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Leonard v. Metlife Insurance Co.

United States District Court, Ninth Circuit

December 12, 2013

THERESA LEONARD, Plaintiff,
v.
METLIFE INSURANCE COMPANY, et al., Defendants.

FINDINGS OF FACT AND CONCLUSIONS OF LAW [Fed. R. Civ. P. 52]

STEPHEN V. WILSON, District Judge.

After considering the parties' trial briefs, associated exhibits, and the arguments of counsel at the November 5, 2013 trial, the Court determines that the following facts have been established by a preponderance of the evidence:

FINDINGS OF FACT

1. Plaintiff Theresa Leonard ("Leonard") was at one time a participant in the Raytheon Company Disability Plan (the "Plan"), an employee welfare benefit plan established by her former employer Raytheon Inc. ("Raytheon"). [RAYTHEON PLAN, §§ 2.6, 2.16, 2.17, pp. 7-8]

2. Pursuant to the terms of the Plan, Raytheon designated Defendant Metropolitan Life Insurance Company ("MetLife") as the Plan's claims administrator [RAYTHEON PLAN, § 2.5, p. 7] and conferred discretion upon MetLife to interpret the terms of the Plan and determine eligibility for benefits: [RAYTHEON PLAN, §§ 7.2 and 7.4, pp. 19-20]

3. The Plan was fully funded by employee contributions. MetLife did not fund the Plan benefits. [RAYTHEON PLAN, §§ 1.2 and 3.1(E), Article IV, pp. 6, 10-11]

4. In order to be entitled to benefits, Leonard must be totally disabled as defined by the Plan. For the first 18 months (the "Own Occupation Period"), the Plan sets forth the following requirements:

(A) The Plan will pay Benefits during the Primary Benefit Period[1] to Participants who:
(1) become Fully Disabled while in a Period of Participation under the Plan; and
(2) are under the care of a Doctor for their Full Disability; and
(3) continue to be Fully Disabled;
(4) have not attained the Plan's maximum age for receiving Benefits, as described in section 5.2(B)(3); and
(5) has satisfied the Waiting Period.

[RAYTHEON PLAN, § 5.1, p. 11-12]

5. The Plan defines Fully Disabled as follows:

Full Disability or Fully Disabled means that because of a sickness or injury which is not covered by an applicable workers' compensation statute, a Participant: (i) cannot perform the essential elements and substantially all of the duties of his or her job with the Employer even with a reasonable accommodation; and (ii) is under the care of a Doctor.

[RAYTHEON PLAN, § 2.11, p. 8]

6. After the 18-Month Own Occupation Period, the Plan changes the definition of disability to an "Any Occupation" standard and imposes the following requirements, detailed below and in paragraph 8, as follows:

(B) The Plan will pay Benefits during the Secondary Benefit Period[2] to Participants who:
(1) are Totally Disabled on the day immediately subsequent to the last day of the Primary Benefit Period; and
(2) are under the care of a Doctor for their Total Disability; and
(3) continue to be Totally Disabled; and
(4) have not attained the Plan's maximum age for receiving Benefits, as described in section 5.2(B)(3).

[RAYTHEON PLAN, § 5.1, p. 12, hereinafter the "Any Occupation Period"]

7. The Plan defines Totally Disability under the "Any Occupation Period" as follows:

Total Disability or Totally Disabled means that because of sickness or an injury which is not covered by an applicable workers' compensation statute:
(A) a Participant cannot do the essential elements and substantially all of the duties of his or her job with the Employer even with reasonable accommodations; and (B) cannot do any other job for which he ...

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