United States District Court, C.D. California
FINDINGS OF FACT AND CONCLUSIONS OF LAW
D. WRIGHT, II UNITED STATES DISTRICT JUDGE.
an action under the Employee Retirement Income Security Act
to recover long-term disability benefits. On October 17,
2016, the parties lodged the record of the underlying
administrative proceeding with the Court. On April 10, 2017,
the Court conducted a bench trial, after which the Court took
the matter under submission. Based on the Administrative
Record, the briefs submitted by the parties, and the argument
of counsel at the trial of this matter, the Court issues the
following findings of fact and conclusions of law.
FINDINGS OF FACT
or about May 5, 2008, Defendant WHM, LLC (“WHM”)
hired Plaintiff Bertha Campos as a full-time employee.
Defendant Reliance Standard Life Insurance Company
(“Reliance”) issued a group long-term disability
policy, policy number VPL 300459 (the “LTD
Plan”), to WHM.
all relevant times during Plaintiff's employment with
WHM, Plaintiff was enrolled in the LTD Plan.
LTD Plan terms provide that “[a] person is eligible for
insurance under this Policy if he/she: (1) is a member of an
Eligible Class . . .; and (2) has completed the Waiting
Period . . .”
LTD Plan terms define “Eligible Class” as
follows: “Each active, Full-time Employee earning an
annual salary of at least $15, 000 except any person employed
on a temporary or seasonal basis.”
LTD Plan terms define “actively at work” and
“active at work” as follows:
“‘Actively at Work' and ‘Active
Work' mean actually performing on a Fulltime basis the
material duties pertaining to his/her job in the place
where[, ] and the manner in which[, ] the job is normally
performed. This includes approved time off such as vacation,
jury duty and funeral leave, but does not include time off as
a result of an Injury or Sickness.”
LTD Plan terms define “full-time” as follows:
“‘Full-time' means working for you for a
minimum of 30 hours during a person's regular work
LTD Plan terms do not expressly define “regular work
April 11, 2013, Plaintiff was working as a banquet server for
WHM when she fell and injured herself.
November 21, 2013, Plaintiff submitted to Reliance a claim
for benefits under the LTD Plan.
April 7, 2014, Reliance sent a letter to Plaintiff that
appeared to deny Plaintiff's claim. The letter did not
explicitly state that Reliance denied her claim, but it cited
language from the LTD Plan terms regarding the full-time
requirement for coverage. The letter then stated: “We
regret our decision could not be more favorable. Our
determination has been based on the information contained in
your file and the policy provisions applicable to your
April 9, 2014, Plaintiff called Reliance to inquire about the
status of her claim, at which time a Reliance representative
informed Plaintiff that Reliance had denied her claim.
According to Reliance's written notes from the call,
Reliance advised Plaintiff that her “claim [was] not
denied due to ...