant Kevin Wilcox was denied the waiver-of-premium benefit

provided to disabled participants under his life insurance plan, which is insured by

Defendant-Appellant Dearborn Insurance Company. Wilcox sued Dearborn to

* This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3. ** The panel unanimously concludes this case is suitable for decision without oral argument. See Fed. R. App. P. 34(a)(2). recover benefits under the Employee Retirement Income Security Act (ERISA). 29

U.S.C. § 1132(a)(1)(B). Following a trial on the record, the district court entered

judgment for Dearborn, and Wilcox appeals. We have jurisdiction under 28 U.S.C.

§ 1291, and we affirm.

We review the district court’s legal conclusions de novo and factual findings

for clear error. Fed. R. Civ. P. 52(a)(6); Collier v. Lincoln Life Assurance Co. of

Bos., 53 F.4th 1180, 1185 n.4 (9th Cir. 2022). We review the district court’s

determination that Wilcox did not show that he was totally disabled under the life

insurance plan for clear error. Deegan v. Cont’l Cas. Co., 167 F.3d 502, 508 (9th

Cir. 1999).

1. To qualify for the waiver-of-premium benefit, Wilcox had to provide

“satisfactory written proof” that he could not work in “any occupation” for which he

was qualified. Wilcox argues that Dearborn and the district court erred by requiring

him to show “persistent symptomatology” rather than recognizing that the risk of his

depression relapsing if he returned to work made him totally disabled. Under the

terms of the plan, he contends, he was totally disabled because his psychiatrist

diagnosed him as unable to work.

Neither Dearborn nor the district court required Wilcox to show ongoing

symptoms of depression, or “persistent symptomatology,” to demonstrate that he

was totally disabled. Instead, they concluded that, in the absence of ongoing

2 symptoms, the evidence presented by Wilcox was insufficient to show that he could

not work in any occupation. Wilcox argues that he could not work because his

psychiatrist stated that Wilcox’s depressive orders “were likely to exacerbate in the

context of work related stress.” The district court’s view that a likely exacerbation

of depression did not establish a total inability to work in any occupation was

plausible and thus not clearly erroneous. See Minidoka Irrigation Dist. v. Dep’t of

the Interior, 406 F.3d 567, 572 (9th Cir. 2005) (describing the clear error standard

of review).

2. Wilcox next argues that the district court improperly considered

reasons that Dearborn did not provide in its appeal denial. When a claim for benefits

under a plan has been denied, the plan administrator must “provide adequate notice

. . . setting forth the specific reasons for such denial.” 29 U.S.C. § 1133(1). A

reviewing district court must examine only the administrator’s rationales. Collier,

53 F.4th at 1188. Here, Dearborn provided Wilcox the specific reasons for its denial:

evidence showed that Wilcox’s depression was improving, and the evidence after

July 2019 suggested only that returning to work would likely “exacerbate” his

depressive disorders. Dearborn cited the evidence on which it relied, and it provided

enough detail to “ensure meaningful review.” Mitchell v. CB Richard Ellis Long

Term Disability Plan, 611 F.3d 1192, 1199 n.2 (9th Cir. 2010) (quoting Glista v.

Unum Life Ins. Co. of Am., 378 F.3d 113, 129 (1st Cir. 2004)). The district court

3 evaluated the record and agreed with Dearborn’s explanation. While the district

court explained its conclusion in greater detail than Dearborn had, it did not adopt

new rationales that “sandbagged” Wilcox. See Collier, 53 F.4th at 1188.

AFFIRMED.