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CAPIANCO v. LONG TERM DISABILITY PLAN OF SPONSOR UROMED

October 20, 2005.

GIL CAPIANCO, Plaintiff,
v.
LONG TERM DISABILITY PLAN OF SPONSOR UROMED CORP., a Corporation, et al., Defendants.



The opinion of the court was delivered by: DANA SABRAW, District Judge

ORDER (1) DENYING PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT AND (2) GRANTING DEFENDANT'S MOTION FOR SUMMARY JUDGMENT
[Doc. Nos. 100, 106]
This matter comes before the Court on the parties' cross-motions for summary judgment. The parties have each filed oppositions to the others' motions and replies to those oppositions. The matter came on for hearing on October 14, 2005. Howard Hellen, Esq. appeared on behalf of Plaintiff, and Bruce Celebrezze, Esq. appeared on behalf of Defendant Hartford. For the reasons set out below, the Court denies Plaintiff's motion, and grants Defendant's motion.

I.

  PROCEDURAL BACKGROUND

  Plaintiff Gil Capianco filed his complaint in this case on March 20, 2003. He brings this action pursuant to the Employee Retirement Income Security Act ("ERISA"). Plaintiff alleges two claims: one for benefits under his former employer's long-term disability insurance plan, and one for statutory penalties under 29 U.S.C. ยง 1132(c). The parties have been through two rounds of summary judgment motions thus far in the case. First, Defendant brought a motion for summary judgment on the issue of exhaustion, which this Court denied. Next, the parties brought cross-motions for summary judgment on the standard of review applicable to this case. Defendant argued for an abuse of discretion standard, and Plaintiff argued in favor of de novo review. The Court denied Defendant's motion, and granted Plaintiff's motion, and decided the appropriate standard of review for this case was de novo. The parties now bring cross-motions for summary judgment on the substance of Plaintiff's claims.

  II.

  FACTUAL BACKGROUND

  Plaintiff is a former employee of UroMed Corporation. As an employee of UroMed, Plaintiff participated in a long-term disability insurance policy issued by Defendant Hartford. The Hartford Policy is part of an ERISA plan.

  On October 29, 2001, Plaintiff submitted a claim for benefits under the Hartford Policy, asserting he was disabled due to multiple sclerosis. (Def.'s Response to Pl.'s Separate Stmt. of Uncontroverted Material Facts in Supp. of Pl.'s Mot. for Summ. J., Fact No. 4.) Defendant denied Plaintiff's claim on May 3, 2002, based on the pre-existing condition exclusion in the Hartford Policy. (Id. at No. 10.) That exclusion generally provides that benefits will not be payable if the insured received medical care for the asserted disability in the ninety days preceding the insured's effective date of coverage. (Decl. of Kim M. Huber in Supp. of Def.'s Mot. for Summ. J. ("Huber Decl."), Ex. A at POL011.)

  Although Plaintiff does not presently dispute that he received medical care for his multiple sclerosis during the ninety-day lookback period described in the pre-existing condition exclusion, (see Pl.'s Response to Def.'s Stmt. of Uncontroverted Facts in Opp'n to Def.'s Mot. for Summ. J., Fact No. 10), he appealed Hartford's denial of his claim on grounds that an exception to the pre-existing condition exclusion applied. (Def.'s Response to Pl.'s Separate Stmt. of Uncontroverted Material Facts in Supp. of Pl.'s Mot. for Summ. J., Fact No. 14.) The exception to the pre-existing condition exclusion preserves the possibility of coverage if the insured was covered under a "Prior Plan," and was not limited by a pre-existing condition under that "Prior Plan." (Huber Decl., Ex. A at POL011.) III.

  DISCUSSION

  The parties move for summary judgment on Plaintiff's claims for benefits and statutory penalties. The parties dispute whether the Court should consider extrinsic evidence in deciding whether Plaintiff is entitled to benefits under the Hartford Policy. They also dispute whether Plaintiff is entitled to benefits under that Policy, and whether he is entitled to any statutory penalties under ERISA.

  A. Summary Judgment

  Summary judgment is appropriate if there is no genuine issue as to any material fact, and the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c). The moving party has the initial burden of demonstrating that summary judgment is proper. Adickes v. S.H. Kress & Co., 398 U.S. 144, 157 (1970). The moving party must identify the pleadings, depositions, affidavits, or other evidence that it "believes demonstrates the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). "A material issue of fact is one that affects the outcome of the litigation and requires a trial to resolve the parties' differing versions of the truth." S.E.C. v. Seaboard Corp., 677 F.2d 1301, 1306 (9th Cir. 1982).

  The burden then shifts to the opposing party to show that summary judgment is not appropriate. Celotex, 477 U.S. at 324. The opposing party's evidence is to be believed, and all justifiable inferences are to be drawn in its favor. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986). However, to avoid summary judgment, the opposing party cannot rest solely on conclusory allegations. Berg v. Kincheloe, 794 F.2d 457, 459 (9th Cir. 1986). Instead, it must designate specific facts showing there is a genuine issue for trial. Id. More than a "metaphysical ...


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