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Gonda v. Permanente Med. Group, Inc.

United States District Court, N.D. California

January 16, 2014

THOMAS A. GONDA, Plaintiff,
v.
THE PERMANENTE MEDICAL GROUP, INC., THE PERMANENTE MEDICAL GROUP, INC. LONG TERM DISABILITY PLAN FOR PHYSICIANS, Defendants

For Thomas A. Gonda, Jr., M.D., Plaintiff: Julian M. Baum, LEAD ATTORNEY, Lisa Ann Lawrence, Julian M. Baum & Associates, Novato, CA; Richard Johnston, Richard Johnston Attorney At Law, Santa Rosa, CA.

For Permanente Medical Group, Inc, in its capacity as Plan Adminstrator, Permanente Medical Group, Inc. Long Term Disability Plan for Physicians, Defendants: Adrienne Clare Publicover, LEAD ATTORNEY, Charan M. Higbee, Wilson Elser Moskowitz Edelman & Dicker LLP, San Francisco, CA.

Page 1092

ORDER DENYING MOTION FOR PARTIAL SUMMARY JUDGMENT

SAMUEL CONTI, UNITED STATES DISTRICT JUDGE.

I. INTRODUCTION

Thomas A. Gonda (" Plaintiff" ) brings this action for equitable relief and long-term disability benefits pursuant to the Employee Retirement Income Security Act of 1974 (" ERISA" ), 29 U.S.C. § 1001 et seq. The Permanente Medical Group, Inc. Long Term Disability Plan for Physicians (the " Plan" ) and The Permanente Medical Group, Inc. (" TMPG" or the " Plan administrator" ) (collectively, " Defendants" ) now move for partial summary judgment. ECF No. 39 (" MSJ" ). Specifically, Defendants seek an order establishing that the abuse of discretion standard should be used to determine Plaintiff's entitlement to Plan benefits. Plaintiff opposes the motion, arguing that the Court should apply the de novo standard of judicial review. ECF No. 38 (" Opp'n" ).[1] The motion is fully briefed, ECF No. 39 (" Reply" ), and appropriate for determination without oral argument per Civil Local Rule 7-1(b). For the reasons set forth below, the Court DENIES the motion and finds that de novo review is the appropriate standard.

II. BACKGROUND

The case concerns an ERISA Plan administered by TPMG and insured by a group disability policy issued by The Life Insurance Company of North America (" LINA" ). ECF No. 35 (" Downey Decl." ) Ex. A. The effective date of the Policy is November 1, 1998, and the Policy's anniversary date is January 1. The Policy grants LINA discretionary authority to make claims decisions. Id. at 1802.

Plaintiff is a former cardio-thoracic surgeon with TPMG. He left work in December 2006 and applied for benefits under the Plan sometime thereafter. Defendants paid Plan benefits to Plaintiff from 2008 until October 2010, when Defendants notified Plaintiff that they were terminating his monthly benefits. Plaintiff appealed that decision. LINA denied his appeal on May 13, 2013.

Prior to the disposition of Plaintiff's administrative appeal, in March 2011, Plaintiff filed this action against the Plan and TPMG, in its capacity as Plan administrator. Plaintiff asserts claims for benefits under the Plan, breach of fiduciary duties, and statutory penalties.

Page 1093

III. LEGAL STANDARD

Entry of summary judgment is proper " if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). Summary judgment should be granted if the evidence would require a directed verdict for the moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 251, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). " A moving party without the ultimate burden of persuasion at trial -- usually, but not always, a defendant -- has both the initial burden of production and the ultimate burden of persuasion on a motion for summary judgment." Nissan Fire & Marine Ins. Co., Ltd. v. Fritz Cos., Inc., 210 F.3d 1099, 1102 (9th Cir. 2000).

" In order to carry its burden of production, the moving party must either produce evidence negating an essential element of the nonmoving party's claim or defense or show that the nonmoving party does not have enough evidence of an essential element to carry its ultimate burden of persuasion at trial." Id. " In order to carry its ultimate burden of persuasion on the motion, the moving ...


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