United States District Court, N.D. California
ORDER DENYING PLAINTIFF'S MOTION TO LIMIT SCOPE
OF THE ADMINISTRATIVE RECORD Re: Dkt. No. 31
PHYLLIS J. HAMILTON United States District Judge
the court is plaintiff's motion to determine the scope of
the administrative record. Dkt. 31. The matter is fully
briefed and suitable for decision without oral argument.
Having read the parties' papers and carefully considered
their arguments and the relevant legal authority, and good
cause appearing, the court hereby rules as follows.
A. Procedural History
an ERISA matter in which Myra Sugiyama has sued Unum Life
Insurance Company (“Unum”) and the Cooley LLP
Health and Welfare Plan. Sugiyama seeks $550, 000 in
accidental death and dismemberment (“AD&D”)
benefits under a policy issued to her brother John Paul
Sugiyama through his employer Cooley LLP
(“Cooley”). Dkt. 1.
instant motion concerns the scope of the administrative
record. Plaintiff argues that because Unum missed a deadline
in its response to her claim, the administrative record was
closed as of April 25, 2016-the date that Unum's response
was allegedly due. In plaintiff's view, whether the
AD&D benefits were properly denied must be determined on
the basis of the record as it existed on April 25, 2016.
maintains that its claim determination was timely because it
notified plaintiff of an extension of time on May 2, 2016. On
June 2, 2016, Unum denied plaintiff's claim for benefits,
relying on a report from the California Highway Patrol
(“CHP”) that Mr. Sugiyama was driving while
intoxicated at the time of the car collision that led to his
death. (Mr. Sugiyama survived that collision, but was fatally
struck by a car after exiting his vehicle.) In Unum's
view, Mr. Sugiyama's death was not covered because of
exclusions for losses “resulting from”
intoxication or the commission of a crime.
Unum's Processing of Plaintiff's Claim
Plaintiff's claim was hand delivered to Cooley on January
26, 2016. Curry Decl. Ex. F; Tracie Sugiyama Decl.
¶¶ 2-3. Cooley completed the form and sent the
claim packet to Unum, which received it on February 4, 2016.
Curry Decl. Ex. G-I. On February 5, 2016, Unum issued a
letter to plaintiff acknowledging its receipt of the claim.
Huffman Decl. Ex. A at 61-63. On March 7 2016, Unum sent
plaintiff a letter informing her that it was
“waiting” on “[p]olice and medical examiner
reports” before it could make a claim decision. Huffman
Decl. Ex. A at 185.
April 27, 2016, Unum sent a letter to the CHP requesting the
accident report. On May 2, 2016, Unum sent a letter to
plaintiff's counsel extending its response deadline an
additional 90 days-which is permitted if “special
circumstances” warrant-because Unum was waiting to
receive the CHP report and the report from the Alameda County
Coroner & Medical Examiner's (“ME”)
office. Curry Decl. Ex. K (the “May 2 Letter”).
On May 20, 2016, Unum formally requested the ME report. Curry
Decl. Ex. L. On June 2, 2016, Unum denied plaintiff's
claim for AD&D benefits based on the CHP and ME reports.
Curry Decl. ¶ 9. Plaintiff sued in this court on August
31, 2016. Dkt. 1.
parties do not address the appropriate standard to be applied
to this motion. Effectively, plaintiff seeks partial summary
judgment on the scope of the administrative record. The court
will therefore apply Rule 56 standards.
may move for summary judgment on a “claim or
defense” or “part of . . . a claim or
defense.” Fed.R.Civ.P. 56(a). Summary judgment is
appropriate when there is no genuine dispute as to any
material fact and the moving party is entitled to judgment as
a matter of law. Id. When deciding a summary
judgment motion, a court must view the evidence in the light
most favorable to the nonmoving party and draw ...