T hi s di s pos i t i on i s notappr opr i a t e f orpubl i c a t i on and i s notpr e c e de nt * e xc e pta s pr ovi de d by 9th C i r . R . 36- 3. NOT F OR P UB L I CAT I ON UN I TE D STATE S C OU RT OF APPE ALS FOR T HE NI NTH CI RC UI T S UN S UN L I N, P la in tif

f - A p p e lla n t, v. M EL LON LON G TER M DI SABI LI TY P L A N , a n E R I S A pl a n, D ef

endant- A pp el l ee . N o. 09- 55434 D. C . No . 8 : 0 8 - c v - 0 0 1 0 7 - DO C - AN ME MOR AN DU M *

A pp ea l fr om the U ni t ed S t at es D i stri ctC ou rt f o rth e C e n tr a l D is tr ic t o f C a lif o rn ia D a vi d O . C a rt e r , D i s tr i c tJ udge , P r e s i di ng A r gue d a nd S ubm i tt e d M a y 5, 2010 P a s a d e n a , C a lif

o rn ia B efo re: N O O N A N , C L IF T O N an d B Y B E E , C i rcu i tJu d g es. P l a i nt i f f - appe l l a ntS un S un L i n ( “ L i n” ) appe a l s the di s tr i c tc ourt ’ s gr a ntof s u m m a ry ju d g m e n t in f

a v o ro f d e f e n d a n t- ap p e lle e M e llo n L o n g T e rm D is ab ility P la n ( “th e P la n ” ) . B e c au s e th e P la n A d m in is tr a to r— th e C o rp o r a te B e n e f its 

# FI LED MA Y13 2 010 M OLLY C. DW Y ER, CLERK U . S. C O U R T OF APPE ALSS ec t i on 6. 5(a) (2) m i rr ors the l angu age of 29 C . F . R . § 2 56 0. 50 3-1(h)(2), 1 w hi ch st at es that“ the cl ai m s proce du re s of apl an w i l l no tbe deem ed t o p rovi de a c l a i m a ntw i th ar e a s onabl e opportuni ty f oraf ul l a nd f a i rr e vi e w of

ac l a i m a nd advers e benefi tdet erm i nat i on un l es s the cl ai m s proce du re s . . . (i v) P rovi de for a re vi ew thatt akes i nt o acc ou ntal l com m ent s, do cum ent s, re cords, and o ther in f o rm a tio n s u b m itte d b y th e c la im a n t r e la tin g to th e c la im , w ith o u t r e g a r d to w h e th e rs u c h in f

o rm a tio n w a s s u b m itte d o rc o n s id e r e din th e in itia l b e n e f it d e te rm in a tio n .” I n 2004, the P l a n f

ound L i n t o be t ot a l l y di s abl e d f r om pe r f orm i ng the 2 e s s e n t i a l d u t i e s o f

h e ro wn o c c u p a t i o n . Un d e rth e t e rm s o f th e P l a n , a f

t e rtwo y e a r s o f b e n e f its u n d e rth e “o w n o c c u p a tio n ” d e f in itio n o f to ta l d is ab ility , b e n e f

its a r e pr ovi de d onl y i f

the c l a i m a nti s de t e rm i ne d t o be t ot a l l y di s abl e d unde rthe m or e e xa c t i ng “ a ny oc c upa t i on” s t a nda r d.

- 2- C o m m itte e ( “C B C ” )

— n e ith e rin te rp r e te d th e P la n u n r e a s o n ab ly n o rab u s e d its d i s c r e t i o n i n d e t e rmi n i n g th a tLi n w a s n o tt o t a l l y d i s ab l e d , w e a f f i rm. L i n a r gue s tha tthe C B C f a i l e d t o pr ovi de he rw i th af ul l a nd f a i rr e vi e w of the de ni a l of

he rc l a i m f

orl ong t e rm di s abi l i ty be ne f i t s . L i n poi nt s t o § 6. 5( a ) ( 2) of th e P l an , w h i ch p ro v i d es th atth e C B C “ sh al l t ak e i n t o acco u n tal l co m m en t s, d o c u m e n ts , r e c o r d s , a n d o th e rin f o rm a tio n s u b m itte d b y th e p a rtic ip a n t r e la tin g to the C l a i m , w i thoutr e ga r d t o w he the rs uc h i nf orm a t i on w a s s ubm i tt e d or consi dere d i n the i ni t i al benefi tdet erm i nat i on . ” A cc ordi ng t o L i n, the C B C ran 1 a f oul of § 6. 5( a ) ( 2) be c aus e i tdi d notdi r e c t l y c ons i de rc e rt a i n doc um e nt s r e l a t i ng t o a n e a r l i e rde t e rm i na t i on tha tL i n w a s t ot a l l y di s abl e d unde ral e s s s tr i nge nt defi ni t i on of t ot aldi sabi l i ty. L i n rel i es on a s t at em entby the P l an’ s a tt orneys “ that 2- 3-

