Daniel Johnson v. Aetna Life Insurance Company ( 2018 )

FILED
NOT FOR PUBLICATION
DEC 10 2018
UNITED STATES COURT OF APPEALS MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
DANIEL JOHNSON, No. 17-55501
Plaintiff-Appellant, D.C. No.
5:15-cv-01940-MWF-DTB
v.
AETNA LIFE INSURANCE COMPANY; MEMORANDUM*
et al.,
Defendants-Appellees.
Appeal from the United States District Court
for the Central District of California
Michael W. Fitzgerald, District Judge, Presiding
Submitted December 3, 2018**
Pasadena, California
Before: RAWLINSON and BEA, Circuit Judges, and BASTIAN,*** District Judge.
*
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).
***
The Honorable Stanley Allen Bastian, United States District Judge for
the Eastern District of Washington, sitting by designation.
Plaintiff-Appellant Daniel Johnson appeals from the district court’s order
affirming Aetna Life Insurance Company (“Aetna”)’s denial of his short-term
disability benefits application. We have jurisdiction under 28 U.S.C. § 1291.
We review a district court’s “application of the standard of review to
decisions by fiduciaries in ERISA cases” de novo. Abatie v. Alta Health & Life
Ins. Co., 458 F.3d 955, 962 (9th Cir. 2006) (en banc). When an ERISA plan gives
the plan administrator discretion to interpret the terms of the plan, district courts
review decisions to deny disability benefits applications for an abuse of discretion.
Id. at 963. Here, the parties agree that FedEx’s self-funded employee welfare
benefit plan (the “Plan”) administered by Aetna confers discretion to Aetna to
interpret its terms. Thus, the district court correctly applied the abuse of discretion
standard.
In the ERISA context, an ERISA administrator abuses its discretion only if it
“(1) renders a decision without explanation, (2) construes provisions of the plan in a
way that conflicts with the plain language of the plan, or (3) relies on clearly
erroneous findings of fact.” Boyd v. Bert Bell/Pete Rozelle NFL Players Ret. Plan,
410 F.3d 1173, 1178 (9th Cir. 2005). Here, Johnson argues only that Aetna abused
its discretion because it ignored his doctors’ recommendations that he cannot or
should not lift more than 25 pounds, which most closely aligns to an argument that
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Aetna relied on clearly erroneous findings of fact when it denied Johnson disability
benefits.
Johnson argues that “Aetna never explained how Johnson could lift 75
pounds and drive a FedEx truck all day, every day,” but this ignores the standard
he must meet to qualify for disability benefits. To qualify for disability benefits
under the Plan, Johnson’s disability must be “substantiated by significant objective
findings which are defined as signs which are noted on a test or medical exam and
which are considered significant anatomical, physiological or psychological
abnormalities which can be observed apart from the individual’s symptoms.”
Johnson’s doctors opined that he cannot or should not lift 75 pounds, which
is an essential function of his job as a courier. Even so, these recommendations are
not significant objective findings as defined above; they are opinions based in part
on Johnson’s relation of pain complaints. The only objective finding that
Johnson’s doctors made that would support his claim for disability benefits is that
his MRI revealed he had a “lateral disc protrusion at L2-3 on the left and
degenerative changes at L4-5 and L5-S1” but no herniation. Although Dr.
Steinmann observed he suffered moderate discomfort when transferring from
sitting to standing and multiple doctors noted he had lumbosacral tenderness in his
back, these are subjective findings because they require input from the patient’s
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complaints of pain. Further, although Johnson repeatedly complained of back
pain, his subjective complaints cannot be used to prove he has an occupational
disability.
Apart from this evidence, Johnson’s doctors found that he was not in acute
distress; had satisfactory motor functions for all of his lower extremities; had
normal reflexes; could walk independently without assistance and had a normal
heel to toe gait; had normal coronal and sagittal plane alignments; and there was no
evidence of spinal orthosis, sensory defects, or neurological deficits.
Based on this evidence, Aetna’s physicians reasonably concluded that “there
was a lack of significant updated quantifiable physical examination findings from
any of the claimant’s treating providers to correlate with the claimant’s subjective
pain complaints to support a functional impairment from the claimant’s own
occupation.” Aetna did not rely on clearly erroneous findings of fact when it
concluded that Johnson was not entitled to disability benefits past November 10,
2014. Therefore, the district court properly found that Aetna did not abuse its
discretion in denying Johnson disability benefits after November 10, 2014.
AFFIRMED.
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