Filed: Nov. 21, 2019
Latest Update: Mar. 03, 2020
Summary: NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS NOV 21 2019 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT JACQUELINE A., No. 18-56187 Plaintiff-Appellant, D.C. No. 2:17-cv-04333-JAK-JEM v. MOTION PICTURE INDUSTRY HEALTH MEMORANDUM* PLAN; OPTUMHEALTH BEHAVIORAL SOLUTIONS OF CALIFORNIA, INC., Defendants-Appellees. Appeal from the United States District Court for the Central District of California John A. Kronstadt, District Judge, Presiding Argued and Submitted Novembe
Summary: NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS NOV 21 2019 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT JACQUELINE A., No. 18-56187 Plaintiff-Appellant, D.C. No. 2:17-cv-04333-JAK-JEM v. MOTION PICTURE INDUSTRY HEALTH MEMORANDUM* PLAN; OPTUMHEALTH BEHAVIORAL SOLUTIONS OF CALIFORNIA, INC., Defendants-Appellees. Appeal from the United States District Court for the Central District of California John A. Kronstadt, District Judge, Presiding Argued and Submitted November..
More
NOT FOR PUBLICATION FILED
UNITED STATES COURT OF APPEALS NOV 21 2019
MOLLY C. DWYER, CLERK
U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
JACQUELINE A., No. 18-56187
Plaintiff-Appellant, D.C. No.
2:17-cv-04333-JAK-JEM
v.
MOTION PICTURE INDUSTRY HEALTH MEMORANDUM*
PLAN; OPTUMHEALTH BEHAVIORAL
SOLUTIONS OF CALIFORNIA, INC.,
Defendants-Appellees.
Appeal from the United States District Court
for the Central District of California
John A. Kronstadt, District Judge, Presiding
Argued and Submitted November 7, 2019
Pasadena, California
Before: MURGUIA and HURWITZ, Circuit Judges, and ZOUHARY, ** District
Judge.
After being denied coverage for several mental health treatment claims,
Jacqueline A. brought this action against the Motion Picture Industry Health Plan
*
This disposition is not appropriate for publication and is not precedent
except as provided by Ninth Circuit Rule 36-3.
**
The Honorable Jack Zouhary, United States District Judge for the
Northern District of Ohio, sitting by designation.
(the “Plan”), a plan governed by the Employee Retirement Income Security Act, and
OptumHealth Behavioral Solutions of California, Inc., the Plan claims administrator.
The district court held a bench trial and entered judgment in favor of the Plan and
Optum.1
1. The district court correctly reviewed the Plan’s decisions for abuse of
discretion. The Plan documents provided the Plan’s directors with full discretion to
make eligibility determinations, and the authority to make final and binding
interpretations of plan provisions. See Abatie v. Alta Health & Life Ins. Co.,
458
F.3d 955, 963 (9th Cir. 2006) (en banc) (“[W]e have repeatedly held that similar
plan wording—granting the power to interpret plan terms and to make final benefits
determinations—confers discretion on the plan administrator.”). Because the Plan
allowed the directors to delegate benefits administration, and that power was
formally delegated to Optum, the administrator’s determinations are also subject to
abuse of discretion review. See Madden v. ITT Long Term Disability Plan for
Salaried Emps.,
914 F.2d 1279, 1283–85 (9th Cir. 1990).
2. We review for abuse of discretion despite Optum’s untimely decision
on two of Jacqueline’s initial appeals. The district court remanded the two appeals
1
Optum, as a plan administrator, was properly named as a defendant. The
denials for each request for benefits at issue in this case came from Optum. See
Spinedex Physical Therapy USA Inc. v. United Healthcare of Ariz., Inc.,
770 F.3d
1282, 1297 (9th Cir. 2014) (holding that an ERISA plan administrator can be liable
if it “cause[s] improper denial of benefits”) (citing 29 U.S.C. § 1132(a)(1)(B)).
2
to Optum for a decision on the merits. On remand, Optum considered supplemental
materials submitted by Jacqueline, and exercised its discretion in deciding the
appeals on the merits. See LaMantia v. Voluntary Plan Adm’rs, Inc.,
401 F.3d 1114,
1123–24 (9th Cir. 2005).
3. The denials of coverage were not an abuse of discretion. The reasons
provided by Optum’s reviewing physicians were not “illogical” and were “drawn
from the facts in the record.” 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) (en banc)). And, Optum always authorized treatment, albeit at
a less intensive level of care than Jacqueline sought. See Stephan v. Unum Life Ins.
Co. of Am.,
697 F.3d 917, 929 (9th Cir. 2012) (“Under this deferential standard, a
plan administrator’s decision ‘will not be disturbed if reasonable.’”) (quoting
Conkright v. Frommert,
559 U.S. 506, 521 (2010)).
AFFIRMED.
3