N O T FO R PUB L ICAT IO N UNITED STATES C OUR T OF APPEALS FOR THE NINTH C IR C U IT
B ARB AR

A SC OLES, Pla i ntiff–Appe lla

nt,
v. INTEL C O RPOR

ATION LONG TER

M DISAB ILITY B ENEFIT PLAN, a n e m p loy e e we lfare b e ne fit pla n, De fe nda nt–Appe l le e . No. 13-36167 D.C . No. 3:12-c v-01665-M O
M EM O R ANDUM *

Appe a l from

the Unite d

Stat e s Distric t C ourt for the Distric t of Ore gon M ic ha e l W . M osm an, C hie f Judge , Pre siding Argue d a nd Subm itte d July

6, 2016 Portla nd, Ore gon B e fore : PREGER SON, B E A, a nd OW ENS, C irc uit Judge s. B arbara Sc ole s wa s a

sy ste m s a

na ly st a t Inte l C orporation (“ Inte l” ) until she
we nt on disa

bility le a ve due to pa

nic disorde r, m a

jor de pre s sive disorde r, and ge ne ra liz e d a

nxie ty disorde r. She qua lifie d for be ne fits unde r the Soc ia l Se c urity 

# FIL ED JUL 29 2016 M OLLY C. DW Y ER, CLERK U
. S
. CO URT O F APPEALS

* This disposition is not a

ppropria te for public ation a

nd is not pre c e de nt e xc e pt a s provide d

by Ninth C irc uit R

ule 36-3. 1Disa

bility Insura nc e progra

m . Sc ole s a lso a

pplie d for be ne fits from

Inte l’ s longte rm -disa bility pla n (“ Plan” ), in whic h she wa s a pa rtic ipa nt. Afte r an initial de nia l, be ne fits we re grante d through the “ own oc c upat ion” pe riod. 2 The Pla n de c line d to
c ontinueSc ole s’ s be ne fits into the “ any oc c upation” pe riod, 3 oste nsibly be c a use Sc ole s ha d fa ile d t o provide suffic ie nt “ Obje c tive M e dic a l Findings to support tha t [she wa s] not a

ble to work ‘ any

oc c upation’ a s sta

te d in [the Pla

n] .” Afte r e xha usting a dm inistra

tive re m e die s a

nd a volunta ry a d m inistra tive a p pe a l, Sc ole s brought suit a

ga i nst thePla

n unde r the Em

ploy e e R e tire m e nt Inc om e Se c urity Ac t of 1974 (“ ER ISA” ), 29 U.S.C . § 1132(a)(1). The distric t c ourt gra nte d sum m ary judgm e nt for the Pla

n. W e have jurisdic tion unde r 28 U.S.C . § 1291, a n d we
re ve rse an d re m and. 1. W e a gre e with thedistric t c ourt tha t a n una lte re d a

buse -of-disc re tion sta nda rd of re vie w a

pplie s. Whe re , a s he re , an ERISA pla n ’ s a d m inistra tor a lso funds the be ne fits, the re is norm a lly a fina n c ia l c o nflic t of inte re st tha t wa rrants
e nha nc e d ske ptic ism

of the be ne fits de nia l
. Se e Me t ro. Life Ins. C o. v . Gle nn , 554

2 A pa rtic ipa nt in thePla

n is e l igiblefor be n e fits for thefirst 18 m onths of disa bility if he is una

b l e to pe rform

his “ re gula

r oc c upation or re a sona

bly re late d oc c upation.”

3 Afte r 18 m onths of disa

bility , a pa

rtic ipa nt in thePla

n is e ligiblefor c ontinue d be ne fits only

if he is una

ble to pe rform

“ any oc c upation for whic h he
. . . is or be c om e s re a sona

bly qua lifie d for by

tra i ning, e duc ation or e xpe rie nc e .” 2U.S. 105, 112, 117 (2008); Salomaa v . Honda Long Te rm Disability Plan , 642 F.3d 666, 675 (9th C ir. 2011). Howe ve r, the Pla n’ s a dm inistra

tor, a n Inte l
c om m itte e , de l e gate d the duty to de c ide c l a im s to unc onflic te d third pa rtie s, re m oving a

ny inhe re nt or struc t

ura l c o nflic t of inte re st. Se e Day v . AT & T Disability Inc ome Plan , 698 F.3d 1091, 1095–96 (9th C ir. 2012) (a m e nde d opinion). 4 M ore ove r, Sc ole s ha s provide d nothing othe r tha n bluste r to support her
argum e nt tha

