United States District Court, E.D. California
MEMORANDUM DECISION AND ORDER GRANTING
DEFENDANT’S MOTION FOR SUMMARY JUDGMENT AND GRANTING IN
PART AND DENYING IN PART PLAINTIFF’S MOTION FOR
ATTORNEY’S FEES, BENEFITS & INTEREST (DOCS. 85,
86)
LAWRENCE J. O’NEILL UNITED STATES CHIEF DISTRICT JUDGE
INTRODUCTION
Plaintiff
William Barnett (“Barnett”) commenced this action
under the Employee Retirement Income Security Act
(“ERISA”), 29 U.S.C. § 1001 et
seq., challenging the termination of his long-term
disability benefits by Defendant Southern California Edison
Long Term Disability Plan (“the Plan”). Judgment
was previously entered in the Plan’s favor. Doc. 55.
Following Barnett’s appeal, the Ninth Circuit vacated
the Court’s judgment and remanded for further
proceedings on one issue. Barnett v. So. Cal. Edison Co.
Long Term Disability Plan, 633 F. App’x 872 (9th
Cir. 2015) (Doc. 77); Doc. 82. Upon remand, Barnett has filed
a motion for attorney’s fees, benefits and interest
(Doc. 85) and the Plan has moved for summary judgment (Doc.
86). This matter is appropriate for resolution without oral
argument. See E.D. Cal. Civ. L.R. 230(g). Having
carefully considered the record in this case in light of the
relevant law, the Court GRANTS the Plan’s motion for
summary judgment and GRANTS IN PART and DENIES IN PART
Barnett’s motion for attorney fees, benefits and
interest.
BACKGROUND
I.
Facts[1]
Southern
California Edison Company (“Edison”) provides a
Long Term Disability (“LTD”) Plan[2] that is “designed to
provide partial income replacement to eligible full-time
employees who are disabled and unable to perform their
regular and customary job for the first two years of
disability, and any reasonable job for the company after two
years.” A.R. at 3553. Edison employees participating in
the Plan become eligible for LTD benefits after they have
been unable to perform their regular and customary job for
six continuous months. Id. at 3555. After two years
of disability, Plan participants must be “totally
disabled in order to remain eligible for benefits.”
Id.
The
Plan includes the following definitions:
Totally disabled means you are unable to perform any
reasonable job for the company due to illness or injury. Your
disability must be substantiated by medical evidence from a
qualified physician specializing in the area of your
disability …
…
A reasonable job is any gainful activity in any job
classification for which you are or may reasonably become
fitted by education, training, or experience. However, the
meaning of “reasonable job” varies among employee
groups depending on where the job is located. For employees
of Southern California Edison, a reasonable job is located at
any of the company within the zone (Northwestern, Basin,
Eastern) in which you were working on your last day of work.
Id. at 3355-56 (emphasis added). Under the Plan, the
Southern California Edison Company Benefits Committee
(“the Benefits Committee”) “has the full
and final power and discretionary authority to determine
eligibility for benefits, to determine covered benefits, and
to construe the terms and provisions of the plans …
[and] may … [i]nterpret, construe and apply the plan
provisions to decide all questions that arise.”
Id. at 3735.[3] The Benefits Committee delegated its
authority to Sedgwick Claims Management Services, Inc.
(“Sedgwick” or “the Administrator”),
which administered the Plan’s LTD claims at all
relevant times. Id. at 104-06, 2512-29, 3729.
Sedgwick has the discretion to review and evaluate all
medical evidence for Plan participants and make factual
determinations as to eligibility for LTD benefits.
Id. at 3556. The contract between the Plan and
Sedgwick was overseen by Deborah Jacobs
(“Jacobs”), a manager in Edison’s
Disability Management department. Jacobs 4/29/13 Decl.
¶¶ 1-2; PRMF ¶ 15.
From
1991 until June 2000, Barnett was employed by Edison as a
program manager at the San Onofre Nuclear Generating Station
(“SONGS”), located at 500 Pacific Coast Highway,
San Clemente, California 92674. A.R. at 1917-18, 2047-48. In
June 2000, Barnett left work because he had lower back
problems, which had led to surgery during the prior year.
