NOT FOR PUBLICATION
UNITED STATES COURT OF APPEALS FILED
FOR THE NINTH CIRCUIT DEC 10 2012
MOLLY C. DWYER, CLERK
SARA G. MAURER, No. 11-16044 U.S. COURT OF APPEALS
Plaintiff - Appellant, D.C. No. 3:08-cv-04109-MMC
v.
MEMORANDUM*
RELIANCE STANDARD LIFE
INSURANCE COMPANY; THE LAW
OFFICES OF SARA G. MAURER LONG
TERM DISABILITY PLAN,
Defendants - Appellees.
Appeal from the United States District Court
for the Northern District of California
Maxine M. Chesney, Senior District Judge, Presiding
Argued and Submitted December 3, 2012
San Francisco, California
Before: SILVERMAN, GRABER, and GOULD, Circuit Judges.
Plaintiff Sara G. Maurer, the beneficiary of a long-term disability plan ("the
Plan") that is governed by the Employee Retirement and Income Security Act of
1974 ("ERISA"), challenges the discretionary decision of Defendant Reliance
*
This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
Standard Life Insurance, the Plan’s administrator, to terminate her disability
benefits. The district court held that Defendant did not abuse its discretion in
terminating her benefits. Because we hold that Defendant permissibly applied the
Plan’s "mental/nervous" limitation to terminate Plaintiff’s benefits, we affirm.
1. We assume, without deciding, that we must apply a high level of
skepticism in assessing whether Defendant abused its discretion. See Abatie v.
Alta Health & Life Ins. Co., 458 F.3d 955, 965–69 (9th Cir. 2006) (en banc)
(discussing the scope of our review in this context). Even applying a high level of
skepticism, the record supports Defendant’s decision to terminate benefits.
2. Defendant permissibly interpreted the "mental/nervous" limitation to
preclude coverage when, in the absence of a mental or nervous disorder, a
beneficiary would be physically capable of working. Defendant’s interpretation is
consistent with the Plan’s limitation of coverage for disabilities that are "caused by
or contributed to" by mental disorders. (Emphasis added.) The doctrine of contra
proferentem does not apply "where, as here, the Plan grants the fiduciary explicit
discretion to interpret the Plan." Winters v. Costco Wholesale Corp., 49 F.3d 550,
554 (9th Cir. 1995); accord Blankenship v. Liberty Life Assurance Co. of Boston,
486 F.3d 620, 625 (9th Cir. 2007). Further, nothing in the text of the Plan specifies
2
that the limitation applies only when a mental disorder is the sole cause of a
disability, as Plaintiff would interpret it.
3. The record contains ample support for Defendant’s conclusion that, in the
absence of any mental or nervous disorder, Plaintiff would be physically capable of
working. Based on Plaintiff’s medical records, three doctors found that her
psychological problems contributed to her disability. Dr. Hauptman concluded
that "psychological factors including stress are the primary factors that correlate
with [Plaintiff’s] reports of increasing musculoskeletal symptoms." Dr.
Schofferman, although acknowledging that he lacked some important information
about Plaintiff’s physical condition, had an "overall sense that without the
psychiatric elements, the patient would be capable of work activity." And Dr.
Birnbaum did not "find purely physical reasons for [Plaintiff’s] claim of disabling
pain" but concluded that her "symptoms are primarily related to chronic pain and
psychiatric dysfunction rather than inflammatory disease." Dr. Hines’ opinion that
Plaintiff’s physical problems caused her mood disorder and Dr. Campagna’s
opinion that there is a physical basis for Plaintiff’s disability are not inconsistent
with Defendant’s conclusion that a mental disorder at least "contributed to" her
disability. (Emphasis added.)
3
4. Because our holding that Defendant did not abuse its discretion in
applying the "mental/nervous" limitation to terminate Plaintiff’s benefits is
sufficient to affirm the judgment of the district court, we need not address the
remaining issues presented and express no views about them.
AFFIRMED.
4