Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Campos v. Reliance Standard Life Insurance Co.

United States District Court, C.D. California

April 12, 2017

BERTHA CAMPOS, Plaintiff,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY; WHM, LLC; and DOES 1 through 10, inclusive, Defendants.

          FINDINGS OF FACT AND CONCLUSIONS OF LAW

          OTIS D. WRIGHT, II UNITED STATES DISTRICT JUDGE.

         This is 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.

         I. FINDINGS OF FACT

         1. On or about May 5, 2008, Defendant WHM, LLC (“WHM”) hired Plaintiff Bertha Campos as a full-time employee.

         2. Defendant Reliance Standard Life Insurance Company (“Reliance”) issued a group long-term disability policy, policy number VPL 300459 (the “LTD Plan”), to WHM.

         3. At all relevant times during Plaintiff's employment with WHM, Plaintiff was enrolled in the LTD Plan.

         4. The 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 . . .”

         5. The 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.”

         6. The 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.”

         7. The 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 week.”

         8. The LTD Plan terms do not expressly define “regular work week.”

         9. On April 11, 2013, Plaintiff was working as a banquet server for WHM when she fell and injured herself.

         10. On November 21, 2013, Plaintiff submitted to Reliance a claim for benefits under the LTD Plan.

         11. On 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 claim.”

         12. On 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 ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.