United States District Court, N.D. California
ORDER GRANTING MOTION FOR PARTIAL SUMMARY JUDGMENT;
DENYING MOTION FOR DETERMINATION OF STANDARD OF REVIEW;
SETTING CASE MANAGEMENT CONFERENCE RE: DKT. NOS. 38,
HAYWOOD S. GILLIAM, JR. United States District Judge.
before the Court are Plaintiff Peter Englert's
(“Plaintiff”) motion for partial summary
judgment, Dkt. No. 38, and Defendant Prudential Insurance
Company of America's (“Defendant”) motion for
determination of the standard of review, Dkt. No. 41. These
motions arise from Plaintiff's action seeking recovery of
employee benefits and equitable relief under the Employee
Retirement Income Security Act of 1974 (“ERISA”).
Dkt. No. 1 (“Compl.”). The parties have each
filed oppositions to the respective motions. Dkt. Nos. 42,
43. For the reasons set forth below, the Court GRANTS
Plaintiff's motion for partial summary judgment and
DENIES Defendant's motion for determination of the
standard of review.
relevant times, Plaintiff was a sales associate at JP Morgan
Chase Bank (“JPMCB”), and participated in a group
long-term disability (“LTD”) plan sponsored by
JPMCB and underwritten by Defendant. Compl. ¶¶ 6-7.
The Parties agree that Plaintiff's LTD benefits stem from
an employee welfare benefit plan that is governed by ERISA.
Id. at ¶¶ 7-9; Dkt. No. 33
(“Answer”) ¶¶ 7-9. The LTD benefits are
detailed, referenced, and/or evidenced in the Group Insurance
Contract and the Group Insurance Certificate titled
“Long Term Disability Coverage” (collectively the
“Policy”). Dkt. No. 41, Ex. 1-2. Other documents
related to the benefits include: (1) a Claims and Appeals
section appended to the Policy (“Claims and
Appeals”), a Plan Administration Summary Plan
Description (“Plan Administration SPD”), (2) a
Long-Term Disability Plan Summary Plan Description
(“Long-Term Disability SPD”),  and (3) a Health
& Income Protection Program for JPMCB and Certain
Affiliated Companies/JPMC Health Care and Insurance Program
for Active Employees (the “Master Wrap Plan” or
“Plan”). Dkt. No. 41, Exs. 2-5; Dkt. No. 38, Exs.
was and is the de facto co-plan administrator and
the provider of LTD benefits. Compl. ¶ 9; Answer ¶
9. Plaintiff alleges that while he was an employee of JPMCB
and a recipient under the Plan, he experienced severe chronic
back pain forcing him to take medical leave effective October
18, 2011. Compl. ¶¶ 8, 13. On November 30,
2012, Defendant sent Plaintiff a letter informing him that
his LTD benefits claim had been approved. Dkt. No. 39, Ex. F.
However, on September 16, 2013, Defendant terminated
Plaintiff's LTD. Compl. ¶ 16; Answer ¶ 16.
Plaintiff appealed the termination, and on June 2, 2014,
Defendant paid Plaintiff back benefits for the period
beginning on September 17, 2013 and ending on May 21, 2014,
before again terminating Plaintiff's benefits effective
May 22, 2014. Compl. ¶ 16; Answer ¶ 16. On November
25, 2014, Plaintiff again appealed, and on January 14, 2015
Defendant again paid Plaintiff back benefits up to and
including December 6, 2014, before again terminating benefits
effective December 7, 2014. Compl. ¶ 16; Answer ¶
16. On July 9, 2015, Plaintiff filed a third appeal, and
Defendant affirmed its December 7, 2014 denial of benefits in
a letter dated September 15, 2015, stating that
Plaintiff's “file no longer supports an impairment
which would prevent him from performing the material and
substantial duties of his regular occupation.” Dkt. No.
39, Ex. C at PRU005025.
October 19, 2015, Plaintiff filed this action against
Defendant and Does 1-20. See generally Compl. The
complaint articulates two causes of action under ERISA: (1) a
claim for recovery of wrongfully withheld LTD benefits; and
(2) a claim for equitable relief in the form of a permanent
injunction preventing Defendant and Does 1-20 from serving as
fiduciaries with respect to Plaintiff's LTD benefits
plan. Id. ¶¶ 24-36. Plaintiff requests
full payment of all LTD benefits due, pre-judgment interest,
disgorgement of profits, surcharge, an injunction against
termination of benefits during the maximum benefit period,
attorneys' fees and costs, and other make-whole relief.