PRMF ¶¶ 1-2. Barnett was certified as disabled, and
was eligible to participate in the Plan because he was unable
to perform his job for six consecutive months. PRMF ¶ 3;
A.R. at 904, 3553.
A
letter from the Plan, dated March 13, 2001, informed Barnett
that his application for LTD benefits had been approved
effective December 20, 2000. A.R. at 1244-45. The letter
provided, in relevant part:
You will continue to qualify for LTD benefits providing you
remain totally disabled, which is defined as unable to
perform any reasonable job for the Company. Periodically, you
will be required to submit medical evidence of your total
disability status. This may include a physical examination by
a doctor of the Company’s choice - one who specializes
in the area of your disability.
Id. at 1244.
In July
2009, based upon its review of Barnett’s medical
records, the Plan exercised its right to certify
Barnett’s eligibility for LTD benefits by having him
undergo an independent medical examination by Dr. Aubrey A.
Swartz, an orthopedic surgeon. PRMF ¶ 17; Neylan Decl.
¶ 3. Dr. Swartz prepared an Independent Medical
Evaluation detailing Barnett’s medical condition that
was subsequently forwarded to John C. Meyers, a vocational
rehabilitation consultant, who prepared a Transferable Skills
Analysis (“TSA”) report, dated August 2, 2009.
Neylan Decl. ¶ 4; A.R. at 1563-73 (copy of Dr.
Swartz’s report); A.R. at 1607-11 (copy of
Meyers’s TSA report). According to the referral letter,
Sedgwick requested a TSA report to help “make a
determination as to whether [Barnett] would be eligible for
continuing LTD benefits … [meaning that he] must be
unable to perform in any occupation as it may be performed
within their company based on certain criteria that will
ultimately be evaluated by [Edison].” A.R. at 1607.
After reviewing Barnett’s medical condition and
possible work accommodations, and comparing Edison’s
“library of job descriptions” to Barnett’s
profile, the TSA concluded Barnett could “reasonably
become fitted to perform the following occupation: Customer
Specialist 1.” Id. Additionally, “[w]ith
an adjustable work station which can be raised or lowered
… [Barnett] could perform other office occupations
such as Telephone Operator, Joint Pole Clerk and
Administrative Aide.” Id.
In a
letter dated August 26, 2009, Sedgwick informed Barnett that
it had determined that he was no longer eligible for LTD
benefits. Id. at 606-09. The letter explained that
pursuant to Dr. Swartz’s report, Barnett had “a
permanent incapacity that would require permanent work
restrictions, ” and the TSA, taking into consideration
these work restrictions, as well as Barnett’s training,
education, and experience, concluded that Barnett was capable
of performing the positions of Customer Specialist 1,
Telephone Operator, Joint Pole Clerk, or Administrative Aide
at Edison. Id. at 608-09. Thus, as Barnett was no
longer “precluded from performing any reasonable job at
[Edison] … [he] no longer [met] the definition of
disability.” Id. at 609. Finally, the letter
noted that Barnett’s LTD benefits claim would be
terminated effective October 1, 2009, and apprised him of his
right to appeal the decision. Id.
On
November 16, 2009, Barnett formally appealed the termination
of his benefits. Id. at 1320-21. As part of the
appeals process, a panel of six doctors reviewed
Barnett’s medical records, and Sedgwick requested that
Myers prepare a supplemental TSA report, which compared the
updated information on Barnett’s medical condition with
Edison’s library of job descriptions. Id. at
1043-45. The updated TSA, dated March 30, 2010, found that
Barnett could “reasonably become fitted to
perform” two occupations: Customer Service Specialist 1
and Telephone Operator. Id. at 1045.
On
March 29, 2010, Dorene Barker (“Barker”), an
Appeals Specialist with Sedgwick emailed Bob Kowal, who was
at SONGS, to see if SONGS could accommodate Barnett’s
work restrictions. Id. at 1352. At some point, it
was confirmed that SONGS could accommodate Barnett’s
work restrictions, but a job was not immediately available at
that time. Id. at 1356. In an email dated April 5,
2010, Jacobs informed Barker that the statement that SONGS
could accommodate Barnett could be used as a basis to find
that Barnett was no longer disabled, under the Plan.
