N O T FO R PUB L ICAT IO N UNITED STATES C OUR T OF APPEALS FOR THE NINTH C IR C UIT
ELGIN K. C OX,

Pla i ntiff-Appe lla

nt,
v. ALLIN C ORPOR

A TION PLAN; e t a l., De fe nda n ts-Appe lle e s. No. 16-15231 D.C . No. 4:12-c v-05880-SB A
M EM O R ANDUM *

ELGIN K. C OX,

Pla i ntiff-Appe lla

nt,
v. ALLIN C ORPOR

A TION PLAN; UNUM LIFE INSUR

ANC E C OM PANY OF AM E R IC A, De fe nda

n ts-Appe lle e s. No. 18-16975 D.C . No. 4:16-c v-04675-SB A

Appe a l from

the Unite d

Stat e s Distric t C ourt for the Northe rn Distric t of C a lifornia Sa undra B . Arm strong, Distric t Judge , Pre siding 

# FIL ED
FEB 17 2021 M OLLY C. DW Y E R, CLERK U. S. CO URT O F APPEALS

* This disposition is not a ppropria te for public at ion 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.A rgue d a nd Subm itte d Ja

nua ry 11, 2021 San Fran c isc o , C a lifornia B e fore : B YB EE a

n d R . NELSON, C irc uit Judge s, a nd W HALEY, ** Distric t Judge
. Elgin C o x(C ox) a

ppe a ls the distric t c ourt’ s judgm e nt in fa vor of Unum

Life Insura nc e C om pa ny (Unum ) in his suit for long te rm disa bility (LTD) be ne fits brought pursua

nt to theEm

ploy e e R e tire m e nt Inc om e Se c urity Ac t (ERISA), 29 U.S.C . § 1132. C ox, a

form e r e m

ploy e e of Allin C orporation (Allin), subm itte d
c la im s for LTD be ne fits ba se d on his diagnose s of ve rtigo a nd diz z ine ss. Howe ve r, Unum , the pla

n a dm i nistra

tor for the Allin Pla

n, te rm inat e d be ne fits a fte r 24 m onths unde r the polic y ’ s se lf-re porte d sy m ptom s lim ita

tion. Thedistric t c ourt
a ffirm e d Unum ’ s de nia l of LTD be ne fits, a nd C ox a ppe a l e d. B e c a

use the pa rtie s
are fully fam ilia r with thefa c ts a

nd re c ord, we re c ite only

those fa c ts re l e va

nt to our de c ision. The distric t c ourt ha d jurisdic tion pursua nt to 29 U.S.C . § 1132(a ), and we have jurisdic tion unde r 28 U.S.C . § 1291. W e re vie w the distric t c ourt’ s unde rly ing findings of fac t for c le ar e rror, Abatie v . Alta He alth &LifeIns. C o. , 458 F.3d 955, 962 (9th C ir. 2006), a n d m ixe d que stions of fa c t a

nd la w, inc luding

* * The Honora

ble R obe rt H. W

ha l e y , Unite d State s Distric t Judge for the Ea ste rn Distric t of W a shington, sitting by de signa tion. 2c ontra c t inte rpre tation, denovo, Ty le r v . C uomo , 236 F.3d 1124, 1134 (9th C ir. 2000) (c ita

tion omitte d). W e re vie w the de nia l of be ne fits for a buse of disc re tion. Se e De me r v . IBM C

orp. LTD Plan , 835 F.3d 893, 896 (9th C ir. 2016). W e REVER SE and REM AND. The distric t c ourt e rre d in finding tha t Unum ’ s 2005 C a lifornia

Se ttle m e nt Agre e m e nt (C SA) with the C a lifornia De pa rtm e nt of Insura

nc e (C DOI) did not
a pply to the Allin Pla

n a nd thus tha

t the C SA’ s prohibition on se lf-re p orte d sym ptom s lim ita

tions did not a

pply . The C SA provide s tha t LTD polic y lim ita tions on se lf-re porte d c o nditions “ sha l l not bea pplie d in e xisting C a lifornia C ontra c t s.” 1 The C SA de fine s a “ C a lifornia