th e C B C d id n o t d ir e c tlyc o n s id e rth o s e d o c u m e n ts in m a k in g its d e te rm in a tio n to de ny [ L i n’ s ] c l a i m , ” butdi d “ ‘ i ndi r e c t l y ’ c ons i de r [ ] the s e doc um e nt s t o the e xt e nt they w er e r evi ew ed and con si dere d b y” an i nd ependentm edi ca l exam i ner r et ai ned b y th e C B C in its r e v ie w o f L in ’s ap p e a l. T h e P lan d o es n o t, b y its term s, co n tain an y “d irec t[] co n sid er [a ti o n ]” r e qui r e m e nt . R a the r , § 6. 5( a ) ( 2) of the P l a n r e qui r e s the C B C t o “ t a ke i nt o a c c ount a l l c om m e nt s , doc um e nt s , r e c or ds , a nd othe ri nf orm a t i on s ubm i tt e d by the p a rtic ip a n t r e la tin g to th e C la im .” T h e C B C f u lly c o m p lie d w ith th is r e q u ir e m e n t: i n i t s l e tt e rof

O c t obe r29, 2007, a dvi s i ng L i n tha ti tw a s r e j e c t i ng he rappe a l , the C B C st at ed th at“ [i ] n m ak i n g [i t s] d et erm i n at i o n , th e C B C co n si d ered [L i n ’ s] e nt i r e a dm i ni s tr a t i ve r e c or d, i nc l udi ng i nf orm a t i on [ L i n] s ubm i tt e d on appe a l a nd the r e portof

a n i nde pe nde ntm e di c a l pr of e s s i ona l . ” M or e ove r , § 6. 5( a ) ( 3) p r o v id e s th a t th e C B C “s h a ll, in th e e v e n t o f a n ap p e a l o f

a n y A d v e r s e B e n e f

it D e t e rm i na t i on tha ti s ba s e d i n w hol e ori n pa rton m e di c a l j udgm e nt , c ons ul tw i th a H e a lth C a r e P r o f

e s s io n a l w h o h a s ap p r o p r ia te tr a in in g a n d e x p e r ie n c e in th e f ie ld of m edi ci ne i nv ol ved i n the m edi ca l j ud gm ent . ” H er e, the C B C desi gn at ed an i nd ependentm edi ca l expertt o revi ew al l do cum ent s s ub m i tt ed by L i n, and then di r e c t l y r e vi e w e d the m e di c a l e xpe rt ’ s r e porta s w e l l a s othe rdoc um e nt s . T he- 4-

C B C di d n oti nt erpret§ 6 . 5(a) (2) a s r equi ri ng i tt o d i re ct l y r evi ew ea ch and every d o c u m e n t c o n s id e r e d b y th e in d e p e n d e n t m e d ic a l e x p e rt. T he P l a n una m bi guous l y de l e ga t e s di s c r e t i on t o the C B C , s o w e r e vi e w the C B C ’s in te rp r e ta tio n o f th e P la n a n d its d e te rm in a tio n th a t L in w a s n o t to ta lly d is ab le d f

o rab u s e o f

d is c r e tio n . Ke arne

yv . Standard I

ns . C o. , 175 F . 3d 1084, 1090 ( 9th C i r . 1999) ( e n ba nc ) . W e m us tde f e rt o the C B C ’ s de c i s i onm a ki ng

“ unl e s s i t[ w a ] s notgr ounde d on any re as on abl e bas i s. ” Sznew ajs v . U ni ted Stat es B anc or p A m e nde d & R e s tate d Supple m e ntal B e ne f i t s P lan , 572 F . 3d 727, 734- 35 ( 9th C i r . 2009) . I n l i ghtof the pl a i n l a ngua ge of

the P l a n, w hi c h pr ovi de s tha tthe C B C ne e d onl y “ t a ke i nt o a c c ount , ” not“ di r e c t l y c ons i de r , ” a l l doc um e nt a t i on, a nd w h i ch actu al l y re qu i res tha tthe C B C c ons ul ta n i nde pe nde nte xpe rton que s t i ons o f m e d ic a l ju d g m e n t, th e C B C d id n o t ab u s e its d is c r e tio n in “in d ir e c tly c o n s id e r [ in g ]” c e rta in m e d ic a l d o c u m e n ts r e la tin g to a n e a r lie rb e n e f its det erm i nat i on un der adi ff er entdi sabi l i ty s t andard. M oreover, the re cord m akes c le a rth a t th e C B C h a d ar e a s o n ab le b a s is f o rd e te rm in in g th a t L in w a s n o t to ta lly di s abl e d unde rthe P l a n’ s “ a ny oc c upa t i on” s t a nda r d. AF F I R ME D.