Janice Parker v. Vulcan Materials Company Long Term Disability Plan, an ERISA plan

This disposition is not appropriate for publication and is not precedent*
except as provided by 9th Cir. R. 36-3.
The panel unanimously concludes this case is suitable for decision**
without oral argument. See Fed. R. App. P. 34(a)(2).
NOT FOR PUBLICATION
UNITED STATES COURT OF APPEALS
FOR THE NINTH CIRCUIT
JANICE PARKER,
Plaintiff - Appellant,
v.
VULCAN MATERIALS COMPANY
LONG TERM DISABILITY PLAN, an
ERISA plan,
Defendant - Appellee.
No. 09-56674
D.C. No. 5:07-cv-01512-SGL-OP
MEMORANDUM*
Appeal from the United States District Court
for the Central District of California
Stephen G. Larson, District Judge, Presiding
Submitted February 9, 2011**
Pasadena, California
Before: D.W. NELSON, REINHARDT, and N.R. SMITH, Circuit Judges.
Janice Parker appeals the district court’s affirmance of Hartford’s denial of
her claim for disability benefits. The district court applied abuse of discretion
FILED
FEB 15 2011
MOLLY C. DWYER, CLERK
U .S. C OU R T OF APPE ALS

-- 1 of 4 --

review and found that Hartford had not abused its discretion in denying benefits.
We reverse and remand to the district court.
1. On appeal, Hartford argues for the first time that the court should
apply the 2004 plan which gives Hartford discretion to interpret the plan terms and
determine eligibility for benefits. Hartford had previously affirmatively asserted
that the 1997 plan applied to Parker’s claim and did not dispute the issue before the
district court. Absent exceptional circumstances, this court will not address issues
not raised before the district court. AlohaCare v. Hawaii, Dept. of Human Servs.,
572 F.3d 740, 744 (9th Cir. 2009). Therefore, we hold that the 1997 plan is
applicable.
2. The district court erred in holding that the standard of review under
the 1997 plan was abuse of discretion. The default standard of review in an ERISA
case is de novo, unless the plan grants the administrator discretionary authority.
Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). The relevant
language in the 1997 plan states only that claimants are entitled to “a full and fair
review” of their claims. Such language is not an unambiguous grant of discretion;
therefore, the correct standard of review is de novo. Sandy v. Reliance Standard
Life Ins. Co., 222 F.3d 1202, 1206 (9th Cir. 2000).
3. The district court erred in holding that the mental disorder limitation
was not implicated in Hartford’s denial of Parker’s claim. Hartford stated, in its

-- 2 of 4 --

letters and district court briefs, that it discontinued paying Parker’s benefits
because of the 24-month mental disorder limitation. Although Hartford ultimately
denied Parker’s claim on the ground that she did not prove she was disabled by a
physical defect, Hartford refused to consider Parker’s previously acknowledged
mental disabilities because of the mental disorder limitation. Therefore, the mental
disorder limitation was implicated.
4. Hartford’s mental disorder limitation is similar to that in Patterson v.
Hughes Aircraft Co., 11 F.3d 948, 950 (9th Cir. 1993). The limitation is
ambiguous, because it is not clear “whether a disability is to be classified as
‘mental’ by looking to the cause of the disability or to its symptoms” or whether a
disability resulting from “a combination of physical and mental factors” is included
in the limitation. Id. Since ambiguities are construed against the drafter, Parker’s
illness is not within the limitation if a physical illness contributes to, or is a cause
or symptom of, the mental disorder. Id. at 950-51. Thus, if Parker’s depression
caused her physical symptoms, she would still be entitled to benefits. Similarly, if
her physical problems contributed to the depression and anxiety that Hartford
previously found to be totally disabling, she is still entitled to benefits, regardless
of the limitation.
Because the district court did not consider the mental disorder limitation or
apply the correct definition of that limitation, we remand for consideration

-- 3 of 4 --

consistent with this disposition. See Mongeluzo v. Baxter Travenol Disability
Benefit Plan, 46 F.3d 938, 943-44 (9th Cir. 1995).
REVERSED and REMANDED

-- 4 of 4 --