C ontra c t” a s “ a

polic y of disa bility inc o m e insura

nc e issue d by

a R e sponde nt whic h is subje c t to thejurisdic t ion of
and a pprove d by

the De pa rtm e nt.” Unum argue s , a nd the distric t c ourt found, tha t the A llin Pla

n wa s not subje c t

to the jurisdic tion of C DOI. This wa s a n e rror. The Allin Pla

n is a C a lifornia

C ontra c t subje c t to theC SA’ s prohibition on
se lf-re porte d sy

m ptom s lim i tations. C a lifornia la w is c le ar tha

t insura n c e provide d in C a lifornia

is subje c t to the jurisdic tion of C DOI. “ All insura n c e ” in C a l ifornia

is gove rne d by the C a lifornia

Insura nc e C ode . C a l. Ins. C ode § 41. All “transa c tion

1 The C SA a

pplie s to C a lifornia

c ontra c ts re ne we d “ following the C SA Effe c t ive Date or De c e m

be r 31, 2007.”B e c a

use the 1997 Allin Pla

n wa s re ne we d on June 30, 2008, the

C SA a pplie s to the Allin Pla

n if it is a C a lifornia

C ontra c t. 3of insura

nc e busine ss” re quire s a dm ission a nd c e rtific ation by

C DOI, a nd
c e rtific ation “ sha ll not begrante d until the a pplic ant c onform s to there quire m e nts of this c o de and of the la

ws of this sta

te ” or fa c e c rim ina l pe na l tie s. C a l. Ins. C ode § 700(a )–(b). Furthe r, “ [n] o group disa b ility polic y sha ll be issue d or de live re d in this sta te nor . . . sha ll a

n insure r provide or a gre e to provide group disa b ility
c ove ra ge until a

c opy of the form

of the polic y

is file d with thec om

m issione r and
a pprove d by him .” C a l Ins. C ode § 10270.9. The C a lifornia

Insura nc e C ode thus
e xplic itly prohibits the provision of group disa bility c o ve ra ge in C a lifornia

unle ss the p olic y is a pprove d by

C DOI. C a l. Ins. C ode § 10270.9. He re , the c ove ra ge wa s provide d in C a lifornia to a C a lifornia

re side nt a

t a C a lifornia subsidia ry of Allin. Unum re c ogniz e d C ox a s a C a lifornia e m ploy e e . Unum ’ s c la im s doc um e nts for C ox de sc ribe d his polic y

subgroup a s “ Em

ploy e e s of Allin C onsulting of C a l ifornia ” and spe c ific a lly note d: “ O ur a gre e m e n t: Em ploy e e s of Allin C onsulting of C a lifornia .” The Allin Pla n itse lf diffe re ntia

te s be twe e n divisions or subsidia rie s of Allin C orporation, inc luding “Allin C onsulting of C a lifornia ” and provide s diffe re nt c ove ra ge for e m ploy e e s of Allin C o nsulting of C a lifornia . M ore ove r, Unum unde rstood tha

t it wa s subje c t to the jurisdic tion of C DOI: in its le tte rs de ny ing C ox’ s c la im , it dire c t e d him to C DOI for re vie w of the de nia l. The de nia l le tte rs inform e d C o x tha t he “ m a y a l so c onta c t the C a lifornia
4De pa

rtm e nt of Insura

n c e if y ou wish to ha

ve the m re vie w y our [] c la i m ,” and provide d c onta c t inform ation for C DOI. Unum c annot now a

rgue tha t the Allin Plan is not subje c t to thejurisdic tion of C DOI. It is irre le va nt tha t the Allin Pla

n sta te s tha t it is governe d by

Pe nnsy lva

nia la w be c a use the C SA a

pplie s to a ll C a lifornia C ontra c ts, without re ga

rd to the polic y ’ s sta

te d gove rning jurisdic tion. The C SA’ s prohibition on se l f-re porte d sy m ptom s lim ita

t ions a pplie s to theAllin Plan . B e c a

use we c onc lude tha

t the C SA prohibits a

pplic ation of theAllin Pla n’ s
se lf-re porte d sy

m ptom s lim i tation, we do not re a c h C ox’ s othe r argum e nts. W e REVER SE and REM AND for furthe r proc e e d ings c onsiste nt with this disposition.

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