Id. Jacobs further wrote, “[t]he letter does
not need to mention anything about job availability - but
maybe modify it a bit to not say he is expected to report
back to work right away and just that he needs to contact his
work location about his return to work.” Id.
Barker subsequently prepared a letter upholding the denial of
Barnett’s LTD benefits. Id.
In a
letter dated April 7, 2010, Sedgwick denied Barnett’s
appeal. Id. at 766-69. The letter noted the
TSA’s finding that Barnett could reasonably become
fitted to perform the positions of Customer Specialist 1 and
Telephone Operator, and that “it was confirmed that Mr.
Barnett’s restrictions could be accommodated by his
work location.” Id. at 768. The letter
continued: “Based on the Independent Medical
Examination, the [TSA], the Panel Reviews and the medical
documentation in Mr. Barnett’s file, the objective
medical evidence failed to support an impairment that
precluded him from performing ‘any reasonable
job’ at Edison International as of October 1,
2009.” Id. at 769. The letter concluded that
because Barnett was no longer precluded from performing any
“reasonable job” with Edison, and was no longer
eligible to receive LTD benefits, the denial of his LTD
benefits was in accordance with the Plan. Id.
Finally, the letter apprised Barnett of his right to file a
civil action under ERISA § 502(a). Id.
II.
Procedural History
Barnett
filed the original complaint in this case on January 27,
2012, alleging three causes of action under ERISA. Doc. 1.
The first cause of action sought to bar the Plan from relying
upon the 180-day contractual limitation as a defense against
the suit; the second cause of action alleged that the Plan
denied Barnett a full and fair review of his claim; and the
third cause of action sought equitable relief on account of
the Plan’s alleged failure to provide Barnett a full
and fair review of his claim. See id. The Court
granted summary judgment in favor of Barnett on the first
cause of action, and permitted the second and third causes of
action to proceed to trial. Doc. 34 at 19.
In a
Pre-Trial Conference Order on July 8, 2013, the Court
dismissed Barnett’s third cause of action because it
determined that this claim was a “repackaged version of
his second cause of action.” Doc. 38 at 1-2. At the
Pre-Trial Conference held on July 11, 2013, the parties
agreed to forego trial and submit briefs on the one remaining
issue of whether, based solely on review of the
administrative record, the Plan abused its discretion by
terminating Barnett’s LTD benefits. Doc. 40 at 15.
In
Barnett’s reply brief, he raised for the first time the
argument that there was no evidence in the record regarding
the “zone” in which he worked or that the two
jobs identified by Myers in the TSA were in that
“zone.” Plaintiff’s Response to
Defendant’s Undisputed Material Facts and Supporting
Evidence (“PRSSUMF”) ¶¶ 14-15; Doc. 53
at 5. Barnett’s reply brief was the last brief
submitted before the Court rendered its first decision in
this case. Id.
On
August 26, 2013, the Court issued a memorandum decision
finding that the Plan did not abuse its discretion in
terminating Barnett’s LTD benefits, and entered
judgment in favor of the Plan. Docs. 55, 56. This judgment
did not address the “zone” issue.[4]
Barnett
filed a notice of appeal on September 9, 2013. Doc. 59. On
appeal, Barnett made, inter alia, the following
arguments: (1) that his LTD benefits could not be terminated
unless and until he was offered a job by Edison; (2) Sedgwick
abused its discretion when it determined that there was a
reasonable job Barnett could perform; and (3) Sedgwick abused
its discretion when it implicitly determined that the
reasonable job was within the proper “zone.”
See Doc. 77.
On
November 2, 2015, the Ninth Circuit issued an order directing
both parties to file supplemental briefs addressing
“whether there is evidence in the record to support a
determination that a job Barnett could perform was
‘within the zone (Northwestern, Basin, or Eastern) in
which [he was] working on [his] last day of
work.’” Doc. 85-2, Ex. 4. The Plan argued that
Sedgwick specifically noted that at the appeals denial stage,
it determined that that SONGS could accommodate
Barnett’s work restrictions and thus, he would be able
to work at the same location he worked at previously, and
that a job at SONGS would be “within the same zone in
which he was working at the time of disability.”
