Toni Feibusch v. Integrated Device Technology, Inc. Employee Benefit Plan, and Sun Life Assurance Co. Of Canada

463 F.3d 880, 38 Employee Benefits Cas. (BNA) 2579, 2006 U.S. App. LEXIS 22743, 2006 WL 2563826
CourtCourt of Appeals for the Ninth Circuit
DecidedSeptember 7, 2006
Docket04-16501
StatusPublished
Cited by24 cases

This text of 463 F.3d 880 (Toni Feibusch v. Integrated Device Technology, Inc. Employee Benefit Plan, and Sun Life Assurance Co. Of Canada) 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
Toni Feibusch v. Integrated Device Technology, Inc. Employee Benefit Plan, and Sun Life Assurance Co. Of Canada, 463 F.3d 880, 38 Employee Benefits Cas. (BNA) 2579, 2006 U.S. App. LEXIS 22743, 2006 WL 2563826 (9th Cir. 2006).

Opinion

HUG, Circuit Judge.

Toni Feibusch (“Feibusch”) appeals the district court’s decision that Sun Life Assurance Co. of Canada (“Sun Life”) did not abuse its discretion in terminating her disability benefits. Feibusch’s principal argument is that the district court incorrectly applied abuse of discretion review rather than de novo review. Feibusch was denied benefits under policy language that states that proof of a disability claim “must be satisfactory to Sun Life.”

We have jurisdiction pursuant to 28 U.S.C. § 1291, and we hold that de novo review applies under the policy language at issue. We reverse the summary judgment in favor of Sun Life and remand for trial proceedings.

I

FACTUAL BACKGROUND

Beginning in 1984, Feibusch was employed by Integrated Device Technology, Inc. (“IDT”) as a technical writer and administrative assistant. Her job duties included typing, answering phones, and creating and maintaining technical data sheets. In a typical day, she was required to sit for seven to seven and a half hours, stand for one-half to one hour, walk for one-half to one hour, and drive for one-quarter hour. Although her job was largely sedentary, she was occasionally required to bend, stoop, climb, reach above her shoulders, kneel, balance, push, and pull. In addition to typing, the job required constant movement of both hands, and use of the right hand with the computer mouse. Feibusch earned more than $50,000 annually.

Feibusch participated in an IDT-sponsored employee disability benefit plan (the “plan”) regulated under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1101 et seq. Benefits under the plan were partially funded by a group long-term disability insurance policy (the “policy”) issued and administered by Sun Life.

Key to this appeal is the language of several Sun Life policy provisions. Ac *882 cording to the policy, proof of a disability claim “must be satisfactory to Sun Life.” An employee is “Totally Disabled” if she “because of Injury or Sickness, is unable to perform all of the material and substantial duties of [her] own occupation.” An employee is “Partially Disabled” if she “because of Injury or Sickness is unable to perform all of the material and substantial duties of [her] own occupation on a fulltime basis,” but is “performing at least one of the material and substantial duties of [her] own occupation or another occupation on a part-time or full-time basis” and “earning less than 80% of [her] Total Monthly earnings due to the same injury or Sickness that caused the Total or Partial Disability.”

In early 1999, Feibusch complained of shoulder pain. She temporarily stopped working in March 1999. Dr. Arthur Ting, Feibusch’s orthopedic surgeon, performed surgery on her shoulder in July and September 1999. Feibusch returned to work part-time in January 2000. On August 25, 2000, Sun Life approved an initial partial disability claim dating from March 1, 2000. In September 2000, Feibusch underwent a third shoulder surgery with Dr. Ting. In a November 2000 report, Dr. Ting noted continued improvement in Feibusch’s condition and stated that despite pain, she had full range of movement in her shoulder and could work part-time if she were limited to medium manual activity. Feibusch continued to receive partial disability payments from Sun Life until January 2001.

In January 2001, however, Feibusch stopped working altogether and began collecting total disability payments. In March 2001, Dr. Ting reported that Fei-busch was unable to return to work. In April 2001, IDT terminated Feibusch’s employment because she was unable to work full-time without restrictions. In July 2001, Dr. Ting found that Feibusch had severe limitation of functional capacity and was incapable of minimum sedentary activity.

As part of its claim review, Sun Life required Feibusch to submit to an independent medical examination by Dr. Charles Borgia. On December 5, 2001, Dr. Borgia stated that Feibusch “could work four hours a day if she took an extra strength Tylenol three times a day.” A February 7, 2002 Sun Life file memo on Feibusch’s case concluded that Feibusch continued to meet the plan’s definition of disability but that she should undergo rehabilitation to aid her in returning to full or part-time work. On July 24, 2002, Dr. James Sarni reviewed Feibusch’s file upon referral from Sun Life and concluded that she “has a functional capability of her shoulder that would allow her to perform her duties as an administrative assistant.” Dr. Sarni opined that Feibusch could return to work on a part-time basis for a few months, and then return to full-time work.

On August 2, 2002, Sun Life determined that Feibusch no longer met the policy’s definition of total disability and terminated her benefits effective July 31, 2002. Sun Life explained that “information in our file at this time fails to support [Feibusch’s] continued physical incapacity to perform the duties of an administrative assistant.” Feibusch appealed this decision through Sun Life’s internal process.

As part of the appeal process, Steve Moon, a certified work capacity evaluator, performed a functional capacity evaluation of Feibusch for Sun Life. On October 31, 2002, Moon stated that although he believed Feibusch was in pain, she could return to work in her former position with certain limitations. On November 5, 2002, Feibusch underwent another independent medical examination by Dr. Walter Newman. Dr. Newman concluded that although Feibusch was likely to suffer from “chronic shoulder pain syndrome” she was *883 “capable of performing her own occupation as an administrative assistant and technical writer.” On December 4, 2002, Sun Life issued a final decision denying Fei-busch’s appeal.

II

PROCEDURAL BACKGROUND

Feibusch filed an ERISA action against IDT and Sun Life. Pursuant to stipulation, IDT was dismissed from the case. The parties filed cross-motions for summary judgment. The district court granted Sun Life’s motion for summary judgment, denied Feibusch’s motion for summary judgment, and directed the entry of judgment in favor of Sun Life. Feibusch timely appealed.

III

ANALYSIS

A. The Proper Standard of Revieio of Feibusch’s Benefits Denial

Following Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), we held that district courts must review ERISA benefit denial claims de novo unless the discretion to grant or deny claims is unambiguously retained by a plan administrator or fiduciary. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1090 (9th Cir.1999) (en banc). Recently, in Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955 (9th Cir.2006) (en banc), we explained:

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463 F.3d 880, 38 Employee Benefits Cas. (BNA) 2579, 2006 U.S. App. LEXIS 22743, 2006 WL 2563826, Counsel Stack Legal Research, https://law.counselstack.com/opinion/toni-feibusch-v-integrated-device-technology-inc-employee-benefit-plan-ca9-2006.