t C l a im Appe a l Fiduc i ary

Se rvic e s, Inc . (“ C AFS” ), whic h de c ide d Sc ole s ’ s volunta

ry a dm inistra

tive a ppe a l, ha d a c onflic t of inte re st be c a use its pre s ide nt “ form e rly

m a de his living a s a

n insura nc e de fe nse attorne y

de fe nding a

nd de fe ating ER

ISA be ne fits c la i m s.” 2. “ Eve n without the spe c ia l ske ptic ism [to be a p plie d] in c a s e s of c o nflic t of inte re s t, de fe re nc e to the pla n a dm inistra

t or’ s judgm e nt doe s not m e an tha t the pla n pre v a i ls. ‘ De fe re nc e ’ is not a ‘ ta lism anic word tha

t c an av oid the proc e ss of judgm e nt.’ ” Salomaa , 642 F.3d a t 675 (bra c ke ts om itte d) (quoting Gle nn , 554 U.S.
at 119). R e e d Group (“ R e e d” ), the c la im s a dm inistra tor tha t de nie d Sc ole s be ne fits

4 W e m ight c om e to a

diffe re nt c onc lusion if, for e x am ple , the fina

nc ia l arrange m e nt be t

we e n the Pla

n a nd the third-pa

rty c la im s a dm i nistra

tors e nc oura g e d the c la im s a dm i nistra tors to de ny

be ne fits. C

f. Gle nn , 554 U.S. a

t 114 (“ [T] he e m

ploy e r’ s own c onflic t m ay e xte nd to its se le c tion of a n insura n c e c om pa ny to a dm iniste r its pla

n .” ). Howe v e r, we have found nothing in the re c ord to support such a

c onc lusion. 3through the“ any oc c upation” pe riod a

n d de c ide d

the first-le v e l a dm inistra

tive
a ppe a l, a nd C AFS, whic h de c ide d the volunta ry a dm inistra

tive a ppe a l, a buse d the ir disc re tion be c a

use , at e a c h sta ge of the a dm inistra tive proc e ss, the y fa ile d to
e nga ge in a

“ m e aningful dialogue ” with Sc o le s re ga rding the be ne fits de nia l. Booton v . Loc k

he e d Me d. Be ne

f it Plan , 110 F.3d 1461, 1463 (9th C i r. 1997); se e also 29 C .F.R . § 2560.503-1. In support of he r c la i m

for Pla n be ne fits, Sc o l e s ga

v e Ae t na Life Insura

nc e C om pa ny (“ Ae tna ” ), whic h

wa s the n the Plan’ s c la im s a dm inistra t or, note s from visits with Dr. Sole

m , he r psy c hiatrist, a

nd re sults of te sts c onduc t e d by Dr. B a lsa m o , a n inde pe nde nt psy c hiatrist. 5 Dr. R ate r, a psy c hiat rist hire d by Ae tna to
re vie w Sc ole s ’ s c l a im

file , sta te d: “ The re stric tion[s] im pose d by Dr. Sole m

are no work for M s. Sc ole s . B a se d on the re vie w of the provide d doc um e ntation, the
re stric tions . . . a

re a ppropria te . ” Ac c ordingly , Ae tna

found suffic ie nt “ Obje c tive M e d ic a l Findings”to support Sc ole s’ s c la im for be ne fits through the

“ own oc c upation” pe riod a

nd ove rturne d a

n e arlie r de c ision to deny suc h be ne fits.

5 Spe c ific a lly , Dr. B a lsa

m o c onduc te d

the se c ond ve rsion of theM inne sota M ultipha sic Pe rsona lity

Inve ntory te st a

nd the Pe rsona lity

Asse ssm e nt Inve ntory te st. Dr. B a lsa

m o e xp la ine d tha

t the se te sts a

re “ obje c t ive from

the sta ndpoint tha

t the y are c onstrue d utiliz ing c ontrol groups a nd a ppropria te sta tistic a l proc e dure s to e sta blish norm s tha

t a re both c o nsiste nt a

nd va lid.” 4Nothing a bout Sc ole s ’ s c la i m

or Dr. R ate r’ s re vie wwould ha ve ne c e ssa

rily lim ite d Sc ole s’ s be ne fits to the“ own oc c upation” pe riod— Dr. R ate r a gre e d with Dr. Sole m

tha t Sc ole s should not work, pe riod— but Ae tna a pprove d be ne fits only through the“ own oc c upation” pe riod a n d not into the

“ any oc c upation” pe riod. Shortly the re a fte r, R e e d took ove r a s the Pla n’ s c la i m s a dm inistra

tor from Ae tna . To de te rm ine whe the r Sc ole s’ s be ne fits would c ontinueinto the “ any oc c upation” pe riod, R e e d “ re que st[e d] upda te d Obje c tive M e dic a l Findings”and sta te d tha t it

