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 JO N A T H A N E . R IV K IN , M . D . , an in d iv id u a l, P la in tif

f - A p p e lla n t, v. TH E U N I O N CEN TRA L LI FE I N SU RA N CE CO M PA N Y a n d SH A RP REES- STEA LY M ED I CA L G RO U P I N C. GROU P L ON G TER M DI SABI LI TY I NS UR AN C E P L AN , D efen d an t s - A p p el l ees. N o. 11- 55975 D. C . No . 3 : 0 9 - c v - 0 1 1 3 6 - WQHWVG 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 S o u th e rn D is tr ic t o f C a lif o rn ia W i l l i a m Q . H a y e s , 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 F e brua ry7, 2013

P a s a d e n a , C a lif

o rn ia B efo re: C A L L A H A N , IK U T A , an d H U R W IT Z , C i rcu i tJu d g es. 

# FI LED JU N 18 2013 M OLLY C. DW Y ER, CLERK U . S. C O U R T OF APPE ALST h e p l an st at es: 1 Y ou w i l l be pa i d aT ot a l D i s abi l i tybe ne f i ti f Y ou: 1. be c om e T ot a l l y D i s abl e d w hi l e i ns ur e d unde rthi s P l a n; 2 . a r e D is ab le d th r o u g h o u t th e E lim in a tio n P e r io d a n d r e m a in D is ab le d b e y o n d th e E lim in a tio n P e r io d ; 3. a r e unde rthe c a r e of aP hy s i c i a n w ho i s pr ovi di ng tr e a tm e ntf or th e In j u ry o r S i ck n ess cau si n g th e D i sab i l i ty; 4. s ubm i tP r oof

of D i s abi l i tys a t i s f

a c t oryt o U s ; a nd 5. a r e e m pl oy e d, Y ourC urr e ntM onthl yE a rni ngs a r e l e s s tha n or eq u al t o 2 0 % o f Y o u r A v erag e M o n th l y E arn i n g s. T he r e i s no di s put e tha tR i vki n m e e t s the de f i ni t i on of “ T ot a l l yD i s abl e d” a nd o th e rw is e q u a lif

ie s f o raT o ta l D is ab ilityB e n e f it. 2 D r . J ona tha n R i vki n appe a l s the di s tr i c tc ourt ’ s gr a ntof s um m a ryj udgm e nt i n f a vorof T he U ni on C e ntr a l L i f

e I ns ur a nc e C om pa ny . W e r e vi e w de novo, A bat i e v . A l ta H

e al th & L i

f e I ns . C o. , 45 8 F . 3d 95 5, 96 2 (9th C i r. 20 06 ) ( en banc), a n d r e v e r s e . U n io n C e n tr a l’s p la n p a y s tw o k in d s o f b e n e f its r e le v a n t to th is c a s e : a “T o tal D isab il ity B en ef it ” a n d a “R es idu al D isab il ity B en ef it .” W h en R iv k in ’s m on thl y i ncom e does notexce ed 20 perc entof hi s pre -di sabi l i ty m on thl y i ncom e, h e r e c e iv e s th e T o ta l D is ab ilityB e n e f it. B yc o n tr a s t, w h e n R iv k in ’s m o n th ly 1 in c o m e d o e s e x c e e d th is 2 0 p e r c e n t th r e s h o ld , h e r e c e iv e s th e R e s id u a l D is ab ilityT h e p la n s ta te s : 2 I f Y o u a r e R e s id u a llyD is ab le d a n d h a v e C u rr e n t M o n th lyE a rn in g s in e xc e s s of 20% of Y ourA ve r a ge M onthl yE a rni ngs , Y ou w i l l be pa i d a R esi d u al D i sab i l i ty B en efi ti f Y o u m eetth e fo l l o w i n g q u al i fi cat i o n s: 1. Y ou s a t i s f

y the E l i m i na t i on P e r i od w i th the r e qui r e d num be rof d a y s o f To t a l D i s ab i l i tya n d / o rRe s i d u a l D i s ab i l i tya n d b e c o me e nt i t l e d t o r e c e i ve L T D be ne f i t s unde rthi s P l a n; 2. Y ou subm i tsa t i sf ac t ory P roof of D i sabi l i ty t o U s thatY ou ar e R e s i dua l l y D i s abl e d a s de f i ne d i n thi s P l a n; a nd, 3 . Y o u a r e e a rn in g le s s th a n 8 0 % o f Y o u rA v e r a g e M o n th ly E arn i n g s. T h e p l an p ro v i d es: 3 W e w i l l c a l c ul a t e Y ourM onthl yB e ne f i tus i ng the 50% O f

f s e tof E arni ng s m etho d. T o d et erm i ne Y ou r benefi t , ca l cul at e Y ou r T ot al D i s abi l i ty B e ne f

i t. . . . F r om the T ot a l D i s abi l i tya m ountde t e rm i ne d, s ubtr a c t50% of

