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Jayce Castell v. Metropolitan Life Insurance Company

March 22, 2012


The opinion of the court was delivered by: Lucy H. Koh United Stat United States District Judge For the Northern District of California


Plaintiff Jayce Castell ("Plaintiff") seeks contempt sanctions against Defendants Metropolitan Life Insurance Company ("MetLife") and Ambrose Employer Group, LLC Long-22 Term Disability Plan ("the Plan") (collectively, "Defendants") pursuant to Federal Rule of Civil Procedure 70(e), asserting that Defendants failed to comply with this Court's judgment filed October 29, 2010*fn1 and amended judgment filed October 20, 2011. The Court held a hearing on March 15, 2012. Having considered the parties' submissions and argument and the relevant law, the Court hereby GRANTS IN PART Plaintiff's motion for contempt sanctions.

and Conclusions of Law ("FFCL") ¶ 1.*fn2 Ambrose Employer Group, LLC was his co-employer for 4 the limited purpose of providing employment benefits, including long-term disability ("LTD") 5 benefits. Id. LTD benefits are provided by the Plan, which is both funded and administered by 6

Plaintiff worked as a "Technical Staff Member," a sedentary-to-light position that requires 8 sitting at a workstation doing computer work and reading. FFCL ¶¶ 1, 3. On April 6, 2005, 9


Plaintiff began working for IPVALUE Management, Inc. in May 2004. Findings of Fact

MetLife. Id. Plaintiff is an insured under the Plan. Id. 7

Plaintiff fell backward onto his buttocks and back. FFCL ¶ 4. Thereafter, he complained of back 10 pain, intermittent leg numbness and pain, pain and/or numbness in other areas, headaches, blurred vision, and dizziness. Id. Plaintiff continued working, but only for partial days and weeks. FFCL

¶ 5. In September 2005, he stopped working completely, asserting that his back pain had become 13 intolerable. Id. On August 16, 2006, he filed a claim for LTD benefits under the Plan, claiming 14 disability as of April 2005 as a result of his fall. FFCL ¶ 6. 15 provide sufficient information to prove entitlement to benefits under "the United Airlines plan," 17 and that MetLife had been unable to reach Plaintiff in October 2006 because his telephone had 18 been disconnected. FFCL ¶ 9. Plaintiff wrote back, informing MetLife that he did not work for 19 United Airlines and that his telephone had not been disconnected and in fact had been prepaid 20 through the year. FFCL ¶ 10. Plaintiff provided his telephone number in that letter. Id. On 21

November 27, 2006, MetLife sent Plaintiff a second denial letter stating that he had failed to prove 22 entitlement to benefits under the Ambrose plan, again asserting that Plaintiff's telephone had been 23 disconnected, and stating that MetLife had been unable to reach Plaintiff's "doctor." FFCL ¶ 11. 24

Plaintiff could sit for only four hours or less a day. FFCL ¶ 12. MetLife responded with a third 26 denial letter. FFCL ¶ 13. On April 19, 2007, Plaintiff sent MetLife a letter requesting 27

September 30, 2010 and docketed at ECF No. 47.

MetLife issued a denial letter on November 2, 2006, stating that Plaintiff had failed to

Plaintiff submitted an Attending Physician's Statement dated February 22, 2007, indicating that 25 reconsideration of his claim. FFCL ¶ 15. MetLife responded with a fourth denial letter indicating 2 that administrative remedies had been exhausted and that no further appeals would be considered. 3

On April 10, 2009, Plaintiff filed this action under the Employee Retirement Income

Security Act of 1974 ("ERISA"), 29 U.S.C. § 1132(a)(1)(B), alleging that Defendants improperly 6 denied his claim for twenty-four months of LTD benefits under the Plan's "own occupation" 7 provision. ECF No. 1. Under the Plan, a claimant is entitled to up to twenty-four months of 8 benefits (following a three-month elimination period) if he is unable to earn more than eighty 9 percent of his predisability income at his "own occupation." FFCL ¶ 8. After this period, the 10 claimant is entitled to continuing benefits if he is unable to earn more than sixty percent of his predisability income at "any gainful occupation" for which he is reasonably qualified. Id. At the time that Plaintiff filed suit with respect to his claim under the "own occupation" provision, he was 13 pursuing administrative remedies with respect to a separate claim for LTD benefits under the "any 14 occupation" provision. Id. 15

On September 30, 2010, following a bench trial, the Court issued Findings of Fact and

Conclusions of Law determining that MetLife had abused its discretion in denying Plaintiff's 17 claim, and that Plaintiff was entitled to twenty-four months of long-term disability benefits under 18 the "own occupation" provision of the Plan. FFCL ¶ 33. The Court noted that it was "undisputed 19 that Castell fell in the manner claimed, and that he suffered disc desiccation, broad-based disc 20 bulge, and disc protrusion." FFCL ¶ 28. Moreover, "[f]ive different physicians that either treated 21 or examined Castell opined that he had significant limitations on sitting and standing." FFCL ¶ 29. 22

None of these physicians expressed doubts with respect to Plaintiff's reports of pain, and there was 23 no suggestion in the record that Plaintiff was malingering. FFCL ¶ 31. The Court pointed out that 24

"[t]he only doctors who suggest that Castell does not suffer disabling pain are the two doctors hired 25 by MetLife." FFCL ¶ 32. Neither of those doctors "ever met or examined Castell; thus neither had 26 any opportunity to assess his credibility." Id. The Court concluded that "[i]f MetLife had credited 27 some or all" of the opinions of the doctors that actually examined and treated Plaintiff, "it 28 necessarily would have concluded" that Plaintiff could not perform his own occupation. FFCL ¶ 2

30. The Court gave short shrift to MetLife's argument to the contrary: 3 suggested by Castell's doctors, "plaintiff fails to explain how these restrictions would keep him from performing his Own Occupation from any employer in his Local Economy." Defs' Cross Mot. at 18. The Court is at a loss to imagine how Castell could perform his own occupation, ...

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