“ would liketo sc he dule [Sc o le s ] for an Inde pe nde nt M e d ic a l Exa m ination with a Psy c hiatrist.” Sc ole s re sponde d to this re que st a nd provide d upda

te d inform ation from Dr. Sole m . Howe v e r, R e e d did not sc he dule Sc ole s for a n inde pe nde nt
m e dic a l e xam ination. Inste a d, it de nie d Sc ole s’ s c la im
. In its de nia l -of-be ne fits le tte r, R e e d re c ogniz e d tha t Sc ole s ha d “ d oc um e nte d dia g nose s of Pa

n ic Disorde r, M a

jor De pre s sive Disorde r an d Ge ne ra liz e d Anxie ty Disorde r,” but found tha

t “ the m e dic a l doc um e ntat ion supporting the se m e dic a l
c onditions doe s not m e e t the re quire m e nts of the[Plan] ,” oste nsibly be c a use “ the M e d ic a l doc um e nts [submitte d] do not c onta in a ny Obje c tive M e dic a l Findings,”

5a s re quire d by the Pla n. 6 The le tte r instruc te d Sc ole s tha t, “ to be c onside re d for be ne fits unde r [the Pla

n] , y ou m ust submi t Obje c tive M e dic a l Findings to support that y ou a re not a b le to work ‘ any

oc c upation.’ ” It a lso sta

te d tha t R e e d disa gre e d with Ae tna ’ s e arlie r de c i sion to gra nt Sc o le s be ne fits through the “ own oc c upation” pe riod. As pa rt of its be ne fits de nia l, R e e d wa s suppose d to te ll Sc ole s, “ i n a

m anne r c a lc ulat e d to be unde rstood by the c la im ant,” “ [t] he spe c ific re a son or re a sons for the a dve rse de te rm ination” and “ [a ] de sc ription of a ny a dditional m ate ria l or inform at ion ne c e ssa

ry for the c la im ant to pe rfe c t the c la im and a n e xpla nat ion of

6 Ac c ording to the

Pla n: “ ‘ Obje c t ive M e dic a l Findings’ m e ans a m e a sura ble , inde pe nde ntly -obse rva

b le a bnorm a lity

whic h is e vide n c e d by

one or m ore sta

nda rd m e dic a l dia gnostic proc e dure s inc luding la boratory te sts, phy sic a l e xam i nation findings, X-ra

y s, M R I’ s, EEG’ s, EC G’ s, ‘ C atsc a n s’ or sim ila

r te sts tha t support the pre s e nt of a

disa bility or indic ate a

func tiona l lim ita

tion. Not all te sts or te st re sults m e e t the c rite ria

of Obje c tive M e dic a l Findings. For e xam ple , te sts tha

t de pe nd on Partic i pa nt se lf-re p o rts, suc h a s trigge r point/te nde r point te sts, a re not c onside re d obje c tive an d do not e sta

blish e ligibility

for be ne fits unde r this Pla n . Te sts whose re sults va ry de pe nding on the

Partic ipa nt’ s e xpe nditure of e ffort, suc h a s grip stre ngth te sts a

nd c ognitivete sts, like wise are not c onside re d obje c tive , but m ay be take n into c onside ration a s c orroborative e vide nc e of disa bility . . . . Obje c tive M e d ic a l Findings do not inc lude phy sic ia ns’ opinions or othe

r third pa rty opinions ba se d on the a c c e pta

n c e of subje c tive c om

pla ints (e .g. he a da c he , fatigue , pa in, na use a ), a ge , tra

n s porta tion, loc a l la

bor m arke t a

nd othe r non-m a

rke t fa c tors. To be c onside re d a

n a bnorm a lity , the te st re sult m u st be c le a

rly re c ogniz a

ble a s out of the range of norm a l for a

he a lthy popula tion. Thesignific anc e of the a b norm a lity

m ust be unde rstood a

nd a c c e pte d by

the m e dic a l c o m

m unity a s dia gnostic of the spe c ific disa bling c ondition a sse rte d by the Partic i pa

nt.” 6why

suc h m ate ria l or inform ation is ne c e ssa ry . ” 29 C .F.R . § 2560.503-1(g)(1). W e have inte rpre te d

this re gula

tion to re quire a

“ m e aningful dialogue be twe e n ERISA pla n a dm inistra

t ors a n d the ir be ne fic ia

rie s.” B ooton , 110 F.3d a

t 1463. Fa

r from
e nga ging in a

“ m e aningful dialogue , ” R e e d’ s de nia l-of-be ne fits le tte r is pe rfunc tory . The Pla

n’ s de finition of “ Obje c tive M e dic a l Findings”a ddre sse s the kinds of e vide nc e ne c e ssa ry to e sta blish a c la i m for be ne fits due to a

phy sic a l disa bility

— but it she d s littlelight on how to prove disa bility a c c ount a

m e nta lhe a lth c ondition. Se esupra note 6. R e e d’ s de c ision re lie d on the la c k of suffic ie nt