Id., Ex. 5. Barnett pointed out that the
administrative record contained no mention of the
“zone” in which Barnett last worked, and thus, it
is impossible for the Plan to prove that the Customer Service
Specialist 1 and Telephone Operator positions identified by
Myers in the TSA were within the “zone” in which
Barnett last worked. Id., Ex. 6.
In its
memorandum decision and order, dated December 7, 2015, the
Ninth Circuit found as follows:
After our careful review of the record, we are unable to say
that the Administrator abused its discretion when it
determined that there was a reasonable job that Barnett could
perform. However, the Administrator did abuse its discretion
when it implicitly determined that the job in question was
within the proper zone. Simply put, there was no evidence of
the zone in which the reasonable job was located, nor was
there explicit evidence of the zone in which Barnett worked.
As a result, the termination of benefits was improper and we
must vacate the district court’s determination and
remand for further proceedings.
Id. at 5. The mandate of the Ninth Circuit issued on
December 30, 2015. Doc. 79.
On
January 25, 2016, this Court requested clarification
“as to whether the ‘further proceedings’
called for in the Ninth Circuit’s opinion are limited
to calculating back-benefits and fees, or alternatively,
whether augmentation of the record is permitted on the merits
of the ‘zone’ issue.” Doc. 81. The Ninth
Circuit responded:
(1) As the district court indicated, we upheld its prior
rulings with the exception of the zone ruling. Our
disposition and mandate were not intended to restrict the
district court’s sound discretion and judgment as to
the handling of any remaining issues presented by the parties
as the case proceeds.
(2) We note, in particular, that we do not intend to indicate
that the district court may not give further consideration to
the zone issue, which may include remand to the Plan
Administrator for further exercise of its discretion
regarding construction of the Plan document and further
explication of its decision in light of that construction, if
the district court deems that necessary or appropriate in
light of the presentation by the parties.
Doc. 82, at 1-2.
On
February 26, 2016, the parties filed a joint status report
regarding the nature and extent of any necessary further
proceedings, in which they submitted that cross-motions for
summary judgment regarding the “zone” issue are
necessary to resolve this case. Doc. 84.
Barnett
filed his motion for attorney’s fees, benefits and
interest (Doc. 85), which contains a motion for summary
judgment, [5] on
March 21, 2016; the Plan cross-moved for summary judgment the
same day (Doc. 86). Oppositions were filed April 4, 2016
(Docs. 87, 88), and Barnett filed a reply on April 11, 2016
(Doc. 89).
SUMMARY
JUDGMENT ON THE ZONE ISSUE
I.
Standard of Review
“Traditional
summary judgment principles have limited application in ERISA
cases governed by the abuse of discretion standard.”
Sephan v. Unum Life Ins. Co. of Am., 697 F.3d 917,
929 (9th Cir. 2012) (citing Nolan v. Heald College,
551 F.3d 1148, 1154 (9th Cir. 2009)). Where “the abuse
of discretion [standard] applies in an ERISA benefits denial
cases, a motion for summary judgment is, in most respects,
merely the conduit to bring the legal question before the
district court and the usual tests of summary judgment, such
as whether a genuine dispute of material fact exists, do not
apply.” Id. (internal citation and quotation
marks omitted); see also Gilliam v. Nevada Power
Co., 488 F.3d 1189, 1192 n.3 (9th Cir. 2007) (internal
citation omitted). “Thus, a summary judgment motion
resting on the administrative record is not a typical summary
judgment, but rather, is a procedural vehicle for determining
whether benefits were properly granted or denied.”
Nalbandian v. Lockheed Martin Corp., No.
10-cv-1242-LHK, 2011 WL 3881473, at *5 (N. D. Cal. Sept. 1,
2011).
Here,
as both parties have moved for summary judgment, the Court
must consider each motion on its own merits, and “must
consider the appropriate evidentiary material identified and
submitted in support of both motions, and in opposition to
both motions, before ruling on each of them.” Fair
Hous. Council of Riverside Cty., Inc. v. Riverside
Two, 249 F.3d 1132, 1134 (9th Cir. 2001). The court also
must “rule[] on each party’s motion on an
individual and separate basis, determining for each side,
whether a judgment may be entered in accordance with the Rule
56 standard.” Tulalip Tribes of Wash. v.
