Kevin Walker v. At&t Benefit Plan No. 3 ( 2023 )

NOT FOR PUBLICATION FILED
UNITED STATES COURT OF APPEALS MAY 15 2023
MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
KEVIN WALKER, No. 22-55450
Plaintiff-Appellant, D.C. No.
2:21-cv-00916-MCS-SK
v.
AT&T BENEFIT PLAN NO. 3; AT&T MEMORANDUM*
SERVICES, INC.,
Defendants-Appellees.
Appeal from the United States District Court
for the Central District of California
Mark C. Scarsi, District Judge, Presiding
Submitted May 11, 2023**
San Francisco, California
Before: MURGUIA, Chief Judge, and FRIEDLAND and BENNETT, Circuit
Judges.
In this Employee Retirement Income Security Act of 1974 (“ERISA”)
disability insurance case, Defendants-Appellees—AT&T Umbrella Benefit Plan
No. 3 and AT&T Services, Inc. (collectively “AT&T”)—denied Plaintiff-
*
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).
Appellant Kevin Walker long-term disability (“LTD”) benefits. Walker was a
participant in the self-funded AT&T West Disability Benefits Program, which is a
component of AT&T’s disability insurance plan (the “Plan”). After Sedgwick
Claims Management Services, Inc., the third-party administrator of the Plan,
denied Walker LTD benefits and denied Walker’s administrative appeal, Walker
sued AT&T in federal court. AT&T moved for summary judgment and Walker
moved for judgment following a bench trial. The district court ruled in AT&T’s
favor, concluding that Walker was not entitled to LTD benefits. Walker appealed.
We have jurisdiction under 28 U.S.C. § 1291, and we affirm.
1. As a participant of the Plan, Walker was eligible for LTD benefits if
the claims administrator determined that he was totally disabled, starting on the
first day immediately following fifty-two weeks of short-term disability benefits.
Under the Plan, a participant is eligible to receive LTD benefits if they have a
“sickness, injury or other medical, psychiatric or psychological condition that
prevents [them] from engaging in any occupation or employment for which [they]
are qualified or may reasonably become qualified, based on training, education or
experience.” A participant is “totally disabled” if they are “incapable of
performing the requirements of an occupation or employment other than an
occupation or employment with a base rate of pay that is less than 50 percent of
[their] Pay at the time [they] became entitled to Long-Term Disability Benefits.”
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To demonstrate that he was entitled to LTD benefits, Walker was required to
submit “[o]bjective medical information sufficient to show that [he] is Disabled.”
2. “In an appeal under ERISA, we review de novo a district court’s grant
of summary judgment, employing the same standard that governed the district
court’s review of the plan administrator’s decision.” Wolf v. Life Ins. Co. of N.
Am., 46 F.4th 979, 984 (9th Cir. 2022). Normally, a court only reviews denials of
claims for abuse of discretion, where its “review is limited to the record before the
plan administrator . . . .” Jebian v. Hewlett-Packard Co. Emp. Benefits Org.
Income Prot. Plan, 349 F.3d 1098, 1110 (9th Cir. 2003). Minor ERISA procedural
violations typically do not alter this standard of review, but when a plan
“administrator engages in wholesale and flagrant violations of the procedural
requirements of ERISA,” a court reviews “de novo the administrator’s decision to
deny benefits.” Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 971 (9th Cir.
2006) (en banc).
Walker argues that Sedgwick denied him a full and fair review by violating
several procedural requirements and by not considering all of Walker’s evidence.
The district court agreed with Walker that Sedgwick had made three procedural
errors. See Walker v. AT&T Benefit Plan No. 3, 2022 WL 1434668, at *4–6 (C.D.
Cal. Apr. 6, 2022). For instance, the district court concluded that Sedgwick
violated 29 C.F.R. § 2560.503-1(g)(1)(iii) because, before denying Walker’s
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appeal, Sedgwick failed to inform him that it needed his entire Social Security
Disability Insurance (“SSDI”) file. Id. at *5.
Although failing to consider the SSDI file is serious and could have
“prevented the administrative record from being fully developed or prevented . . . a
court from knowing all relevant facts,” O’Rourke v. N. Cal. Elec. Workers Pension
Plan, 934 F.3d 993, 1000 (9th Cir. 2019), the district court ultimately did consider
all the relevant facts, see Walker, 2022 WL 1434668, at *7–9. The district court,
“f[inding] all proposed new facts in [Walker’s] favor,” and “conduct[ing] a de
novo review,” still concluded that “[n]one of this [additional] evidence materially
disputes the evidence in the administrative record.” Id. at *7–8. And on appeal,
even assuming that Sedgwick’s procedural errors warrant de novo review, Walker
cannot show that plan administrators erred and that he is entitled to LTD benefits.
