Court Opinion

ID: 9960177
Source: CourtListenerOpinion
Date Created: 2024-04-15 17:01:04.219489+00
Date Added: 2024-06-11T08:19:15.751004
License: Public Domain

NOT FOR PUBLICATION                           FILED
                    UNITED STATES COURT OF APPEALS                        APR 15 2024
                                                                      MOLLY C. DWYER, CLERK
                                                                       U.S. COURT OF APPEALS
                           FOR THE NINTH CIRCUIT

JACQUELINE ROEDER,                              No.    22-56226

                Plaintiff-Appellant,            D.C. No.
                                                8:21-cv-01715-JVS-KES
 v.

GUARDIAN LIFE INS. CO.; PSC                     MEMORANDUM*
BIOTECH CORPORATION PLAN,

                Defendants-Appellees.

                   Appeal from the United States District Court
                      for the Central District of California
                    James V. Selna, District Judge, Presiding

                      Argued and Submitted January 10, 2024
                               Pasadena, California

Before: RAWLINSON, MELLOY,** and H.A. THOMAS, Circuit Judges.

      Jacqueline Roeder appeals the district court’s de novo review of the

administrative record regarding Guardian Life Insurance Company’s (Guardian)

denial of her application for long-term disability benefits under a policy governed

      *
             This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
      **
            The Honorable Michael J. Melloy, United States Circuit Judge for the
U.S. Court of Appeals for the Eighth Circuit, sitting by designation.
by the Employee Retirement Income Security Act of 1974 (ERISA). “We review

de novo a district court’s choice and application of the standard of review to

decisions by fiduciaries in ERISA cases . . . [and] for clear error the underlying

findings of fact.” Est. of Barton v. ADT Sec. Servs. Pension Plan, 820 F.3d 1060,

1065 (9th Cir. 2016); see also Wolf v. Life Ins. Co. of N.A., 46 F.4th 979, 984 (9th

Cir. 2022) (“De novo review applies to the denial of benefits under an ERISA-

governed insurance policy where . . . the policy does not assign the administrator

discretionary authority to determine eligibility of benefits or to construe the plan’s

terms.”).1 Finding neither errors of law nor clearly erroneous factual findings, we

affirm.

      PSC Biotech hired Roeder on January 6, 2020. Her long-term disability

coverage became effective on February 1, 2020. On April 1, 2020, Roeder stopped

working and subsequently filed an application for long-term disability benefits

alleging severe neck pain. Subsequent medical records demonstrated that Roeder

has a degenerative cervical spine condition.

      The policy excluded coverage for any disability manifesting during the first

twelve months of employment if the applicant “suffered from a physical . . .

condition, whether diagnosed . . . which caused symptoms within three months

1
 The policy at issue here did not assign Guardian discretionary authority, and the
district court conducted a de novo review of Guardian’s decision.

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before the effective date of [the applicant’s] insurance . . . for which a prudent

person would usually seek medical advice or treatment . . . [and which] caused or

substantially contributed to” the disability. Guardian reviewed Roeder’s medical

records, including records from the three-month look-back period of November

2019 through January 2020, and denied coverage based primarily on medical notes

from a January 2020 urgent care visit. At that visit, Roeder complained of sinus

pain and neck pain and received intravenous antibiotics as well as trigger point

injections and electrical stimulation in her neck. The district court found that,

although Roeder’s degenerative cervical spine condition was not diagnosed or

suspected during the look-back period, it caused the symptom of neck pain for

which Roeder sought medical treatment. The district court thus upheld Guardian’s

decision to deny Roeder’s long-term disability benefits.

      On appeal, Roeder argues: (1) the medical notes from the January 2020

urgent care visit fail to demonstrate a specific diagnosis; (2) those notes are unclear

in that her sinus pain and intravenous antibiotics suggest that her neck pain could

have been related to an infection; and (3) the record as a whole fails to prove that

her symptoms in January 2020 were related to her later-diagnosed degenerative

cervical spine condition. Roeder emphasizes that no treatment provider indicated

that her neck pain was caused by a degenerative cervical spine condition. Her

arguments are unavailing.

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      The exclusion, framed in terms of symptoms for which a prudent person

would seek treatment, does not require a diagnosis during the look-back period.

Further, while the medical notes from the January 2020 urgent care visit were not a

model of clarity, they permit the conclusion that Roeder suffered symptoms and

received treatment for two separate complaints: antibiotics for a sinus infection and

injections and electrical stimulation for neck pain. Finally, we find no clear error

in the district court’s conclusion that Roeder’s medical records as a whole showed

her symptoms in January 2020 were caused by the later-diagnosed degenerative

cervical spine condition. See Anderson v. Bessemer City, 470 U.S. 564, 573–74

(1985) (“If the district court’s account of the evidence is plausible in light of the

record viewed in its entirety, the court of appeals may not reverse it even though

convinced that had it been sitting as the trier of fact, it would have weighed the

evidence differently. Where there are two permissible views of the evidence, the

factfinder’s choice between them cannot be clearly erroneous.”).2

      AFFIRMED.

      2
         Because we affirm the judgment of the district court based on the policy’s
symptom-based, “prudent person” exclusion provision, we need not address the
parties’ extensive arguments as to the policy’s other exclusion provisions.

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