Wash., 783 F.3d 1151, 1156 (9th Cir. 2015)
II.
Analysis
a.
Augmentation of the Record Following Remand
The
Plan offers extrinsic evidence for the Court’s
consideration on remand-specifically, testimonial and
documentary evidence from Jacobs as to how Edison determined
zones under the Plan and how Edison determined the zone for
SONGS employees; and documentary evidence from Lorie Obal, a
senior business analyst at Edison, demonstrating that
Customer Specialist I and Telephone Operator positions
existed at Edison in a certain zone during the relevant
times.[6] In
ERISA cases applying the abuse of discretion[7] standard, the district
court is generally confined to the evidentiary record before
the plan administrator and may not consider extrinsic
evidence. Abatie v. Alta Health & Life Ins. Co.,
458 F.3d 955, 970 (9th Cir. 2006) (en banc). While there are
some exceptions to this general rule, see id. at
972-73, neither the Plan nor Barnett has objected to
augmentation of the record in this case. In fact, both
parties premise their legal arguments upon the Plan’s
newly submitted evidence. See Doc. 85-1 at 6-7; Doc.
86-1 at 7-17. The parties have therefore waived any objection
they may have to the Court’s consideration of this
evidence. See FDIC v. Garner, 126 F.3d 1138, 1145,
(9th Cir. 1997) (finding that the failure to present any
argument or pertinent authority waives the argument);
accord Pelfresne v. Village of Williams Bay, 917
F.2d 1017, 1023 (7th Cir. 1990) (“A litigant who fails
to press a point by supporting it with pertinent authority,
or by showing why it is sound despite a lack of supporting
authority… forfeits the point. We will not do his
research for him.”). For these reasons, the Court will
treat the Plan’s extrinsic evidence as if it were part
of the original administrative record in this case. See
Abatie, 458 F.3d at 972-73.
b. The
Law of the Case and Rule of Mandate
A key
undisputed fact in this case is that SONGS, the location at
which Barnett last worked, “is unique among [Edison]
jobsites in that it sits on land leased from Camp Pendleton
and as such is located on a federal enclave.”
See Doc. 85-1 at 1; Doc. 86-1, at 5; PRSSUF ¶
39. SONGS is therefore not technically part of any Edison
service territory. Jacobs 3/18/16 Decl. ¶ 8. Included as
an exhibit to Jacobs’s declaration is a map entitled
“Disability Program Geographic Zones, ” which
indicates that it is used by Edison’s LTD Plan and
depicts three “zones” in the Southern California
area: Northern, Eastern, and Central. Jacobs 3/18/16 Decl.,
Ex. 3. The map does not indicate the location of SONGS.
See Id. The Plan advances two possible ways to
interpret the zone issue in light of its admission that SONGS
is not depicted on the map and does not technically belong to
a zone. Doc. 86-1 at 8. First, the Plan argues that “a
position existing in a contiguous geographic zone would meet
the zone requirement for employees at SONGS.”
Id. Second, the Plan argues that “a job that
exists at [Barnett]’s own former work location would be
considered within the same zone in which he was working on
the date of disability.” Id. at 9.
Barnett
contends that the Plan’s post-remand interpretations of
the zone issue are impermissible under the rule of mandate
and law of the case doctrines. Doc. 85-1 at 5-6 (citing
Hall v. City of Los Angeles, 697 F.3d 1059, 1067
(9th Cir. 2012), and United States v. Thrasher, 483
F.3d 977, 982 (9th Cir. 2000)). In light of the Plan’s
admission that SONGS does not technically belong to a zone,
Barnett submits that the jobs in question are thus
not in the zone in which he last worked, by a
literal reading of the word. Id. Barnett argues that
the Ninth Circuit’s mandate “does not permit [the
Plan] to change its theory of the case and argue that it is
not necessary to prove that Barnett was in a specific
zone” and then interpret the plan “to eliminate
the need to place Barnett within one of the three company
zones.” Id. at 7; Doc. 89 at 6-7.
