Raymond Vaught v. Scottsdale Healthcare Corporation Health Plan

* This disposition is not appropriate for publication and is not precedent
except as provided by 9th Cir. R. 36-3.
NOT FOR PUBLICATION
UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT
RAYMOND VAUGHT,
Plaintiff - Appellant,
v.
SCOTTSDALE HEALTHCARE
CORPORATION HEALTH PLAN,
Defendant - Appellee.
No. 09-17561
D.C. No. 2:05-CV-00718-DGC
MEMORANDUM*
Appeal from the United States District Court
for the District of Arizona
David G. Campbell, District Judge, Presiding
Argued and Submitted December 8, 2010
San Francisco, California
Before: HUG, D.W. NELSON, and McKEOWN, Circuit Judges.
Raymond Vaught appeals the district court’s judgment that the Scottsdale
Healthcare Corporation Health Plan (the “Plan”) properly denied his claim for
medical expenses under a provision excluding coverage of accidents related to
driving under the influence of alcohol or drugs (the “DUI Provision”). The district
FILED
JAN 10 2011
MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS

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09-17561 2
court’s decision was based on the administrative record, but also noted that the
court had previously determined that the introduction of extrinsic evidence was
appropriate under Mongeluzo v. Baxter Travenol Long Term Disability Benefit
Plan, 46 F.3d 938, 943-44 (9th Cir. 1995). We have jurisdiction under 28 U.S.C.
§ 1291. We review de novo the district court’s choice and application of the
standard of review to decisions by fiduciaries of an employee benefit plan subject
to the Employee Retirement Income Security Act (“ERISA”), and for clear error
the district court’s underlying findings of fact. Abatie v. Alta Health & Life Ins.
Co., 458 F.3d 955, 962 (9th Cir. 2006) (en banc) (citations omitted). We also
review de novo the district court’s legal conclusions in interpreting provisions of
an ERISA benefit plan. Metro. Life Ins. Co. v. Parker, 436 F.3d 1109, 1113 (9th
Cir. 2006) (citations omitted).
For the reasons stated in its well-crafted order, the district court properly
interpreted the DUI Provision in Vaught’s favor to exclude coverage of accidents
related to driving while legally intoxicated; found that Vaught, whose whole blood
alcohol level was almost three times the state’s legal limit, was legally intoxicated
at the time of his motorcycle accident; and determined after de novo review that
the Plan’s denial of Vaught’s medical expenses was proper.
AFFIRMED.

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