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June 12, 2002


The opinion of the court was delivered by: Breyer, District Judge.


Rowena Leung ("Mrs.Leung") filed this suit to collect on life insurance benefits under a policy that her husband, now deceased, had with his employer, Skidmore, Owings, & Merrill LLP ("SOM"). Mrs. Leung has named SOM, Skidmore, Owings & Merrill Group Life Insurance Plan (the "Insurance Plan"), and Connecticut General Life Insurance Company ("Connecticut General") and their parent CIGNA as defendants.

At a hearing on May 24, 2002, the Court granted plaintiffs motion to amend her complaint. The amended complaint states three causes of action. Now before the Court are defendants' motions to dismiss. For the reasons stated below, summary judgment in favor of all defendants is hereby GRANTED.*fn1


SOM hired Edmund Leung as a structural engineer in 1968. He received long-term disability ("LTD") and life insurance benefits through SOM's cafeteria plan. In August 1989, Mr. Leung's physician, Dr. Robert Kubin, diagnosed severe hypertension and Mr. Leung left work. Mr. Leung's symptoms included severe memory loss, speech difficulties, and incontinence. Because he was unable to return to work within a year, Mr. Leung was terminated on August 7, 1990. With the help of SOM employees, Mr. Leung was eventually able to secure LTD benefits.

On November 27, 1990, Mr. Leung signed a "Benefit Payment and Withholding Election Form" liquidating his 401(k) plan. Aguirre Decl., Ex. A. Mr. Leung did not fill in the blank asking for the date of retirement or termination. Id. However, the withdrawal made by Mr. Leung was possible only after termination of employment. Over the next several years, SOM and the Leungs corresponded regarding LTD benefits, and at least once with regard to the Leungs' purchase of a home. This correspondence is relevant only so far as it goes to the issue of whether Mr. Leung was aware of his termination in 1990 or whether he believed he was still technically "employed" by SOM and on disability leave. This correspondence will be highlighted where relevant.

Mr. Leung died on June 9, 1997. Mrs. Leung spent the next year and a half investigating the circumstances of her husband's death. In the spring of 1999 Mrs. Leung began to investigate her husband's life insurance policy with the help of her daughter, Allison Wakefield. She started by visiting SOM's office where she met with Frances Redwine. Subsequently she sent several letters to Redwine.

SOM's life insurance carrier had changed several times since Mr. Leung stopped working at SOM. As a result, Mrs. Leung apparently submitted claims to several carriers that never insured Mr. Leung. She also named multiple carriers in this suit. While the details of the confusion do not appear to be particularly important, the confusion was not Mrs. Leung's alone. Initially, SOM had difficulty determining which carrier provided Mr. Leung's life insurance.

Only employees who worked 30 hours per week were eligible for life insurance under the plan. See Id. at 288. The SPD also states that coverage terminated when the employee "leave[s] active service." Id. at 289. Two further provisions are of particular importance here. First, premiums were waived for a year upon sufficient proof that the employee has been totally disabled for a period of nine months or more. Second, an employee could convert his group coverage to individual coverage if application was made within 31 days of termination of the group coverage.

In a letter dated April 5, 2000, CIGNA, the parent of Connecticut General, informed SOM that Mr. Leung's coverage had been canceled because Mr. Leung never applied for a Waiver of Premium or Conversion after he went out on disability on August 4, 1989. A copy of this letter was forwarded to plaintiff.


Summary judgment is appropriate when the "pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c). An issue is "genuine" only if there is sufficient evidence for a reasonable fact finder to find for the nonmoving party. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248-49, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A fact is "material" if the fact may affect the outcome of the case. See id. at 248, 106 S.Ct. 2505. "In considering a motion for summary judgment, the court may not weigh the evidence or make credibility determinations, and is required to draw all inferences in a light most favorable to the nonmoving party." Freeman v. Arpaio, 125 F.3d 732, 735 (9th Cir. 1997). A principal purpose of the summary judgment procedure is to identify and dispose of factually unsupported claims. See Celotex Corp. v. Catrett, 477 U.S. 317, 323-24, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986).

The party moving for summary judgment bears the initial burden of identifying those portions of the pleadings, discovery, and affidavits which demonstrate the absence of a genuine issue of material fact. See id. at 323, 106 S.Ct. 2548. Where the moving party will have the burden of proof on an issue at trial, it must affirmatively demonstrate that no reasonable trier of fact could find other than for the moving party. See id. Once the moving party meets this initial burden, the non-moving party must go beyond the pleadings and by its own evidence "set forth specific facts showing that there is a genuine issue for trial." Fed.R.Civ.P. 56(e). The non-moving party must "identify with reasonable particularity the evidence that precludes summary judgment." Keenan v. Allan, 91 F.3d 1275, 1279 (9th Cir. 1996) (quoting Richards v. Combined Ins. Co., 55 F.3d 247, 251 (7th Cir. 1995), and noting that it is not a district court's task to "scour the record in search of a genuine issue of triable fact"). If the non-moving party fails to make this showing, the moving party is entitled to judgment as a matter of law. See Celotex, 477 U.S. at 323, 106 S.Ct. 2548.


Plaintiffs complaint states the following three causes of action: 1) an ERISA § 502(a)(1) claim for life insurance benefits, 2) an ERISA § 502(a)(3) claim for other relief, and 3) a claim that SOM violated a ERISA § 502(c) by failing to provide requested documents and information.

I. Claim for Benefits under ERISA § 502(a)(1) (against all defendants)

Plaintiff brings a claim under ERISA § 502(a)(1) for payment of benefits under her husband's life insurance policy. Defendants raise several defenses to this claim.

A. Failure to Exhaust

Defendants claim that this action is barred because plaintiff has failed to exhaust her administrative remedies under the plan. The "general rule governing ERISA claims [is] that a claimant must avail himself or herself of a plan's own internal review procedures before bringing suit in federal court." Diaz v. United Agr. Employee Welfare Ben. Plan and Trust, 50 F.3d 1478, 1483 (9th Cir. 1995). As plaintiff points out, however, the exhaustion requirement is generally waived where resort to the plan's procedures would be futile or inadequate. See id.

There is no dispute that plaintiff did not technically exhaust her claim. In fact, she never formally submitted a claim for life insurance benefits to Connecticut General. However, in a letter dated April 5, 2000, CIGNA, the parent of Connecticut General, informed Mrs. Leung that it would "need . . . documentation" of "Waiver of Premium or Conversion" to process her claim. See Pennasilico Decl.Ex. B. Plaintiff admits that she has no such documentation. Accordingly, if her efforts ...

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