Opinion ID: 3038689
Heading Depth: 3
Heading Rank: 4

Heading: the date the Employee fails to provide adequate

Text: employment earnings information or proof of 10906 FEIBUSCH v. SUN LIFE ASSURANCE continuing Total or Partial Disability as requested; 5. the date the Employee’s current earnings exceed 80% of his Indexed Total Monthly Earnings; All Employees earning $50,000 or more annually 6. the date Sun Life determines the Employee is able to perform on a full-time basis all of the material and substantial duties of his own occu- pation, even if the Employee chooses not to work. All Employees earning under $50,000 annually 7. for the first 24 months of Total Disability or for Partial Disability, the date Sun Life determines the Employee is able to perform on a full-time basis all of the material and substantial duties of his own occupation, even if the Employee chooses not to work; 8. after the first 24 months of Total Disability, the date Sun Life determines the Employee is able to perform on a full-time basis all of the material and substantial duties of any occupation for which he is or becomes reasonably qualified for by education, training or experience, even if the Employee chooses not to work. [6] The provisions are oddly structured, with three separate headings, including one that applies only to item 6. The district court determined that items 1 and 6 were alternate bases for terminating total disability payments. Actually, these provisions cannot serve as alternate bases because item 1 is inconsistent with item 6. Item 1 may be meant to generally apply to all employees, but it conflicts with Item 6, which FEIBUSCH v. SUN LIFE ASSURANCE 10907 applies only to a specific subset of employees that included Feibusch — those earning at least $50,000. “Under wellsettled contract principles, specific provisions control over more general terms.” Chan v. Society Expeditions, Inc., 123 F.3d 1287, 1296 (9th Cir. 1997). Under item 1, total disability benefits cease when the employee is no longer totally disabled.1 Under the plan an employee is totally disabled when she is unable to “perform all of the material and substantial duties of [her] own occupation.” Item 6 uses the same exact quoted words except adding the phrase “on a full-time basis.” Thus, if item 1 alone can serve as a basis for terminating benefits, item 6 — the only provision specific to employees earning at least $50,000 — would serve no purpose whatsoever. “[W]e must interpret the contract in a manner that gives full meaning and effect to all of the contract’s provisions.” In re Crystal Properties, Ltd., 268 F.3d 743, 748 (9th Cir. 2001). Finally, we note that an ERISA policy ambiguity must be interpreted in favor of the employee. See Patterson v. Hughes Aircraft Co., 11 F.3d 948, 950 (9th Cir. 1993). Therefore, item 6 governs and in order to terminate total disability benefits Sun Life must show that Feibusch was able to perform on a full-time basis all of the material and substantial duties of her own occupation. [7] Because the district court did not apply the de novo standard of review and did not correctly interpret the plan’s provisions for termination of total disability, we reverse the grant of summary judgment and remand. IV PROCEEDINGS ON REMAND The district judge’s order stated that if the court conducted a trial under a de novo standard “the court would find from 1 The parties agree that Feibusch is not eligible for partial disability under the plan because she is no longer working. 10908 FEIBUSCH v. SUN LIFE ASSURANCE the overwhelming evidence that Feibusch could work at least part-time.” (emphasis added). As we have indicated, that would not be the appropriate inquiry, as the question would be whether she could work full-time. There are significant differences and claims of inaccuracy regarding the written statements of the various evaluators in the administrative record. In resolving these discrepancies, it may be advisable for the court at trial to consider additional evidence and perhaps oral testimony as is permitted in ERISA cases. See Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938, 943-44 (9th Cir. 1995); Thomas, 228 F.3d at 997 (suggesting that admission of additional evidence would be helpful on remand when the credibility of various medical experts is at issue); Quesinberry v. Life Ins. Co. of North America, 987 F.2d 1017, 1025 (4th Cir. 1993) (holding that district court did not abuse its discretion in considering live expert medical testimony at ERISA bench trial, when medical issue was complex and when payor on policy was also the plan administrator). In resolving any factual dispute the court must issue findings of fact and conclusions of law as required by Rule 52(a) of the Federal Rules of Civil Procedure. V