Sharon Seleine v. Fluor Corporation Long-Term Di ( 2010 )

NOT FOR PUBLICATION
UNITED STATES COURT OF APPEALS FILED
FOR THE NINTH CIRCUIT NOV 29 2010
MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS
SHARON SELEINE, No. 09-55257
Plaintiff - Appellant, D.C. No. 8:07-cv-01214-VBK
v.
MEMORANDUM*
FLUOR CORPORATION LONG-TERM
DISABILITY PLAN, an ERISA plan,
Defendant - Appellee.
Appeal from the United States District Court
for the Central District of California
Victor B. Kenton, Magistrate Judge, Presiding
Argued and Submitted September 2, 2010
Pasadena, California
Before: KOZINSKI, Chief Judge, O’SCANNLAIN and GOULD, Circuit Judges.
Sharon Seleine appeals from the district court’s judgment in favor of the
Fluor Corporation Long-Term Disability Plan (“Plan”) after a bench trial. The
Plan terminated Seleine’s disability benefits after the administrator, Life Insurance
Company of North America (“LINA”), determined that she did not meet the Plan’s
*
This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
“any occupation” definition of disability. The facts are known to the parties and
will not be repeated here except to the extent necessary.
I
Seleine contends that the district court misapplied the abuse-of-discretion
standard of review by failing to accord sufficient weight to LINA’s structural
conflict. Such conflict bears little weight, however, absent evidence that it “tainted
the entire administrative decisionmaking process.” Montour v. Hartford Life &
Accident Ins. Co., 588 F.3d 623, 631 (9th Cir. 2009). The district court’s
conclusion that such evidence is lacking was not clearly erroneous. Furthermore,
even if Seleine were correct, remand would not be required given the district
court’s alternative holding that it would uphold the benefits decision on de novo
review. See Pannebacker v. Liberty Life Assurance Co. of Bos., 542 F.3d 1213,
1218 (9th Cir. 2008).
II
We reject the contention that Seleine was entitled to “any occupation”
benefits merely because she was awarded “own occupation” benefits under the
Plan in a prior action. Because the definition of disability under the “any
occupation” standard is more stringent and covers a later time period, Seleine’s
entitlement to “own occupation” benefits lacks any preclusive effect in this action.
2
See United States v. Edwards, 595 F.3d 1004, 1013 (9th Cir. 2010); accord Muniz
v. Amec Constr. Mgmt., Inc., No. 09-55689, 2010 WL 4227877, at *5 (9th Cir. Oct.
27, 2010) (noting that the initial determination that a claimant is disabled does not
“operate[] forever as an estoppel so that an insurer can never change its mind”
(internal quotation marks omitted)). Nor does the law of the case help Seleine,
since entitlement to “any occupation” benefits was not considered or decided in the
prior action. See United States v. Cote, 51 F.3d 178, 181 (9th Cir. 1995).
III
The district court correctly held that LINA’s decision to terminate Seleine’s
benefits was not an abuse of discretion. LINA ordered an independent medical
examination, and the examiner concluded that Seleine’s “significant subjective
complaints” were “grossly disproportionate to her objective findings.” ER 147.
During the forty-minute examination, Seleine did not display any pain or distress
while sitting, standing, or walking, despite her claims of debilitating neck and back
pain. The examiner noted that Seleine’s x-rays and MRI “revealed only
degenerative changes, reasonably consistent with [her] age.” Id. The examiner
therefore concluded that Seleine was able to sit continuously for fifty minutes per
hour, with a ten-minute break to reduce stiffness. A peer reviewer agreed with the
conclusions of the independent medical examiner, and a vocational expert
3
identified several sedentary occupations that Seleine could perform in light of her
training, education, and experience. LINA reasonably determined from this
information that Seleine was not disabled under the “any occupation” definition.
LINA was not required to credit the opinions of Seleine’s treating physicians
or the neurosurgeon hired by her lawyer. See Black & Decker Disability Plan v.
Nord, 538 U.S. 822, 831 (2003). Nor was LINA bound by the Social Security
Administration’s decision to award Seleine disability benefits.1 See Montour, 588
F.3d at 635. We are unpersuaded that LINA’s decision to rely on other evidence
meant that it ignored Seleine’s evidence or reached a biased result. Rather, its
decision was well within the discretion granted to it as the plan administrator. Id.at 629–30.
IV
For the foregoing reasons, we conclude that the district court did not err in
upholding LINA’s termination of Seleine’s disability benefits.
AFFIRMED.
1
Although LINA failed to explain why it reached a different conclusion than
the Social Security Administration, we are satisfied that such failure did not taint
the decisionmaking process given the significant differences between the benefits
determinations under the Social Security Act and under an ERISA plan. See Black
& Decker Disability Plan, 538 U.S. at 832–34.
4