Case ID: f-appx_408/html/0089-01.html
Source: Caselaw Access Project
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Date Created: 2024-08-24T03:29:51.129683

Raymond VAUGHT, Plaintiff-Appellant, v. SCOTTSDALE HEALTHCARE CORPORATION HEALTH PLAN, Defendant-Appellee.
    No. 09-17561.
    United States Court of Appeals, Ninth Circuit.
    Argued and Submitted Dec. 8, 2010.
    Filed Jan. 10, 2011.
    Randolph Bachrach, General, Law Office of R.G. Bachrach, Chandler, AZ, for Plaintiff-Appellant.
    Daniel B. Pasternak, Esquire, Lawrence J. Rosenfeld, Greenberg Traurig, LLP, Phoenix, AZ, for Defendant-Appellee.
    Before: HUG, D.W. NELSON, and McKEOWN, Circuit Judges.
   MEMORANDUM

Raymond Vaught appeals the district court’s judgment that the Scottsdale Healthcare Corporation Health Plan (the “Plan”) properly denied his claim for medical expenses under a provision excluding coverage of accidents related to driving under the influence of alcohol or drugs (the “DUI Provision”). The district court’s decision was based on the administrative record, but also noted that the court had previously determined that the introduction of extrinsic evidence was appropriate under Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938, 943-44 (9th Cir.1995). We have jurisdiction under 28 U.S.C. § 1291. We review de novo the district court’s choice and application of the standard of review to decisions by fiduciaries of an employee benefit plan subject to the Employee Retirement Income Security Act (“ERISA”), and for clear error the district court’s underlying findings of fact. Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 962 (9th Cir.2006) (en banc) (citations omitted). We also review de novo the district court’s legal conclusions in interpreting provisions of an ERISA benefit plan. Metro. Life Ins. Co. v. Parker, 436 F.3d 1109, 1113 (9th Cir.2006) (citations omitted).

For the reasons stated in its well-crafted order, the district court properly interpreted the DUI Provision in Vaught’s favor to exclude coverage of accidents related to driving while legally intoxicated; found that Vaught, whose whole blood alcohol level was almost three times the state’s legal limit, was legally intoxicated at the time of his motorcycle accident; and determined after de novo review that the Plan’s denial of Vaught’s medical expenses was proper.

AFFIRMED. 
      
       This disposition is not appropriate for publication and is not precedent except as provided by 9th Cir. R. 36-3.