Mark Stephan v. Unum Life Insurance Company Of

697 F.3d 917, 54 Employee Benefits Cas. (BNA) 1887, 2012 WL 3983767, 2012 U.S. App. LEXIS 19139
CourtCourt of Appeals for the Ninth Circuit
DecidedSeptember 12, 2012
Docket10-16840
StatusPublished
Cited by85 cases

This text of 697 F.3d 917 (Mark Stephan v. Unum Life Insurance Company Of) 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
Mark Stephan v. Unum Life Insurance Company Of, 697 F.3d 917, 54 Employee Benefits Cas. (BNA) 1887, 2012 WL 3983767, 2012 U.S. App. LEXIS 19139 (9th Cir. 2012).

Opinions

Opinion by Judge BERZON; Dissent by Judge O’SCANNLAIN.

OPINION

BERZON, Circuit Judge:

In August 2007, just three months after he had begun a new job at Thomas Weisel Partners (“TWP”), Plaintiff-Appellant Mark Stephan (“Stephan”) had a bicycling accident that resulted in a spinal cord injury, rendering him quadriplegic and thus permanently disabled. Stephan was insured under TWP’s long-term disability insurance plan, underwritten and administered by Defendant-Appellee Unum Life Insurance Company (“Unum”). Stephan disputes Unum’s calculation of his predisability earnings, upon which his disability benefits were based. In calculating his earnings, Unum included only Stephan’s monthly salary but not his annual bonus. Stephan’s earnings, and therefore his disability benefits, would be considerably higher if the bonus were included.

The central issue in this appeal is whether the bonus should have been counted. The district court reviewed Unum’s decision and upheld Unum’s benefit determination. The court also denied Stephan’s motion to compel discovery of a series of internal memoranda created by Unum’s in-house counsel regarding Stephan’s claim. Stephan appeals from each of the district court’s rulings.

We agree with the district court that the applicable standard of review is abuse of discretion. The district court also correctly held that because Unum was responsible both for evaluating benefits claims and paying them, it operated under a conflict of interest, which “ ‘must be weighed as a factor in determining whether there is an abuse of discretion’ ” (quoting Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 113, 128 S.Ct. 2343, 171 L.Ed.2d 299 (2008)). However, in determining what weight ought to be given the conflict, the district court erred in three ways: First, it failed to apply the traditional rules of summary judgment to its analysis of whether and to what extent a conflict of interest impacted Unum’s benefits determination. Second, it incorrectly held that certain internal memoranda between Unum’s claims analyst and its in-house counsel were not discoverable. Finally, it did not take into account substantial evidence that Unum’s conflict of interest “infiltrated the entire decision-making process” and therefore ought to be accorded “significant weight.” Montour v. Hartford Life & Accident Ins. Co., 588 F.3d 623, 634 (9th Cir.2009).

We remand to the district court to reconsider the impact of Unum’s conflict of interest; correspondingly, what weight to accord the conflict in determining whether Unum abused its discretion; and ultimately whether Unum did indeed abuse its discretion in failing to include Stephan’s bonus in his predisability earnings.

I. FACTUAL AND PROCEDURAL BACKGROUND

A. The Plan

The long-term disability insurance policy (“the Plan”) issued by Unum to TWP, Stephan’s employer, “provide[d] financial protection” for TWP employees should they become disabled, by ensuring that [922]*922disabled employees would continue to receive sixty percent of their monthly earnings up to a maximum of $20,000. The Plan authorized Unum to interpret its provisions and to determine claimants’ eligibility for benefits.

B. Stephan’s Claim

On April 18, 2007, TWP offered Stephan a position as Managing Director in its Institutional Sales department. Stephan’s offer letter stated, in relevant part:

Your salary rate will be $200,000 annually. Your salary will be paid semimonthly, less payroll deductions and all required withholdings. You will be eligible to participate in Thomas Weisel Partners’ discretionary bonus program. Although bonuses are generally discretionary, you will be guaranteed [a] $300,000 bonus for your first 12 months of employment, provided you perform at the level both you and we anticipate and that you have not voluntarily terminated your employment or been terminated for cause prior to the relevant payment dates.

When he accepted his new position, Stephan became insured under TWP’s policy, underwritten by Unum.

Four months later, Stephan suffered a severe spinal cord injury in a bicycling accident, as a result of which he became quadriplegic. Shortly thereafter, he applied for disability benefits under the Plan. On December 3, 2007, Unum sent Stephan a letter stating that his disability claim had been approved and specifying that Stephan would receive disability benefits of $10,000 per month. Unum based this amount on Stephan’s annual salary of $200,000 per year. Later that month, TWP paid Stephan the $300,000 bonus promised in his offer letter.

Stephan appealed Unum’s benefits determination, arguing that his benefits should have been based not on his annual salary of $200,000 per year but on an annual income of $500,000 — his base salary plus the annual bonus guaranteed to him in his offer letter. In support of his appeal, Stephan pointed to the disability claim form submitted by TWP Human Resources, which stated that Stephan’s annual earnings were $500,000; the insurance premiums TWP paid Unum based on that rate of compensation; and Stephan’s offer letter guaranteeing him a bonus of $300,000. Stephan also attached several additional documents to his appeal: He provided Unum a memo from TWP explaining that “in each month prior to the date of [Stephan’s] disability, TWP recorded compensation expense, associated with the cash component of [his] guaranteed bonus payment”; another memo from TWP explaining how the company calculated its insurance premiums; and a letter from accountant and former Unum Director of Financial Assessment, Carol Poulin, analyzing Stephan’s claim and finding that “Mr. Stephan’s monthly income,” on which his disability benefits should be based, “consists of both his pro-rated salary and pro-rated guaranteed bonus.”

Unum rejected Stephan’s appeal, maintaining “that the original basic monthly earnings calculation was correct.” The letter from Unum rejecting Stephan’s appeal observed:

As Mr. Stephan began working in April and stopped working in August he did not work a full 12 months and it is apparent that TWP went outside then-own employment agreement when [Stephan] received a bonus in December 2007. This is consistent with the information provided in a December 14, 2007 conference call with TWP representatives when they indicated that they intended to morally honor his contract.

Further, Unum stated that it did

not appear [Stephan’s] bonus was a true accrual as indicated by TWP. If it were [923]*923truly an accrual, the bonus would have been paid monthly, which would have been reflected in [Stephan’s] payroll records.

Unum noted that contrary to Stephan’s claim that TWP paid insurance premiums on a salary of $500,000, Unum’s “premium billing department confirmed that premiums for [Stephan’s disability] coverage were based on earnings of $100,000; not his salary at the time of disability and not including any bonus.” Finally, Unum rejected the analysis of accountant Carol Poulin.

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697 F.3d 917, 54 Employee Benefits Cas. (BNA) 1887, 2012 WL 3983767, 2012 U.S. App. LEXIS 19139, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mark-stephan-v-unum-life-insurance-company-of-ca9-2012.