The
Court disagrees with Barnett’s law of the case and rule
of mandate argument as precluding the Plan from setting forth
its new legal theories following remand. “The law of
the case doctrine … generally precludes a court from
reconsidering an issue decided previously by the same court
or by a higher court in the identical case.”
Hall, 697 F.3d at 1067. “The issue in question
must have been decided explicitly or by necessary implication
in the previous disposition.” Id. The aim of
the law of the case doctrine is to promote consistency,
finality, and efficiency. Thrasher, 483 F.3d at 982.
A related doctrine, the rule of mandate, shares these goals
and serves to limit “the district court’s
‘authority’ on remand, ” and obligates the
district court to carry the higher court’s order
“into execution according to the mandate.”
Id. However, the district court “may consider
and decide any matters left open by the mandate of [the
higher court].” Id. (quoting In re Sanford
Fork & Tool Co., 160 U.S. 247, 255-56 (1895));
see also United States v. Kellington, 217 F.3d 1084,
1092-93 (9th Cir. 2000) (“In construing a mandate, the
lower court may consider the opinion the mandate purports to
enforce as well as the procedural posture and substantive law
from which it arises”).
Here,
the parameters of the law of the case and the rule of mandate
now before the Court are set forth clearly in the Ninth
Circuit’s memorandum decision vacating and remanding
the judgment in favor of the Plan (Doc. 77), and its
subsequent clarification order (Doc. 82). The Ninth
Circuit’s decision held that Sedgwick abused its
discretion “when it implicitly determined that the job
in question was within the proper zone, ” as there was
“no evidence of the zone in which the reasonable job
was located, nor was there explicit evidence of the zone in
which Barnett worked.” Doc. 77 at 4. In its
clarification request, the Court specifically inquired as to
whether further proceedings were either “limited to
calculating back-benefits and fees, or,
alternatively, whether augmentation of the record is
permitted on the merits of the ‘zone’
issue.” Doc. 81 at 2 (emphasis added). The Ninth
Circuit responded by expressly permitting the Court to
“give further consideration to the zone issue, ”
(Doc. 82 at 2), and noted that its “disposition and
mandate were not intended to restrict the district
court’s sound discretion and judgment as to the
handling of any remaining issues presented by the parties as
the case proceeds.” Id. The Ninth Circuit also
noted in particular that it did not intend to indicate that
the Court could not give further consideration to the zone
issue. Doc. 82 at 2.
When
considered collectively, the Ninth Circuit’s opinion
only addresses the quantum of proof present in the
then-existing record and the clarification order permits the
Court to resolve the zone issue by considering the
Plan’s arguments and evidence on remand concerning the
issue. The Plan’s new arguments following remand
concerning the zone issue are therefore not foreclosed by the
law of the case doctrine or the rule of mandate, because the
only issue explicitly decided by the Ninth Circuit is that
Sedgwick’s implicit determination that the jobs were
within the zone where Barnett last worked was unsupported by
the administrative record before the Court. See Doc.
77 at 4. Accordingly, the Ninth Circuit’s decision
permits further factual development as to the zone issue on
remand and allows the Court to consider the Plan’s
submitted evidence and its argument that this evidence
provides a reasonable basis for the termination of
Barnett’s LTD benefits. The Court must now determine
whether the reasonable jobs Barnett was capable of performing
were within the zone in which he last worked.
c.
Whether There Were Customer Service Specialist I and
Telephone Operator Positions[8] in the Zone Where Barnett Last Worked
“When
reviewing interpretive challenges for abuse of discretion,
the Court closely reads contested terms and ‘appl[ies]
contract principles derived from state law [, ] …
guided by the policies expressed in ERISA and other federal
labor laws.’” Tapley v. Locals 302 and 612 of
Intern. Union of Operating Engineers-Employers Const. Indus.
Ret. Plan, 728 F.3d 1134, 1140 (9th Cir. 2013) (quoting
Richardson v. Pension Plan of Bethlehem Steel Corp.,
112 F.3d 982, 985 (9th Cir. 1997)). Under the abuse of
discretion standard, “the decision of an administrator
will not be disturbed unless the court determines that the
decision was arbitrary or capricious.” Horn v.
