O'Neil v. Fireman's Fund Insurance
O'Neil v. Fireman's Fund Insurance
Opinion of the Court
MEMORANDUM
Appellee Fireman’s Fund Insurance Company (“FFIC”) last employed Appellant John O’Neil on January 27, 1984.
The district court properly applied an abuse of discretion standard of review to O’Neil’s case because the Plan’s language conferred discretionary authority on EBAC “[t]o interpret the provisions of the Plan ... including the right to remedy possible ambiguities, inconsistencies or omissions ...” and “[t]o determine the manner in which benefits shall be paid under the Plan, if discretionary, and the persons who are entitled thereto.... ” See Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963-64 (9th Cir. 2006) (en banc) (holding that plan administrator wording granting the power to interpret plan terms and to make final benefits determination warrants abuse of discretion review).
We conclude that EBAC did abuse its discretion in finding that California’s notice-prejudice rule barred O’Neil’s claim. See UNUM Life Ins. Co. of Am. v. Ward, 526 U.S. 358, 363, 366-67, 119 S.Ct. 1380, 143 L.Ed.2d 462 (1999) (explaining the notice-prejudice rule’s applicability tq ERISA claims). The Plan did not unambiguously state when a claimant must submit his claim because there was no provision within the actual Plan identifying when a claim must be presented. Therefore, O’Neil’s request for benefits should not have been barred on that ground.
However, EBAC did not abuse its discretion in finding that O’Neil was not “totally disabled” on January 27,1984, his last day of employment, because there was no documented change in circumstances after O’Neil’s treating physician cleared O’Neil for work on December 5, 1983. We hold that EBAC did not abuse its discretion in denying O’Neil’s request for benefits under the Plan.
AFFIRMED.
This disposition is not appropriate for publication and is not precedent except as provided by 9th Cir. R. 36-3.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.