Michael Alves v. Hewlett-Packard Benefits Plan

NOT FOR PUBLICATION FILED
UNITED STATES COURT OF APPEALS NOV 19 2019
MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
MICHAEL ALVES, No. 18-55819
Plaintiff-Appellant, D.C. No.
2:16-cv-09136-RGK-JEM
v.
HEWLETT-PACKARD MEMORANDUM*
COMPREHENSIVE WELFARE
BENEFITS PLAN; HEWLETT-PACKARD
ENTERPRISE COMPANY,
Defendants-Appellees.
Appeal from the United States District Court
for the Central District of California
R. Gary Klausner, District Judge, Presiding
Submitted November 15, 2019**
Pasadena, California
Before: M. SMITH, MILLER, and COLLINS, Circuit Judges.
Plaintiff-Appellant Alves challenges ERISA Plan Administrator Sedgwick’s
(Sedgwick) termination of his short-term disability benefits, and denial of his
*
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).
application for long-term disability benefits, under the Hewlett Packard Enterprise
Comprehensive Welfare Benefits Plan (Plan). Alves, a former technology
consultant, suffers from congestive heart failure and other ailments. Sedgwick
determined that Alves’s condition did not prevent him from continuing to perform
his largely sedentary job duties. After a bench trial on the papers, the district court
upheld Sedgwick’s decisions as to both types of benefits.
We affirm the district court’s judgment insofar as it upholds Sedgwick’s
termination of Alves’s short-term disability benefits under the Plan. Sedgwick’s
determination that Alves was not “Totally Disabled,” and able to perform his
sedentary work duties, was supported by the record and was not an abuse of
discretion. See Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 676
(9th Cir. 2011) (quoting United States v. Hinkson, 585 F.3d 1247, 1262 (9th Cir.
2009) (enbanc)).
However, we vacate the district court’s judgment affirming the denial of
Alves’s long-term disability benefits appeal, and remand to the district court with
instructions to remand to Sedgwick for it to redo its evaluation and correctly apply
the terms of the Plan. See Pannebecker v. Liberty Life Assurance Co. of Boston,
542 F.3d 1213, 1221 (9th Cir. 2008) (citing Saffle v. Sierra Pac. Power Co.
Bargaining Unit Long Term Disability Income Plan, 85 F.3d 455, 460–61 (9th Cir.
1996)). Sedgwick abused its discretion in denying Alves’s appeal on the ground
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that he failed to meet the one-week “waiting period” provided in the Plan, even
though Alves, who validly received short-term benefits for several months, clearly
met the requirement. See Salomaa, 642 F.3d at 678.
On remand, we remind Sedgwick that, to the extent that its decision is based
on a medical judgment, it must “consult with a health care professional who has
appropriate training and experience in the field of medicine involved in the
medical judgment,” 29 C.F.R. § 2560.503-1(h)(3)(iii), and “who is neither an
individual who was consulted in connection with the adverse benefit determination
that is the subject of the appeal, nor the subordinate of any such individual,” 29
C.F.R. § 2560.503-1(h)(3)(v).
Accordingly, we PARTIALLY AFFIRM and PARTIALLY VACATE the
district court’s judgment, and REMAND to the district court with instructions to
remand to Sedgwick for a redetermination of Alves’s long-term disability benefits
appeal. We award the costs on appeal to Alves. 29 U.S.C. § 1132(g)(1).
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