Y ourC urr e ntM onthl yE a rni ngs . T he a m ount r e m a in in g is Y o u rM o n th lyB e n e f it. 3 B en efi t . T o cal cu l at e th e R esi d u al D i sab i l i ty B en efi t , th e ad m i n i strat o r m u stfi rst

2 ca lcu late R iv k in ’s T o tal D isab il ity B en ef itan d m u st th en su b trac t h alf o f R iv k in ’s m onthl y i nc om e . T o c a l c ul a t e the T ot a l D i s abi l i tyB e ne f i t , the a dm i ni s tr a t or 3 begi ns w i th 4 0 p er ce ntof R i vk i n’ s pre -di sabi l i ty m on thl y i ncom e and thenT h e p la n p r o v id e s th r e e m e th o d s f o rc a lc u la tin g th e T o ta l D is ab ility 4 B e n e f it. T h e p a rtie s a g r e e th a t in th is c a s e , th e T o ta l D is ab ilityB e n e f it is c a lc u la te d u s in g th e D ir e c t M e th o d . U n d e rth is m e th o d , th e T o ta l D is ab ility B e n e f it is c a lc u la te d a s f

o llo w s : “T a k e th e le s s e ro f . . . Y o u rA v e r a g e M o n th ly E a rn in g s m u ltip lie d b y th e D ir e c t B e n e f it P e r c e n t s h o w n in th e C o v e r a g e S c h e d u le [ 40 pe r c e nt ] . . . [ a nd] s ubtr a c ta l l O the rI nc om e R e duc t i ons , i nc l udi ng thos e f or w h i c h Y o u w e r e e l i g i b l e b u td i d n o tap p l yo rap p e a l a s d e s c r i b e d i n th e ‘ Cl a i ms P r o v is io n s ’ s e c tio n o f

th is P la n .” 4 s ubtr a c t s c e rt a i n “ O the rI nc om e R e duc t i ons ” tha ta r e de f i ne d bythe pl a n. T he 4 p l an d efi n es “ O th er In co m e R ed u ct i o n s” as fo l l o w s:

W h a t A re T h e O th er In co m e R ed u cti o n s? O th e rI n c o me R educt i on s are benefi t s Y ou ar e e l i gi bl e t o rec ei ve fr om other s ou rc es du e t o Y ou r D i sabi l i ty. If Y ou re ce i ve benefi t s f

rom any of the other s o u r c e s lis te d b e lo w , th e y w ill b e u s e d to r e d u c e Y o u rM o n th ly B e n e f it. C ons i s t e ntw i th thi s de f i ni t i on, the pl a n e num e r a t e s ni ne s uc h r e duc t i ons , i nc l udi ng une m pl oy m e ntbe ne f

i t s , S oc i a l S e c ur i tybe ne f i t s , di s abi l i tybe ne f

i t s r e c e i ve d f

r om a n aut om obi l e pol i c y , a nd da m a ge s i nt e nde d t o c om pe ns a t e f orl os te a rni ngs . T he l i s ta l s o i nc l ude s ( a s N o. 8) “ I nc om e f r om a nyw ork f

orpa yorpr of

i tnot consi dere d . . . R es i du al D i sabi l i ty or R ehabi l i t at i ve E m pl oym ent . ” A c c or di ng t o U ni on C e ntr a l , R e duc t i on N o. 8 i nc l ude s a nyi nc om e f r om p ar t-ti m e o r tem p o ra ry w o rk th at is eq u al to o r les s th an 2 0 p er ce n t o f a claim an t’ sU ni on C entra l fi rs toffe re d thi s i nt erpret at i on du ri ng l i t i gat i on . B ef ore 5 R iv k in f ile d s u it, U n io n C e n tr a l o f f e r e d o rap p lie d o th e rin te rp r e ta tio n s o f th e p la n . 5 p r e - d is ab ilityin c o m e . U n d e rU n io n C e n tr a l’s in te rp r e ta tio n , w h e n R iv k in 5 r e c e i ve s aT ot a l D i s abi l i ty B e ne f i t( i . e . , w he n he i s e a rni ng 20 pe r c e ntorl e s s of p r e - d is ab ilityin c o m e ) , U n io n C e n tr a l w ill r e d u c e h is b e n e f it b y1 0 0 p e r c e n t o f

