Sara Maurer v. Reliance Standard Life Insuran ( 2012 )


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  •                             NOT FOR PUBLICATION
    UNITED STATES COURT OF APPEALS                           FILED
    FOR THE NINTH CIRCUIT                              DEC 10 2012
    MOLLY C. DWYER, CLERK
    SARA G. MAURER,                                  No. 11-16044               U.S. COURT OF APPEALS
    Plaintiff - Appellant,             D.C. No. 3:08-cv-04109-MMC
    v.
    MEMORANDUM*
    RELIANCE STANDARD LIFE
    INSURANCE COMPANY; THE LAW
    OFFICES OF SARA G. MAURER LONG
    TERM DISABILITY PLAN,
    Defendants - Appellees.
    Appeal from the United States District Court
    for the Northern District of California
    Maxine M. Chesney, Senior District Judge, Presiding
    Argued and Submitted December 3, 2012
    San Francisco, California
    Before: SILVERMAN, GRABER, and GOULD, Circuit Judges.
    Plaintiff Sara G. Maurer, the beneficiary of a long-term disability plan ("the
    Plan") that is governed by the Employee Retirement and Income Security Act of
    1974 ("ERISA"), challenges the discretionary decision of Defendant Reliance
    *
    This disposition is not appropriate for publication and is not precedent
    except as provided by Ninth Circuit Rule 36-3.
    Standard Life Insurance, the Plan’s administrator, to terminate her disability
    benefits. The district court held that Defendant did not abuse its discretion in
    terminating her benefits. Because we hold that Defendant permissibly applied the
    Plan’s "mental/nervous" limitation to terminate Plaintiff’s benefits, we affirm.
    1. We assume, without deciding, that we must apply a high level of
    skepticism in assessing whether Defendant abused its discretion. See Abatie v.
    Alta Health & Life Ins. Co., 
    458 F.3d 955
    , 965–69 (9th Cir. 2006) (en banc)
    (discussing the scope of our review in this context). Even applying a high level of
    skepticism, the record supports Defendant’s decision to terminate benefits.
    2. Defendant permissibly interpreted the "mental/nervous" limitation to
    preclude coverage when, in the absence of a mental or nervous disorder, a
    beneficiary would be physically capable of working. Defendant’s interpretation is
    consistent with the Plan’s limitation of coverage for disabilities that are "caused by
    or contributed to" by mental disorders. (Emphasis added.) The doctrine of contra
    proferentem does not apply "where, as here, the Plan grants the fiduciary explicit
    discretion to interpret the Plan." Winters v. Costco Wholesale Corp., 
    49 F.3d 550
    ,
    554 (9th Cir. 1995); accord Blankenship v. Liberty Life Assurance Co. of Boston,
    
    486 F.3d 620
    , 625 (9th Cir. 2007). Further, nothing in the text of the Plan specifies
    2
    that the limitation applies only when a mental disorder is the sole cause of a
    disability, as Plaintiff would interpret it.
    3. The record contains ample support for Defendant’s conclusion that, in the
    absence of any mental or nervous disorder, Plaintiff would be physically capable of
    working. Based on Plaintiff’s medical records, three doctors found that her
    psychological problems contributed to her disability. Dr. Hauptman concluded
    that "psychological factors including stress are the primary factors that correlate
    with [Plaintiff’s] reports of increasing musculoskeletal symptoms." Dr.
    Schofferman, although acknowledging that he lacked some important information
    about Plaintiff’s physical condition, had an "overall sense that without the
    psychiatric elements, the patient would be capable of work activity." And Dr.
    Birnbaum did not "find purely physical reasons for [Plaintiff’s] claim of disabling
    pain" but concluded that her "symptoms are primarily related to chronic pain and
    psychiatric dysfunction rather than inflammatory disease." Dr. Hines’ opinion that
    Plaintiff’s physical problems caused her mood disorder and Dr. Campagna’s
    opinion that there is a physical basis for Plaintiff’s disability are not inconsistent
    with Defendant’s conclusion that a mental disorder at least "contributed to" her
    disability. (Emphasis added.)
    3
    4. Because our holding that Defendant did not abuse its discretion in
    applying the "mental/nervous" limitation to terminate Plaintiff’s benefits is
    sufficient to affirm the judgment of the district court, we need not address the
    remaining issues presented and express no views about them.
    AFFIRMED.
    4
    

Document Info

Docket Number: 11-16044

Judges: Silverman, Graber, Gould

Filed Date: 12/10/2012

Precedential Status: Non-Precedential

Modified Date: 11/6/2024