Opinion ID: 173652
Heading Depth: 2
Heading Rank: 1

Heading: Application of Summary Plan Document

Text: Appellants first argue that the district court erred in holding that the booklet distributed by Paine Webber was a SPD. The “Disability Plan” booklet does not contain all of the twelve requirements for a SPD, as listed in Pisciotta v. Teledyne Industries, Inc., 91 F.3d 1326, 1329 (9th Cir. 1996) (citing 29 U.S.C. § 1022(b)). However, the “Disability Plan” booklet refers employees to a booklet entitled “Legal and Administrative Overview” booklet, also distributed to plan participants, for further information about filing or appealing a claim and their rights as plan participants. This court has held that an ERISA plan may be made up of several booklets and documents. See Horn v. Berdon, Inc. Defined Benefit Pension Plan, 5 938 F.2d 125, 127 (9th Cir. 1991); see also 29 C.F.R. § 2520.102–3(s) (a plan’s claims procedures may be furnished as a separate document). The “Disability Plan” booklet and the “Legal and Administrative Overview” booklet, when read together, substantially comply with the requirements for a summary plan description under 29 U.S.C. § 1022(b).
Appellants argue that the district court erred in applying the language of the “Disability Plan” booklet in light of the disclaimer in that booklet. The “Disability Plan” booklet states that the SPD “does not determine rights under the LTD Plan but is intended only to summarize the important provisions of the LTD Plan” and that in the event of any inconsistency between the SPD and the policy, “the terms of the Plan Document will govern.” This court held in Pisciotta that a similar disclaimer which “clearly stated that the contract was the controlling document” and “was available for review by any employee who wished to see it” was enforceable. 91 F.3d at 1331. Enforcement of the disclaimer is not precluded by Bergt, 293 F.3d at 1144-45 (applying language from the plan master document which was more favorable to the employee than the SPD language); since Bergt makes no reference to any disclaimer clause being present in that case, nor does it discuss the holding in Pisciotta regarding the effect of a disclaimer clause, it is not 6 controlling here. The “Legal and Administrative Overview” booklet informed Paine Webber employees that the insurance policy was the controlling document, and also informed them that the insurance policy was available for review by any employee who wished to see it and told them how to find it. Under Pisciotta, the disclaimer in this case is enforceable, and the district court should have applied the language found in the policy.
Appellants further argue that the language in the Paine Webber “Disability Plan” booklet cannot be applied due to the integration clause in the policy. The policy provides the entire contract between Paine Webber and Reliance “is this Policy, your Application ... and any attached amendments.” The policy further provides that any change or waiver “must be in writing, signed by either our President, a Vice President, or a Secretary” and “must also be attached to this Policy.” An integration clause which contained language similar to that found in the Reliance policy was enforced by this court in Grosz-Salomon v. Paul Revere Life Ins. Co., 237 F.3d 1154 (9th Cir. 2001). See also Shaw v. Connecticut General Life Ins. Co., 353 F.3d 1276, 1282-84 (11th Cir. 2003)(citing GroszSalomon and enforcing the integration clause).7 Applying Grosz-Salomon, we hold Gunn argues that the reasoning in Grosz-Salomon applies only to plan 7 amendments, not to “contemporaneous plan documents.” However, Gunn points to 7 that the integration clause precludes the application of the language in the “Disability Plan” booklet to the extent that it differs from the language in the policy. 4. “Disability Plan” Booklet Outside Administrative Record Appellants also argue that the district court should not have considered the “Disability Plan” booklet because it was not a part of the administrative record. Judicial review of an ERISA plan administrator’s decision on the merits is generally limited to the administrative record. Montour, 588 F.3d at 632; Banuelos v. Construction Laborers’ Trust Funds for Southern California, 382 F.3d 897, 904 (9th Cir. 2004).8 In the absence of the disclaimer and the integration clause, the no evidence that the “Disability Plan” booklet was drafted at the same time as the policy, or that Reliance had any involvement in the preparation of the booklet. 8 The district court may hear extrinsic evidence for the limited purpose of determining to what degree, if any, a plan administrator’s decision was affected by a conflict of interest, see Abatie, 458 F.3d at 970, or when the standard of review of the administrative decision is de novo, Banuelos, 382 F.3d at 904. However, neither of these exceptions apply here. Although Barham v. Reliance Standard Life Ins. Co., 441 F.3d 581, 585 n. 1 (8th Cir. 2006), cited by Gunn, would permit a court to consider evidence outside the administrative record for the purpose of determining whether a de novo or discretionary standard of review should apply, a court may not consider plan documents outside the administrative record in addressing the merits of the administrator’s decision to grant or deny benefits. See Banuelos, 382 F.3d at 90304. It is not “unfair,” as Gunn suggests, for Reliance to contest the application of the SPD language; unlike Barham, where Reliance verified that the version of the policy in the record was accurate, Reliance never admitted in this case that the SPD was a valid Plan document. 8 appropriate course of action would have been for the district court to remand the matter to Reliance to permit it to interpret the language in the “Disability Plan” booklet. However, since we have held that the disclaimer and the integration clause are enforceable, we will refer to the definitions in the policy in reviewing Reliance’s decision to deny benefits.