To start, Walker concedes that “[t]here is a general consensus about [his]
medical conditions and physical limitations” restricting him from “lifting, pushing,
or pulling greater than 20 lbs. and . . . frequent bending or stooping.”1 Despite this
consensus, Walker argues that he is totally “disabled by chronic pain.” Walker
1
Walker only takes issue with Dr. Vlachos’ report, contending that it is “internally
contradictory and demonstrably untrue in material respects.” However, the district
court “[d]iscount[ed] this report” and viewed “the rest of the evidence in the light
most favorable to [Walker],” and it still concluded that “the undisputed evidence
indicates that [Walker] could work a sedentary job where he did not have to lift
more than 20 pounds.” Walker, 2022 WL 1434668, at *6.
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contends that the record includes “objective findings of observable medical
conditions that are known to cause pain.” However, no doctor came to this
conclusion, including his own treating doctors. Accordingly, the record shows that
Walker could work with some restrictions.
Next, Walker contends that he cannot perform “any occupation” listed in the
transferable skills assessments (“TSAs”). Sedgwick’s termination letter cited eight
alternative occupations that Walker could perform, Sedgwick’s appeal denial letter
cited nine occupations that Walker could perform, and Sedgwick’s final TSA lists
two such jobs. Although the TSAs do vary without adequate explanation, the final
TSA lists two sedentary jobs that provide at least 50% of Walker’s prior pay that
he could perform given his physical limitations: Repair Order Clerk and Utility
Clerk Locator. Sedgwick concluded that it was “able to confirm [the] existence of
one of the two alternate occupation[s] identified” in the final TSA. Walker does
not dispute that he can physically perform these jobs; instead, he argues that the
TSAs “did not consider evidence that Walker’s training and experience in
[Information Technology] is obsolete.”
The Plan, however, only requires that Walker be “qualified or may
reasonably become qualified based on training, education, or experience” for “any
occupation.” Walker admits that he could become qualified with some additional
training: he states that “he would require at least one month of additional training
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to become qualified to perform the job of Repair Order Clerk, and at least 6
months an[d] up to a year of additional training to become qualified to perform the
occupation of Utility Clerk.” Accordingly, the record supports the conclusion that
there exists at least one occupation that Walker could become qualified to perform
given his physical work restrictions. See Pannebecker v. Liberty Life Assurance
Co. of Bos., 542 F.3d 1213, 1219 (9th Cir. 2008) (reiterating that the “language of
the ‘any occupation’ standard is not demanding” (quoting McKenzie v. Gen. Tel.
Co. of Cal., 41 F.3d 1310, 1317 (9th Cir. 1994)).2
In addition, Walker argues that his SSDI award is evidence supporting his
disability. “Social Security disability awards do not bind plan administrators, but
they are evidence of disability.” Salomaa v. Honda Long Term Disability Plan,
642 F.3d 666, 679 (9th Cir. 2011) (footnote omitted). First, the SSDI file
corroborates the medical consensus that Walker was generally limited to
occasionally lifting or carrying twenty pounds and frequently lifting or carrying ten
pounds. Second, the SSDI award does not show that Walker could not perform
any job without some reasonable training. The Plan and the Social Security Act
(“SSA”) have different disability requirements. For example, under the SSA, a
2
Walker argues at length that requiring additional training violates the plain
meaning of the Plan. However, Walker admits that the plain language of the Plan
only requires that Sedgwick show that there is “any occupation or employment for
which you are qualified or may reasonably become qualified, based on training,
education or experience.”
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person is disabled if “he is not only unable to do his previous work but cannot,
considering his age, education, and work experience, engage in any other kind of
substantial gainful work which exists in the national economy.” 42 U.S.C.
§ 1382c(a)(3)(B). This definition—unlike the Plan’s—does not include work
Walker could become qualified for given reasonable training, but rather only work
that he is already qualified to perform.
Accordingly, the district court did not err because the court considered
Walker’s supplemental evidence and conducted a de novo review and properly
concluded that the outcome remains the same. We therefore affirm the denial of
LTD benefits. See Wolf, 46 F.4th at 984.
3. Finally, Walker appeals the district court’s conclusion that he lacked
standing to bring an action for injunctive relief to prevent AT&T from placing an
equitable lien on certain funds received as an offset to any LTD benefits that were
overpaid. “For injunctive relief, which is a prospective remedy, the threat of injury
must be ‘actual and imminent, not conjectural or hypothetical.’” Davidson v.
Kimberly-Clark Corp., 889 F.3d 956, 967 (9th Cir. 2018) (citation omitted). That
is, the “threatened injury must be certainly impending to constitute injury in fact”
and “[a]llegations of possible future injury are not sufficient.” Clapper v. Amnesty
Int’l USA, 568 U.S. 398, 409 (2013) (citation omitted). Here, AT&T has not
threatened to take out an equitable lien and Walker points to nothing in the record
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to show that a lien is “certainly impending.” Id. Walker only argues that “AT&T
can at any point, and by any means” place a lien to collect on an overpayment.
Walker identifies no overpayment that he ever received, and, in any event, such
hypothetical future injury is insufficient. See id.***
AFFIRMED
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