Provident Life & Acc. Ins. Co., 351 F.Supp.2d 954,
958 (N.D. Cal. 2004) (citing McKenzie v. General Tel. Co.
of Cal., 41 F.3d 1310, 1316 (9th Cir. 1994) and
Clark v. Wash. Teamsters Welfare Trust, 8 F.3d 1429,
1431 (9th Cir. 1993)). “The touchstone of
‘arbitrary and capricious’ conduct is
unreasonableness.” Clark, 8 F.3d at 1432. An
ERISA plan administrator’s decision will be upheld if
it is grounded “‘in any reasonable
basis.’” Pac. Shores Hosp. v. United
Behavioral Health, 764 F.3d 1030, 1041-42 (9th Cir.
2014) (emphasis in original) (quoting Horan v. Kaiser
Steel Ret. Plan, 947 F.2d 1412, 1417 (9th Cir. 1991);
see also Conkright v. Frommert, 559 U.S. 506, 521
(2010) (internal citations omitted) (“Applying a
deferential standard of review does not mean that the plan
administrator will prevail on the merits. It means only that
the plan administrator’s interpretation will not be
disturbed if reasonable.”). On the other hand,
“ERISA plan administrators ‘abuse their
discretion if they render decisions without any explanation,
… construe provisions of the plan in a way that
conflicts with the plain language of the plan’ or
‘rel[y] on clearly erroneous findings of
fact.’” Day v. AT&T Disability Income
Plan, 698 F.3d 1091, 1096 (9th Cir. 2012) (quoting
Taft v. Equitable Life Assurance Soc’y, 9 F.3d
1469, 1472-73 (9th Cir. 1994)); see also Salomaa v. Honda
Long Term Disability Plan, 642 F.3d 666, 676 (9th Cir.
2011) (finding that the plan administrator abused its
discretion where its decision “was illogical,
implausible, and without support in inference that could
reasonably be drawn from facts in the record”).
Finally, the doctrine of contra proferentem, which
provides that “ambiguities are to be construed
unfavorably to the drafter, ” Black’s Law
Dictionary 377 (9th ed. 2009), “does not apply when a
plan ‘grants the administrator discretion to construe
its terms.’” Day, 698 F.3d at 1098
(citing Blankenship v. Liberty Life Assur. Co. of
Boston, 486 F.3d 620, 625 (9th Cir. 2007)).
The
Plan first argues that the existence of Customer Service
Specialist I and Telephone Operator positions in the
“Central zone”[9] at the relevant times constitutes a
sufficiently “reasonable basis” to sustain
Sedgwick’s termination of Barnett’s LTD benefits.
Conkright, 559 U.S. at 521. In support of this
Central zone argument, the Plan has submitted the following
evidence, in the form of a sworn declaration from Jacobs, who
oversaw the day-to-day administration for the Plan, attesting
that:
1) “[f]or purposes of determining ‘zones’
under the Plan, [Edison] relied in part on the Utility
Workers Union of America (‘UWUA’) map of
‘Disability Program Geographic Zones, ’”
which references a “Northern” zone, an
“Eastern” zone, and a “Central” zone;
2) the “Central” zone covers Los Angeles and
surrounding areas, extending south to El Toro, and includes
Rosemead and Long Beach;
3) SONGS “is not pictured on the zone map because it is
technically not part of [Edison] service territory, by virtue
of sitting on a federal enclave”;
4) “in practice, SONGS employees were treated as being
part of the Central zone as it is contiguous with SONGS and
is the zone closest to the SONGS location.”
Jacobs 3/18/16 Decl. ¶¶ 7-9. The Plan then points
out that Customer Specialist I and Telephone Operator
positions existed within the Central zone at locations within
approximately sixty miles from SONGS at the times relevant to
the decision to terminate Barnett’s benefits and the
appeal. Doc. 86-1 at 8-9. Specifically, the Plan highlights a
Customer Specialist I position located in Long Beach,
approximately 52.5 miles away from SONGS, ...