“ Obje c t ive M e dic a l Findings”in Sc ole s’ s c la i m file , but R e e d’ s le tte r gave no furthe r guida

nc e on the m e aning of “ Obje c tive M e dic a l Findings”in the m e nta lhe a lth c onte xt. M ore im porta ntly , Sc ole s ha d pre viously subm itte d e vide n c e that Ae t

na ha d found to sa

tisfy the Pla n’ s re q uire m e nts. Although R

e e d wa s not bound by

Ae tna ’ s de c ision or interpre tat i on of the Pla n’ s te rm s , it ha d to e xpla in why it disa g re e d with Ae tna , its diffe re nt inte rpre tation of the te rm “ Obje c tive M e d i c a l Findings,”
and why Sc ole s’ s e v ide nc e wa s— unde r R e e d’ s inte rpre tation of thePla n’ s te rm s— i nsuffic ie nt to support her c la im
. S e e Salomaa , 642 F.3d a

t 679 (“ [T] he pla n a dm inistra

t or de nie d the c la im

la rge ly on a c c ount of a

bse nc e of obje c t ive
m e dic a l e vide nc e , y e t

fa ile d to te ll Sa lom a a

what m e dic a l e vide nc e it wa nte d.” );
7Saffon v . W

e lls Fargo &

C o. Long Te rm Disability

Plan , 522 F.3d 863, 870 (9th C ir. 2008) (“ M e tLife ’ s te rm ination le tte r to Sa ffon is e q ua lly uninform ative . It note s m e re l y

tha t ‘ [t] he m e dic a l inform at ion provide d no longe r provide s e v ide nc e of disa bility tha t would pre ve nt y ou from pe rform ing y our job or oc c upation,’ but doe s not e xpla in why

tha t is thec a se , a

nd c e rta inly

doe s not e nga ge Dr. Kudrow’ s c ontra ry a sse rtion. Thete rm ination le tte r doe s sugge s t Sa ffon c an a ppe a l by providing ‘ obje c tive m e dic a l inform ation to support [he r] ina bility to pe rform

the dutie s of [he r] oc c upation,’ but doe s not e xpla in why the inform at ion Sa ffon ha s
a lre a dy provide d is insuffic i e nt for tha t purpose . ” ). Sim ila

rly , R e e d should ha

ve , but did not, e xpla in why Sc ole s did not qualify for be ne fits unde r the Pla n e ve n though sheha d qua lifie d for Soc ia l Se c urity Disa b ility Insura nc e be ne fits. Se e Salomaa , 642 F.3d a

t 679 (“ Evide n c e of a

Soc ia l Se c urity award of disa bility be ne fits is of suffic ie nt signific a nc e tha t fa ilure to a ddre s s it offe rs support tha t the pla n a dm inistra

t or’ s de n ia l wa s arbitra

ry , a n a buse of disc re tion. W e ighty e v ide nc e
m ay ultim ate l y

be unpe rsua sive , but it c annot be ignore d.” (footnote om i tte d)). R e e d’ s le tte r a ffirm ing the de nia l of be ne fits is e ve n m ore opa que and uninform ative . R e e d wa s re q uire d to giveSc ole s’ s c la im a “ full a nd fa i r re vie w”
and to notify

Sc ole s , “ in a

m anne r c a lc ulate d

to be unde rstood by the c la im ant,” of

“ [t] he spe c i fic re a s on or re a s ons for the a d ve rse de te rm i nation.” 29 C .F.R
. 8§ 2560.503-1(h), (j). Inste a d , R e e d’ s le tte r re c i te d de finitions from the Pla n, liste d doc um e nts in thea dm inistra tive re c ord, a

nd c opie d ve rbatim a

psy c hiatrist’ s re vie w of the doc um e nts in there c ord. Tha t re v ie w le ft unc le ar the pre c ise re a sons for de nia l, the sta

nda rd by whic h R e e d wa s judging “ Obje c tive M e dic a l Findings,”
and the thre shold to qualify for Pla n be ne fits for pa

rtic ipa nts with me nta l-he a lth
c onditions. C AFS’ s fina l de n ia l le tte r wa s m ore inform ative , insofa r a s it (1) e xpla ine d why Sc ole s m ight ha

