VICKI COLLIER V. LINCOLN LIFE ASSURANCE COMPANY

Court of Appeals for the Ninth Circuit·Decided November 21, 2022·No. 21-55465·Published

Opinion

FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS NOV 21 2022 MOLLY C. DWYER, CLERK

U.S. COURT OF APPEALS

FOR THE NINTH CIRCUIT

VICKI COLLIER, No. 21-55465

Plaintiff-Appellant, D.C. No.

8:20-cv-00839-JVS-KES

v.

LINCOLN LIFE ASSURANCE COMPANY OPINION OF BOSTON,

Defendant-Appellee.

Appeal from the United States District Court for the Central District of California James V. Selna, District Judge, Presiding

Argued and Submitted July 28, 2022 Pasadena, California

Before: Richard A. Paez and Paul J. Watford, Circuit Judges, and Richard D. Bennett,* District Judge.

Opinion by Judge Paez

*

The Honorable Richard D. Bennett, United States District Judge for the District of Maryland, sitting by designation.

SUMMARY **

Employee Retirement Income Security Act

The panel reversed the district court’s judgment in favor of Lincoln Life Assurance Company of Boston and remanded in an ERISA action brought by Vicki Collier.

Collier challenged Lincoln’s denial of her claim for long-term disability benefits. On de novo review, the district court affirmed Lincoln’s denial of Collier’s claim, but it adopted new rationales that the ERISA plan administrator did not rely on during the administrative process. Specifically, the district court found for the first time that Collier was not credible and that she had failed to supply objective evidence to support her claim.

The panel held that when a district court reviews de novo a plan administrator’s denial of benefits, it examines the administrative record without deference to the administrator’s conclusions to determine whether the administrator erred in denying benefits. The district court’s task is to determine whether the plan administrator’s decision is supported by the record, not to engage in a new determination of whether the claimant is disabled. Accordingly, the district court must examine only the rationales the plan administrator relied on in denying benefits and cannot adopt new rationales that the claimant had no opportunity to respond to during the administrative process.

The panel held that the district court erred because it relied on new rationales to affirm the denial of benefits. As Lincoln did not present these rationales during the administrative process, Collier was afforded no opportunity to respond to them, and was denied her statutory right to “full and fair review” of the denial of her claim. The panel reversed and remanded for the district court to reconsider Collier’s claim de novo, with no deference to the administrator’s decision, and to determine whether the record evidence supports the reasons on which Lincoln relied to deny benefits.

**

This summary constitutes no part of the opinion of the court. It has been prepared by court staff for the convenience of the reader.

COUNSEL

Glenn R. Kantor (argued), Zoya Yarnykh, and Sally Mermelstein, Kantor & Kantor LLP, Northridge, California; for Plaintiff-Appellant.

Kristina N. Holstrom (argued), Ogletree Deakins Nash Smoak & Stewart PC, Phoenix, Arizona; Byrne J. Decker, Ogletree Deakins Nash Smoak & Stewart PC, Portland, Maine; for Defendant-Appellee.

OPINION

PAEZ, Circuit Judge:

Vicki Collier (“Collier”) appeals the district court’s judgment in favor of Lincoln Life Assurance Company of Boston (“Lincoln”) in an action arising under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. Collier filed a claim for long-term disability (“LTD”) benefits through her employer-sponsored disability insurance policy (“the Plan”), which was administered by Lincoln. Lincoln denied Collier’s claim for LTD benefits. Collier then pursued an internal appeal, but Lincoln again denied her claim. On de novo review, the district court affirmed Lincoln’s denial of Collier’s claim. In so doing, the district court adopted new rationales that the plan administrator did not rely on during the administrative process.

We reverse and remand. When a district court reviews de novo a plan administrator’s denial of benefits, it examines the administrative record without

deference to the administrator’s conclusions to determine whether the administrator erred in denying benefits. See Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006) (en banc); Kearney v. Standard Ins. Co., 175 F.3d 1084, 1088– 89 (9th Cir. 1999) (en banc). The district court’s task is to determine whether the plan administrator’s decision is supported by the record, not to engage in a new determination of whether the claimant is disabled. Accordingly, the district court must examine only the rationales the plan administrator relied on in denying benefits and cannot adopt new rationales that the claimant had no opportunity to respond to during the administrative process.