28, 2016, the parties filed cross-motions to determine the
standard of review the Court must apply in assessing
Plaintiff's first cause of action seeking recovery of
disability benefits pursuant to 29 U.S.C. §
1132(a)(1)(B). See Dkt. Nos. 38, 41. In his motion
for partial summary judgment, Plaintiff contends that the
Court should apply de novo review because the
Policy, SPDs, and the Plan do not sufficiently confer
discretion to trigger the more deferential abuse of
discretion standard. Dkt. No. 38 at 3. Furthermore, Plaintiff
contends that even if these documents did confer such
discretion, these provisions would be voided under California
Insurance Code §10110.6. Id. at 4. In contrast,
Defendant argues that the Court must apply an abuse of
discretion standard because the Plan sufficiently granted
discretion and California Insurance Code § 10110.6 is
preempted by ERISA. Dkt. No. 41 at 4-8.
SUMMARY JUDGMENT LEGAL STANDARD
motion for determining the standard of review in an ERISA
suit may be brought as a motion for judgment on the pleadings
under Federal Rule of Civil Procedure 12(c). See Murphy
v. Cal. Physicians Servs., No. 14-cv-02581, 2016 WL
5682567, at *1 (N.D. Cal. Oct. 3, 2016). However, if
“matters outside the pleadings are presented to and not
excluded by the court, the motion must be treated as one for
summary judgment under Rule 56.” Fed.R.Civ.P. 12(d).
Addressing the standard of review at the pleadings stage has
been found to be appropriate in ERISA suits where, for
example, the “motions are directed at a single and
specific question of law; both parties have attached the
relevant Plan-related documents with their respective motion;
and plaintiff has additionally submitted a statement of
recent decision after the close of briefing.”
Hirschkron v. Principal Life Ins. Co., 141 F.Supp.3d
1028, 1029 (N.D. Cal. 2015). Because the motions here are
specifically targeted at determination of the standard of
review and the parties have submitted extrinsic documents,
the Court will treat both motions as motions for partial
summary judgment. See id.; Fed.R.Civ.P. 12(d); Dkt.
No. 39, Exs. A-F; Dkt. No. 41, Exs. 1-5; Dkt. Nos. 44, 45.
judgment is proper where the pleadings and evidence
demonstrate that “there is no genuine issue as to any
material fact and . . . the movant is entitled to judgment as
a matter of law.” Fed.R.Civ.P. 56(c)(2); Celotex
Corp. v. Catrett, 477 U.S. 317, 322 (1986); see also
State Farm Fire & Cas. Co. v. Geary, 699 F.Supp.
756, 759 (N.D. Cal. 1987) (“Partial summary judgment
that falls short of a final determination, even of a single
claim, is authorized by Rule 56 in order to limit the issues
to be tried.”). A material issue of fact is a question
a trier of fact must answer to determine the rights of the
parties under the applicable substantive law. Anderson v.
Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A dispute
is genuine “if the evidence is such that a reasonable
jury could return a verdict for the nonmoving party.”
moving party bears “the initial responsibility of
informing the district court of the basis for its
motion.” Celotex, 477 U.S. at 323. To satisfy
this burden, the moving party must demonstrate that no
genuine issue of material fact exists for trial. Id.
at 322. To survive a motion for summary judgment, the
non-moving party must then show that there are genuine
factual issues that can only be resolved by the trier of
fact. Reese v. Jefferson Sch. Dist. No. 14J, 208
F.3d 736, 738 (9th Cir. 2000). To do so, the non-moving party
must present specific facts creating a genuine issue of
material fact. Fed.R.Civ.P. 56(c); Celotex, 477 U.S.
at 324. The Court must review the record as a whole and draw
all reasonable inferences in favor of the non-moving party.
Hernandez v. Spacelabs Med. Inc., 343 F.3d 1107,
1112 (9th Cir. 2003).
ERISA Claims Standard of Review
of an employee benefit plan governed by ERISA may challenge
the denial of benefits pursuant to 29 U.S.C. § 1132.
See 29 U.S.C. § 1132(a)(1)(B). A court must
review a denial of ERISA benefits 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.”
Firestone Tire & Rubber Co. v. Bruch, 489 U.S.
101, 115 (1989); see also Abatie v. Alta Health &
Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006) (en
banc) (“De novo is the default standard of
review.”). Where the benefit plan grants discretionary
authority to the plan administrator, the standard of review
shifts to abuse of discretion. Abatie, 458 F.3d at
963. For a plan to be afforded the more lenient abuse of