N O T FO R PUB L ICAT IO N UNITED STATES C OUR T OF APPEALS FOR THE NINTH C IR C UIT R IC HARD C AREY, Plaintiff - Appe lla nt, v. UNITED OF OM AHA LIFE INSUR ANC E C OM PANY, De fe nda

nt - Appe lle e . No. 14-55483 D.C . No. 8:13-c v-00740-C JC R NB M EM O R ANDUM *

Appe a l from

the Unite d

Stat e s Distric t C ourt for the C e ntra l Distric t of C a lifornia C orm a c J. C arne y , Distric t Judge , Pre siding Argue d a nd Subm itte d M arc h 11, 2016 Pa sa de n a , C a l ifornia B e fore : REINHAR

DT, M U R GUIA, a

nd OW ENS, C irc uit Judge s . R ic ha rd C are y a ppe a ls from

the distric t c ourt’ s orde r granting Unite d of Om aha Life Insura

nc e C o m pa ny ’ s m otion for sum

m ary judgm e nt. W e have jurisdic tion unde r 28 U.S.C . § 1291, a nd we re v e rse and re m and. 

# FIL ED MAR 21 2016 M OLLY C. DW Y ER, CLERK U . S . CO URT O F APPEALS

* This disposition is not a ppropria te for public a t ion a

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

by 9th C ir. R . 36-3.C are y wa s not re quire d to e xha u st his a dm inistra

tive re m e die s be c a

use he qua lifie s for the futility

e xc e ption to the e xha

ustion re quire m e nt. Although not spe c ific a lly

m andate d by

the Em ploy e e R e tire m e nt Inc om e Se c urity Ac t of 1974 (ER ISA), this c ourt re quire s a n ERISA pla intiff to “ ava il him se lf or he rse lf of a pla n ’ s own inte rna l re vie w proc e dure s be fore bringing suit in fe d e ra l c ourt.” Vaught v . Sc ottsdale

He althc areC

orp. He alth Plan , 546 F.3d 620, 626 (9th C ir. 2008) (quoting Diaz v . Unite d Agric . Emp. W e lfare Be ne fit Plan &

Tr. , 50 F.3d 1478, 1483 (9th C ir. 1995)). The re are , howe ve r, a fe w e xc e ptions to tha

t rule . One suc h e xc e ption is the futility doc trine , unde r whic h a

c la im an t doe s not ha

ve to e xha ust a dm inistra

tive re m e die s if doing so would be futile . Se e id. at

626-27. He re , C are y

ha s de m onstra

te d tha t the e xc e ption a

pplie s by showing tha

t a furthe r re que st for re vie w would ha ve be e n futile . Afte r Unite d de nie d C are y be ne fits unde r his long-te rm disa bility (LTD) pla

n, C are y file d a c om pla int with the C a l ifornia

De pa rtm e nt of Insura

nc e (DOI), sta

ting tha t his be n e fits we re im prope rly de nie d. The DOI the n se nt a le tte r to Unite d, a sking Unite d to

“ re e va luate ” C are y ’ s c la im for be ne fits. Unite d re s ponde d in a le tte r to C are y

tha t it ha d “ re vie w[e d ] a ll of the doc um e ntation in [C are y ’ s] file ” and wa s “ una ble to a pprove [his] LTD c la i m .” Unite d sta te s tha t, in this lette r, it wa s not c onduc ting a

2substa

ntive re vie w of C are y ’ s c la im , but wa s inste a d sim p ly “ sum m ariz ing” the

“ history of Unite d’ s initia l c la im

de c ision.” B e c a use of the im

pre c ision in Unite d’ s c o m m unic a tions, howe ve r, a

pe rson in C are y ’ s position would ha ve thought tha

t Unite d ha d re vie we d the substa nc e of his c a se and de c ide d a

ne w tha t he wa s not e ntitle d to be ne fits. The pla in la ngua ge of the c om

m unic a t i ons indic a te d to C are y tha t pursuing a

furthe r re q

ue st for re vie w— thinking tha

t one ha d a lre a dy oc c urre d—

would ha ve be e n futile . C

.f. Vaught , 546 F.3d a

t 628 (e xpla ining this c ourt’ s “ princ iple tha t te rm s in a

n ERISA pla n should beinte rpre te d in a n ordina ry and popula

r se nse a s would a

[pe rson] of ave ra ge inte llige nc e and e xpe rie nc e ” (inte rna l quota tion m arks om itte d)); Booton v . Loc k he e d Me d. Be ne

fit Plan , 110 F.3d 1461, 1463 (9th C i r. 1997) (whe n c om m unic a ting to c la im ants tha t be ne fits a

re de nie d, “ t

he re a son for the de nia l m ust be sta te d in re a sona

bly c le ar la ngua ge ” ). Unite d a rgue s tha t C are y c annot e sta

blish futility

be c a u se its le tte r inform e d C are y tha t he c ould a

ppe a l the re sults of the

re vie w it c onduc t e d a fte r re c e iving the DOI inquiry . This portion of the le tte r doe s not a lte r our c o n c lusion, howe ve r, be c a use it doe s not sugge st to theordina ry re a de r that the a

ppe a l would be c onduc te d by

an outsidebody

or by a diffe re n t body

within Unite d

tha t m ight, on the b a sis of thesa

m e e vide nc e tha

t Unite d ha d a lre a dy

twic e re je c t e d, find good 3c a

use to c om e to a

n oppositec onc lusion. Tha t is, a pe rson in C are y ’ s position would ha ve thought tha

t it would be

futile to a

ppe a l a ga in to Unite d a fte r it ha d twic e de nie d his c la im . The distric t c ourt a buse d its disc re tion by

holding tha

t e xha ustion would not ha

ve be e n futile and gra

nting sum m ary judgm e nt in fa

vor of Unite d . As we hold tha

t e xha ustion would ha

v e be e n futile , we ne e d not a d dre ss C are y ’ s a rgum e nts re ga

rding whe the r the DOI c ould a c t a s his re p re se ntat ive in the a dm inistra

tive a ppe a ls proc e ss. RE V E RSE D and RE M ANDE D .

4