R. Evans v. Sun Life & Health Ins. Co , 601 F. App'x 497 ( 2015 )

NOT FOR PUBLICATION
UNITED STATES COURT OF APPEALS FILED
FOR THE NINTH CIRCUIT APR 22 2015
MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS
R. JEFFREY EVANS, No. 13-55601
Plaintiff - Appellee, D.C. No. 8:11-cv-01516-CJC-FFM
v.
MEMORANDUM*
SUN LIFE & HEALTH INSURANCE
COMPANY, a Connecticut corporation,
Defendant - Appellant.
Appeal from the United States District Court
for the Central District of California
Cormac J. Carney, District Judge, Presiding
Argued and Submitted April 10, 2015
Pasadena, California
Before: KLEINFELD, BENAVIDES**, and CLIFTON, Circuit Judges.
Sun Life & Health Insurance Co. appeals from the district court’s judgment
awarding R. Jeffrey Evans past due benefits under his ERISA plan, attorneys’ fees,
*
This disposition is not appropriate for publication and is not precedent
except as provided by 9th Cir. R. 36-3.
**
The Honorable Fortunato P. Benavides, Senior Circuit Judge for the
U.S. Court of Appeals for the Fifth Circuit, sitting by designation.
costs, and interest. We have jurisdiction under 28 U.S.C. § 1291. We review de
novo the district court’s choice and application of the standard of review to
decisions by fiduciaries in ERISA cases. Abatie v. Alta Health & Life Ins. Co.,
458 F.3d 955, 962 (9th Cir. 2006) (en banc). We affirm.
Both parties agree that the plan gives Sun Life discretion to determine
eligibility for benefits. Thus, the district court correctly reviewed Sun Life’s
decision for abuse of discretion. Id. at 963. The review is generally limited to the
administrative record. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1090–91 (9th
Cir. 1999) (en banc). The district court did not abuse its discretion by not
expanding the record. Sun Life’s conflict of interest required more skeptical
judicial review. Montour v. Hartford Life & Accident Ins. Co., 588 F.3d 623, 631
(9th Cir. 2009).
Weighing all the facts and circumstances, we conclude that the district court
correctly found that Sun Life abused its discretion in denying Evans’s long-term
disability benefits application. The record, including the police officer’s
application for a 72-hour detention of Evans and Evans’s medical records, shows
that Evans became disabled before his employment was terminated, and that his
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psychiatric symptoms improved but not enough to return to work as a trial lawyer
during the 180-day elimination period. Sun Life exhibited bias against Evans,
including its failure to remedy the error caused by another patient’s record mixed
with Evans’s by having another physician review the corrected record despite its
acknowledgment that Evans was entitled to such review, its decision to conduct a
pure paper review, its failure to grapple with treating physicians’ and its own
psychiatrist’s earlier contrary determinations, and its purported reliance on
objective evidence when none could be adduced for the particular condition. See
Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 678 (9th Cir. 2011);
Montour, 588 F.3d at 634, 635.
Sun Life’s argument that the case should be remanded for determinations on
the amount of past due benefits is unsupported. See Grosz-Salomon v. Paul
Revere Life Ins. Co., 237 F.3d 1154, 1163 (9th Cir. 2001).
AFFIRMED.
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