Theresa Leonard v. Metlife Insurance Company , 645 F. App'x 544 ( 2016 )

FILED
NOT FOR PUBLICATION MAR 23 2016
MOLLY C. DWYER, CLERK
UNITED STATES COURT OF APPEALS U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
THERESA LEONARD, No. 14-55049
Plaintiff - Appellant, D.C. No. 2:12-cv-10003-SVW-SS
v.
MEMORANDUM*
METLIFE INSURANCE COMPANY,
Defendant - Appellee.
THERESA LEONARD, No. 14-55141
Plaintiff - Appellee, D.C. No. 2:12-cv-10003-SVW-SS
v.
METLIFE INSURANCE COMPANY,
Defendant - Appellant.
Appeal from the United States District Court
for the Central District of California
Stephen V. Wilson, District Judge, Presiding
Argued and Submitted March 11, 2016
Pasadena, California
*
This disposition is not appropriate for publication and is not precedent
except as provided by 9th Cir. R. 36-3.
Before: REINHARDT, MURGUIA, and OWENS, Circuit Judges.
In No. 14-55049, Plaintiff Theresa Leonard appeals from the district court’s
judgment entered against her in an action for disability benefits brought under the
Employee Retirement Income Security Act of 1974 (ERISA). In No. 14-55141,
Defendant MetLife Insurance Company (MetLife) cross-appeals from the district
court’s holding that Plaintiff’s action was not barred by the statute of limitations.
As the parties are familiar with the facts, we do not recount them here. We affirm
in No. 14-55049, and we dismiss MetLife’s cross-appeal in No. 14-55141.
1. We have jurisdiction over Plaintiff’s appeal under 28 U.S.C. § 1291,
and affirm the district court’s judgment entered against Plaintiff. The district court
properly concluded that Plaintiff was required to exhaust her administrative
remedies before bringing this action. Although not specifically mandated by
ERISA, this court requires an ERISA plaintiff to avail “herself of a plan’s own
internal review procedures before bringing suit in federal court.” Vaught v.
Scottsdale Healthcare Corp. Health Plan, 546 F.3d 620, 626 (9th Cir. 2008)
(quoting Diaz v. United Agric. Emp. Welfare Plan & Tr., 50 F.3d 1478, 1483 (9th
Cir. 1995)). A plaintiff can forgo this exhaustion requirement, however, when
exhausting administrative remedies would be futile or a plan does not establish or
2
follow claims procedures as required by ERISA. See id. at 626-27. Here, Plaintiff
failed to show that either exception applied.
First, Plaintiff failed to show that appealing MetLife’s determination through
the process outlined in the plan was “demonstrably doomed to fail.” Diaz, 50 F.3d
at 1485. Plaintiff’s argument that appealing would have been futile because
MetLife was bent on denying her benefits is belied by the record. MetLife had
previously reversed a claims determination when Plaintiff followed the appeals
process outlined in the plan. Furthermore, the record shows that MetLife made
several attempts to collect additional information to determine whether Plaintiff
qualified for benefits during the Any Occupation Period. Plaintiff also argues that
exhausting her administrative remedies would have been futile because MetLife
had all of the information that it needed. As MetLife explained, however, the
definition of “disabled” changed during the Any Occupation Period and MetLife
needed updated medical records. Even assuming that MetLife had all of the
information it needed, that does not excuse Plaintiff from failing to appeal based
on the assumption that an appeal would have been futile, especially in light of
MetLife’s previous reversal of its claim determination.
Second, Plaintiff failed to show that MetLife’s claim procedures violated
ERISA. Specifically, the record does not support Plaintiff’s contention that
3
MetLife’s denial letter failed to provide a basis for the denial. MetLife’s letter
outlined its reasoning for denying her benefits under the Any Occupation Period.
Furthermore, Plaintiff fails to support her argument with persuasive authority that
she is entitled to this exception because MetLife failed to consult with a vocational
expert before making its claim determination.
2. Defendant brings a cross-appeal to challenge the district court’s
holding that Plaintiff’s action was not barred by the applicable statute of
limitations. However, because Defendant’s cross appeal challenges a ruling, and
not a judgment, we lack jurisdiction to hear it. Accordingly, we dismiss the cross-
appeal in No. 14-55141.
No. 14-55049: AFFIRMED.
No. 14-55141: DISMISSED.
4