h is e a rn in g s . W h e n R iv k in is r e c e iv in g aR e s id u a l D is ab ilityB e n e f it ( i.e ., w h e n h e is e a rni ng m or e tha n 20 pe r c e ntof pr e - di s abi l i tyi nc om e ) , R e duc t i on N o. 8 doe s not ap p l y, an d U n i o n C en tral w i l l red u ce h i s b en efi tb y 5 0 p ercen to f h i s earn i n g s. T h i s i n t e rp r e t a t i o n o f

th e p l a n i s c o n tr a ryt o i t s p l a i n l an g u a g e . As p rev i o u sl y m en t i o n ed , th e p l an d efi n es th e cat eg o ry o f “ O th er In co m e R ed u ct i o n s” a s appl y i ng t o “ be ne f

i t s ” R i vki n i s e nt i t l e d t o r e c e i ve f r om othe rs our c e s “ due t o” h i s d i sab i l i ty. T h e “ o th er so u rces” l i st ed i n th e “ O th er In co m e R ed u ct i o n s” prov i si on ar e a l l consi st entw i th thi s def i ni t i on : for e xam pl e, the l i sti ncl ud es di s abi l i ty be ne f

i t s f r om a n aut om obi l e pol i c y , w hi c h i s atype of be ne f i tape r s on m a y be e nt i t l e d t o r e c e i ve due t o adi s abi l i ty . B yc ontr a s t , i nc om e e a rne d by R iv k in f r o m p a rt- tim e o rte m p o r a ryw o rkis n o t a“b e n e f it” r e c e iv e d “d u e to ” h is di s abi l i ty . U ni on C e ntr a l doe s notpr ovi de a nypl aus i bl e ba s i s f ori t s c onc l us i on tha ti nc om e f

r om pa rt - t i m e ort e m por a rye m pl oy m e ntc oul d m e e tthe de f i ni t i on of

“ O ther I ncom e R educt i on s. ”B ec ause U ni on C entra l ’ s i nt erpret at i on of the pl an w as erroneou s e ven 6 u n d e rad e f

e r e n tia l s ta n d a r d o f

r e v ie w , w e n e e d n o t a d d r e s s R iv k in ’s a r g u m e n t, ba s e d on C o n kri

g h t v. Fro m m ert , 13 0 S . C t . 16 40 , 16 51 (201 0), thatthe di stri ct c o u rt s h o u ld h a v e r e v ie w e d U n io n C e n tr a l’s p la n in te rp r e ta tio n d e n o v o . 6 I ti s a n abus e of

di s c r e t i on f

orapl a n a dm i ni s tr a t ort o “ c ons true pr ovi s i ons of the pl an i n a w aythatconfl i ct s w i th the pl ai n l angu age of the pl an. ” D a y v. A T & T D is abi l i t yI nc om e P lan , 698 F . 3d 1091, 1096 ( 9th C i r . 2012) ( quot i ng T af t v. E qu i tab le L i

f e A ss uran ce So c’

y , 9 F .3 d 1 4 6 9 , 1 4 7 2

– 7 3 ( 9 th C ir . 1 9 9 4 ) ) , ab roga ted on othe rgr ounds bySaf f on v . W e l l s Far go & C o. L ong T

e rm D is abi l i t

yP lan , 522 F .3 d 8 6 3 , 8 7 2 n .2 ( 9 th C ir . 2 0 0 8 ) ) , ce rt. deni ed , __ S . C t . __, N o. 12- 1144, 2013 W L 1147413 ( A pr . 22, 2013) . B e c aus e U ni on C e ntr a l ’ s i nt e rpr e t a t i on of R e duc t i on N o. 8 i s c ontr a ry t o the de f i ni t i on of “ O the rI nc om e R e duc t i ons , ” U ni on C entra l abused i t s di sc re t i on i n i nt erpret i ng the pl an. A s are sul t , the di stri ctcourt e rr e d in g r a n tin g s u m m a ry ju d g m e n t in f a v o ro f U n io n C e n tr a l. 6 RE V E RS E D A ND RE MAND E D.