ve qua l ifie d for Soc ia l Se c urity Disa bility Insura nc e be ne fits but not Pla

n be ne fits a

nd (2) hinte d at the kinds of e v ide nc e ne c e ssa ry to e sta blish
e ligibility for Pla n be ne fits, suc h a s “ ge ne ra lly a c c e pte d te sting re sults,”“ t ria ls of
va rious m e dic ation, c ha

nge s in thefre que nc y of tre atm e nt, c h ange s in the tre atm e n t a

pproa c h, or re ports of in-pa tie nt tre atm e nt.” B ut C A FS did not sugge st what “ t e sts” would show tha t Sc ole s is disa

ble d from working—i t note d tha

t Dr. B a lsa m o ’ s re port wa s “ instruc tive , ” but did not sta te whe t he r Sc ole s ne e de d only

to subm it a sim ila r, upda te d re port. In a

ny e ve nt, a ny c l arity provide d by

C AFS c am e too la te , a s C A FS wa s the fina l a dm inistra tive re vie we r, and Sc o l e s la c ke d furthe r opportunitie s to submit ne w m e dic a l e v ide nc e . Se e Saffon , 522 F.3d a t 871 (“ The
se c o nd pa ra gra ph doe s c om

m unic ate som e use ful inform ation. In re sponding to Dr. Kudrow’ s va

rious re ports, M e tLife note s tha t ‘ [i] t is not c l e ar what

Dr. Kudrow
9use d

a s a ba sis for [his diag nosis] . . . a s we ’ ve not be e n furnishe d with a Func tiona l C a

p a c ity Eva luat i on tha

t would obje c tive ly

m e a sure and doc um e nt y our c urre nt le ve l of func tiona l a bility .’ This a

ppe ars to be not only M e t Life ’ s first (a nd only ) re sponse to Dr. Kudrow’ s e va luation, but also thefirst re fe re nc e in the re c ord to the a bse nc e of a

Func t iona l C a

pa c ity Eva l uation . . . . Sinc e this wa s M e tLife ’ s fina l de nia l of Sa ffon’ s c la im , this information c am e too la te to do Sa ffon a

ny good.” ). In sum , we hold tha

t R e e d a nd C A FS a

buse d the ir disc re tion be c a use the y fa ile d to provide Sc ole s with a m e a ningful opportunity

to providee vide n c e tha

t would sa tisfy the i r a s-y e t -une xpla ine d inte rpre tation of thete rm “ Obje c tive M e d ic a l Findings.” C

f. Salomaa , 642 F.3d a

t 680 (“ An a dm inistra

tor doe s not do its duty unde r [ER ISA] by

sa y ing m e re ly

‘ we are not pe rsua d e d ’ or ‘ y our e vide nc e is insuffic ie nt.’ Nor doe s it do its duty by e la b orating upon its ne gative an swe r with
m e aningle ss m e d ic a l m

um bo jum bo.” ). W e thus re ve rse the distric t c ourt’ s gra nt of
sum m ary judgm e nt in fa

vor of the Pla

n. 3. B e c a use it is unc le a

r how the te rm

“ Obje c tive M e dic a l Findings” a pplie s in the m e nta l-he a lth c onte xt a nd whe the r Sc ole s’ s e vide nc e m e e ts the Pla n’ s de finition of tha

t te rm , we re m a

nd this c a se to the distric t c ourt, whic h sha ll, in the first insta nc e , de te rm ine whe the r to ta ke ne we vide nc e or re m and this c a se to the
10Plan ’ s a dm inistra tor for a ne w de c ision on Sc o l e s’ s c la im
. S e e Saffon , 522 F.3d a

t 873–74 & n.6 (re m anding to the distric t c ourt to ta

ke ne w e vide nc e “ w he re proc e d ura l irre gula

ritie s ha ve pre ve nte d full de ve lopm e nt of the a dm inistra tive
re c o rd” ); Saffle

v . Sie rra Pac
. Pow e r C

o. Bargaining Unit Long Te r m Disability Inc o mePlan , 85 F.3d 455, 460–61 (9th C ir. 1996) (orde ring a re m and to the ER ISA pla

n’ s a d m inistra tor to a pply the c orre c t te rm s of the long-te rm -disa bility pla n in the first insta

nc e ). RE V E RSE D and RE M ANDE D w ith instr uc tions. 7

7 The Pla n’ s m otion to strike , Dkt. No. 37, is DE NIE D . The Pla n’ s m otion for an e xte nsion of time to re ply to Sc o le s’ s re sponse to the m otion to strike , Dkt. No. 42, is G RANT E D
. 11