The district court erred because it relied on new rationales to affirm the denial of benefits—rationales that Lincoln did not assert during the administrative process. See Harlick v. Blue Shield of California, 686 F.3d 699, 719-20 (9th Cir. 2012). Specifically, the district court found for the first time that Collier was not credible, and that she had failed to supply objective medical evidence to support her claim. As Lincoln did not present these rationales during the administrative process, Collier was afforded no opportunity to respond to them, and was denied her statutory right to “full and fair review” of the denial of her claim. See 29 U.S.C. § 1133(2). Accordingly, we reverse and remand for the district court to reconsider Collier’s claim de novo, with no deference to the administrator’s decision, and to determine whether the record evidence supports the reasons on which Lincoln relied to deny

benefits.

I.

From 2013 to 2018, Collier worked at the Automobile Club of Southern California (“AAA”) as an insurance sales agent. During that time, Collier experienced persistent pain in her neck, shoulders, upper extremities, and lower back, which limited her ability to type and sit for long periods of time. Collier was eventually diagnosed with a variety of physical impairments that restricted her mobility in her back, shoulders, elbows, and wrists. Collier underwent surgery on her right shoulder and later returned to work, but her pain continued. She received a variety of treatments to mitigate the pain, including cortisone, epidural, and Botox injections, oral pain medication, acupuncture, and physical therapy.

In April 2018, she applied for worker’s compensation. A worker’s compensation representative recommended that AAA institute certain ergonomic accommodations for Collier to allow her to work with less pain. Despite these accommodations,1 Collier reported that her pain persisted. In May 2018, Collier stopped working at AAA, citing her reported pain.

As an employee of AAA, Collier purchased LTD insurance through the Plan, which qualified her as a Plan participant. Collier was entitled to LTD benefits if she

1 AAA installed a document reader, a vertical mouse, a new keyboard, and an ergonomic chair in Collier’s office. AAA promised to supply a standing desk but did not do so.

could show that she was disabled under the terms of the Plan. The Plan provided that Collier would be considered “disabled” if:

during the [26 week] Elimination Period and the next 12 months of Disability [Collier], as a result of Injury or Sickness, [was] unable to perform with reasonable continuity the Substantial and Material Acts necessary to pursue [her] Own Occupation in the usual and customary way; and thereafter, [Collier was] unable to perform, with reasonable continuity, the Substantial and Material Acts of any occupation, meaning that as a result of sickness or injury [Collier was] not able to engage with reasonable continuity in any occupation in which [she]

could reasonably be expected to perform satisfactorily in light of [her]

age, education, training, experience, station in life, and physical and mental capacity. 2

In February of 2019, Collier filed a claim for LTD benefits with Lincoln.

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

VICKI COLLIER V. LINCOLN LIFE ASSURANCE COMPANY, (9th Cir. 2022).

VICKI COLLIER V. LINCOLN LIFE ASSURANCE COMPANY (VICKI COLLIER V. LINCOLN LIFE ASSURANCE COMPANY) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Firestone Tire & Rubber Co. v. Bruch
489 U.S. 101 (Supreme Court, 1989)
Black & Decker Disability Plan v. Nord
538 U.S. 822 (Supreme Court, 2003)
Glista v. Unum Life Insurance Co. of America
378 F.3d 113 (First Circuit, 2004)
Orndorf v. Paul Revere Life Insurance
404 F.3d 510 (First Circuit, 2005)
Amato v. Bernard
618 F.2d 559 (Ninth Circuit, 1980)
John Halpin v. W.W. Grainger, Incorporated
962 F.2d 685 (Seventh Circuit, 1992)
Marolt v. Alliant Techsystems, Inc.
146 F.3d 617 (Eighth Circuit, 1998)
Alton Robinson v. Aetna Life Insurance Company
443 F.3d 389 (Fifth Circuit, 2006)
Abatie v. Alta Health & Life Ins. Co.
458 F.3d 955 (Ninth Circuit, 2006)
Jeanene Harlick v. Blue Shield of California
686 F.3d 699 (Ninth Circuit, 2012)
Andre Lesgras v. Aetna Life Insurance
786 F.3d 1233 (Ninth Circuit, 2015)
Daniel Demer v. IBM Corp Ltd Plan
835 F.3d 893 (Ninth Circuit, 2016)
Scott Wolf v. Ins. Co. of N. America
46 F.4th 979 (Ninth Circuit, 2022)