Michael Alves v. Hewlett-Packard Benefits Plan ( 2019 )


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  •                            NOT FOR PUBLICATION                           FILED
    UNITED STATES COURT OF APPEALS                       NOV 19 2019
    MOLLY C. DWYER, CLERK
    U.S. COURT OF APPEALS
    FOR THE NINTH CIRCUIT
    MICHAEL ALVES,                                  No.    18-55819
    Plaintiff-Appellant,            D.C. No.
    2:16-cv-09136-RGK-JEM
    v.
    HEWLETT-PACKARD                                 MEMORANDUM*
    COMPREHENSIVE WELFARE
    BENEFITS PLAN; HEWLETT-PACKARD
    ENTERPRISE COMPANY,
    Defendants-Appellees.
    Appeal from the United States District Court
    for the Central District of California
    R. Gary Klausner, District Judge, Presiding
    Submitted November 15, 2019**
    Pasadena, California
    Before: M. SMITH, MILLER, and COLLINS, Circuit Judges.
    Plaintiff-Appellant Alves challenges ERISA Plan Administrator Sedgwick’s
    (Sedgwick) termination of his short-term disability benefits, and denial of his
    *
    This disposition is not appropriate for publication and is not precedent
    except as provided by Ninth Circuit Rule 36-3.
    **
    The panel unanimously concludes this case is suitable for decision
    without oral argument. See Fed. R. App. P. 34(a)(2).
    application for long-term disability benefits, under the Hewlett Packard Enterprise
    Comprehensive Welfare Benefits Plan (Plan). Alves, a former technology
    consultant, suffers from congestive heart failure and other ailments. Sedgwick
    determined that Alves’s condition did not prevent him from continuing to perform
    his largely sedentary job duties. After a bench trial on the papers, the district court
    upheld Sedgwick’s decisions as to both types of benefits.
    We affirm the district court’s judgment insofar as it upholds Sedgwick’s
    termination of Alves’s short-term disability benefits under the Plan. Sedgwick’s
    determination that Alves was not “Totally Disabled,” and able to perform his
    sedentary work duties, was supported by the record and was not an abuse of
    discretion. See Salomaa v. Honda Long Term Disability Plan, 
    642 F.3d 666
    , 676
    (9th Cir. 2011) (quoting United States v. Hinkson, 
    585 F.3d 1247
    , 1262 (9th Cir.
    2009) (enbanc)).
    However, we vacate the district court’s judgment affirming the denial of
    Alves’s long-term disability benefits appeal, and remand to the district court with
    instructions to remand to Sedgwick for it to redo its evaluation and correctly apply
    the terms of the Plan. See Pannebecker v. Liberty Life Assurance Co. of Boston,
    
    542 F.3d 1213
    , 1221 (9th Cir. 2008) (citing Saffle v. Sierra Pac. Power Co.
    Bargaining Unit Long Term Disability Income Plan, 
    85 F.3d 455
    , 460–61 (9th Cir.
    1996)). Sedgwick abused its discretion in denying Alves’s appeal on the ground
    2
    that he failed to meet the one-week “waiting period” provided in the Plan, even
    though Alves, who validly received short-term benefits for several months, clearly
    met the requirement. See 
    Salomaa, 642 F.3d at 678
    .
    On remand, we remind Sedgwick that, to the extent that its decision is based
    on a medical judgment, it must “consult with a health care professional who has
    appropriate training and experience in the field of medicine involved in the
    medical judgment,” 29 C.F.R. § 2560.503-1(h)(3)(iii), and “who is neither an
    individual who was consulted in connection with the adverse benefit determination
    that is the subject of the appeal, nor the subordinate of any such individual,” 29
    C.F.R. § 2560.503-1(h)(3)(v).
    Accordingly, we PARTIALLY AFFIRM and PARTIALLY VACATE the
    district court’s judgment, and REMAND to the district court with instructions to
    remand to Sedgwick for a redetermination of Alves’s long-term disability benefits
    appeal. We award the costs on appeal to Alves. 29 U.S.C. § 1132(g)(1).
    3