Mariana Nelson v. Standard Ins. Co.

Ninth Circuit

Mariana Nelson v. Standard Ins. Co.

706 F. App'x 444

CourtCourt of Appeals for the Ninth Circuit

DecidedDecember 18, 2017

Docket16-55227

StatusUnpublished

This text of 706 F. App'x 444 (Mariana Nelson v. Standard Ins. Co.) 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

Mariana Nelson v. Standard Ins. Co., 706 F. App'x 444 (9th Cir. 2017).

Pincite

Opinion

MEMORANDUM **

The District Court properly dismissed Nelson’s claims alleging violations of California Insurance Code § 10144. The text and the legislative history of the provision make clear that it bars discrimination in accessing insurance, but does not mandate the content of insurance coverage, Therefore, we agree that the policy does not violate § 10144 by providing different coverage for mental and physical disorders.

We also agree with the District Court that Standard did not violate ERISA. ERISA § 502 affords significant discretion to plan administrators. Determinations must be upheld unléss the administrator abused its discretion by reaching a decision that was (1) implausible (2) illogical, or (3) without support in the record. Stephan v. Unum Life Ins. Co. of Am., 697 F.3d 917, 929-30 (9th Cir. 2012). We see no abuse of discretion. The District Court correctly concluded that Standard’s interpretation of the relevant provisions of its policy was reasonable. The administrator’s decision was not implausible or illogical. The record on which the administrator relied included the results of extensive examinations by Nelson’s physicians, medical records from treating physicians, and the opinions of other physicians establishing that mental disability was the substantial component of Nelson’s illness. Standard was not required to assess the cause of Nelson’s depression because Standard’s plan explicitly addressed combined or concurrent causation. Thus, the state law doctrine of proximate cause was inapplicable. Cf. Winters v. Costco Wholesale Corp., 49 F.3d 550, 554 (9th Cir. 1995).

We have considered Nelson’s other arguments and conclude they are without merit.

AFFIRMED.

Nelson’s motion for certification (Dkt. Entry No. 35) is denied.

**

This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3.

Free access — add to your briefcase to read the full text and ask questions with AI

MEMORANDUM **

The District Court properly dismissed Nelson’s claims alleging violations of California Insurance Code § 10144. The text and the legislative history of the provision make clear that it bars discrimination in accessing insurance, but does not mandate the content of insurance coverage, Therefore, we agree that the policy does not violate § 10144 by providing different coverage for mental and physical disorders.

We also agree with the District Court that Standard did not violate ERISA. ERISA § 502 affords significant discretion to plan administrators. Determinations must be upheld unléss the administrator abused its discretion by reaching a decision that was (1) implausible (2) illogical, or (3) without support in the record. Stephan v. Unum Life Ins. Co. of Am., 697 F.3d 917, 929-30 (9th Cir. 2012). We see no abuse of discretion. The District Court correctly concluded that Standard’s interpretation of the relevant provisions of its policy was reasonable. The administrator’s decision was not implausible or illogical. The record on which the administrator relied included the results of extensive examinations by Nelson’s physicians, medical records from treating physicians, and the opinions of other physicians establishing that mental disability was the substantial component of Nelson’s illness. Standard was not required to assess the cause of Nelson’s depression because Standard’s plan explicitly addressed combined or concurrent causation. Thus, the state law doctrine of proximate cause was inapplicable. Cf. Winters v. Costco Wholesale Corp., 49 F.3d 550, 554 (9th Cir. 1995).

We have considered Nelson’s other arguments and conclude they are without merit.

AFFIRMED.

Nelson’s motion for certification (Dkt. Entry No. 35) is denied.

**

This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3.

Cite This Page — Counsel Stack

Bluebook (online)

706 F. App'x 444, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mariana-nelson-v-standard-ins-co-ca9-2017.

Opinion

Related

Cite This Page — Counsel Stack