United States District Court, S.D. California
For Robin Curran, Plaintiff: Barbara Ann Casino, LEAD ATTORNEY, Stennett / Casino, San Diego, CA.
For United of Omaha Life Insurance Company, Defendant: Martin E. Rosen, LEAD ATTORNEY, Barger and Wolen LLP, Irvine, CA; James Hazlehurst, Barger & Wolen LLP, Los Angeles, CA.
ORDER (1) GRANTING PLAINTIFF'S MOTION FOR PARTIAL SUMMARY JUDGMENT; AND, (2) DENYING DEFENDANT'S CROSS MOTION FOR PARTIAL SUMMARY JUDGMENT
Honorable Janis L. Sammartino, United States District Judge.
Presently before the Court are Plaintiff Robin Curran's (" Plaintiff" ) and Defendant United of Omaha Life Insurance Company's (" United" ) cross motions for partial summary judgment on the standard of review. (Pl. Mot. for Partial Summ. J., ECF No. 33; Def. Mot. for Partial Summ. J., ECF No. 32.) The Court heard oral argument on April 28, 2014 and the motions were taken under submission thereafter. Having considered the parties' arguments and the law, the Court GRANTS Plaintiff's motion for partial summary judgment and DENIES United's cross motion for partial summary judgment.
Plaintiff brings this action under the Employee Retirement Income Security Act of 1974 (" ERISA" ), 29 U.S.C. § 1001 et seq. Plaintiff seeks long-term disability benefits under her employer-sponsored plan, known as the Pacific Monarch Resorts, Inc. Benefit Plan. (Pl. Mot. for Partial Summ. J. 2, ECF No. 33.) United issued the insurance policy funding the benefits (" the Policy" ) and served as the plan administrator. ( Id. ) The Policy went into effect on January 1, 2000 and remained in force through December 31, 2012. ( Id. ) An amendment to the Policy vesting United with discretionary authority to interpret the plan and determine
eligibility for benefits was implemented on January 1, 2008. ( Id. )
Plaintiff was covered by the Policy when she became disabled on October 13, 2008. ( Id. at 4.) Her symptoms included swelling of the knees, joint pain, cognitive difficulties, dizziness, and vertigo. ( Id. ) Plaintiff underwent numerous tests, one of which yielded positive results for Lyme Disease. ( Id. ) This diagnosis was made on the basis of test results, as well as clinical examination and medical history. ( Id. )
United paid Plaintiff disability benefits under the Policy for 24 months, through January 17, 2011, on the basis of her self-reported symptoms. ( Id. ) United then denied Plaintiff's claim for continued disability benefits on May 9, 2011, finding that Plaintiff was able to " perform in the same physical capacity as prior to [her] last day of work." ( Id. at 5.) Plaintiff filed a timely appeal and the appeal was denied by United on March 9, 2012. ( Id. ) Plaintiff subsequently filed this action for benefits on August 7, 2012. (Compl., ECF No. 1.)
Summary judgment is appropriate where the Court is satisfied that " there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed. R. Civ. Pro. 56(c); Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). Material facts are those that may affect the outcome of the case. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A genuine issue of material fact exists only if " the evidence is such that a reasonable jury could find for the nonmoving party." Id. " The evidence of the nonmovant is to be believed, and all justifiable inferences are to be drawn in [her] favor." Id. at 255.
The initial burden of establishing the absence of a genuine issue of material fact falls on the moving party. Celotex, 477 U.S. at 323. The movant can carry his burden in two ways: (1) by presenting evidence that negates an essential element of the nonmoving party's case; or (2) by demonstrating to the Court that the nonmoving party " failed to make a sufficient showing on an essential element of her case with respect to which she has the burden of proof." Id. at 322-23.
Once the moving party satisfies this initial burden, the nonmoving party must set forth specific facts showing that there is a genuine issue for trial. Celotex, 477 U.S. at 324. To do so, the nonmoving party must " do more than simply show that there is some metaphysical doubt as to material facts." Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). Rather, to survive summary judgment, the nonmoving party must " make a showing sufficient to establish the existence of [every] element essential to that party's case, and on which that party will bear the burden of proof at trial." Celotex, 477 U.S. at 322. Furthermore, the nonmoving party cannot oppose a properly supported summary judgment motion by " rest[ing] on mere allegations or denials of his pleadings." Anderson, 477 U.S. at 256. The nonmoving party must identify those facts of record that would contradict the facts identified by the movant.
" A denial of benefits challenged under 29 U.S.C. 1132(a)(1)(B) 'is to be reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to construe
the terms of the plan." Polnicky v. Liberty Life Assurance Co. of Boston, No. C. 13-1478 SI, 999 F.Supp.2d 1144, 2013 WL 6071997, at *2 (N.D. Cal. Nov. 18, 2013) (quoting Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989)). " Where the plan or policy grants such discretion, the standard of review is abuse of discretion." Cerone v. Reliance Standard Life Ins. Co., 13CV184 MMA (DHB), 9 F.Supp.3d 1145, *4 (S.D. Cal. Mar. 28, 2014) (citing Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863, 866 (9th Cir. 2008)).
Here, Plaintiff maintains that the standard of review must be de novo, rather than abuse of discretion, because (1) the Policy does not unambiguously provide discretionary authority for United to determine eligibility for benefits; and, (2) even if the Policy vests United with such discretion, the grant of discretion is void pursuant ...