Barboza v. CAL. ASS'N OF PROFESSIONAL FIREFIGHTERS

651 F.3d 1073
CourtCourt of Appeals for the Ninth Circuit
DecidedJune 30, 2011
Docket09-16818
StatusPublished

This text of 651 F.3d 1073 (Barboza v. CAL. ASS'N OF PROFESSIONAL FIREFIGHTERS) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Barboza v. CAL. ASS'N OF PROFESSIONAL FIREFIGHTERS, 651 F.3d 1073 (9th Cir. 2011).

Opinion

651 F.3d 1073 (2011)

David BARBOZA, Plaintiff-Appellant,
v.
CALIFORNIA ASSOCIATION OF PROFESSIONAL FIREFIGHTERS, a California corporation; California Association of Professional Firefighters, Long-Term Disability Plan; California Administration Insurance Services, Inc., a California corporation, Defendants-Appellees.

No. 09-16818.

United States Court of Appeals, Ninth Circuit.

Argued and Submitted January 10, 2011.
Filed June 30, 2011.

*1075 Geoffrey V. White (argued), Law Office of Geoffrey V. White, San Francisco, CA, for the appellant.

Brendan J. Begley (argued), Weintraub Genshlea Chediak, Sacramento, CA, for the appellees.

Marcia Bove (argued), United State Department of Labor, Washington, D.C., for amicus curiae the Secretary of Labor.

Before: J. CLIFFORD WALLACE, JOHN T. NOONAN, and BARRY G. SILVERMAN, Circuit Judges.

OPINION

WALLACE, Senior Circuit Judge:

David Barboza appeals from the district court's summary judgment in favor of the California Association of Professional Firefighters, that Association's Long-Term Disability Plan, and the California Administration of Insurance Services, Inc. (collectively the Plan). We have jurisdiction pursuant to 28 U.S.C. § 1291, and we reverse and remand for further proceedings.

I.

In March 2008, Barboza filed an action against the Plan for refusing to pay certain long-term disability benefits. Although the parties ultimately agreed that Barboza is entitled to an award of benefits, they still dispute whether the Plan was permitted to offset that award based on certain payments that Barboza received, or at least could have received, pursuant to state law. Without reaching this issue, the district court, upon a motion for summary judgment, dismissed Barboza's claims without prejudice due to his failure to exhaust available administrative remedies under the Plan. Whether the district court erred in doing so is the subject of this appeal.

In addressing that alleged error, we are unconcerned with whether Barboza did in fact pursue all of the administrative remedies available to him; he admits he did not. What we are concerned with is whether Barboza's claim should have been deemed exhausted pursuant to certain administrative regulations implemented under *1076 the Employee Retirement Income Security Act of 1974 (ERISA). See 29 C.F.R. § 2560.503-1(l). According to Barboza and the Secretary of the Department of Labor, who filed an amicus brief on Barboza's behalf, his claims should be deemed exhausted due to the Plan's failure to resolve his request for disability benefits in a timely fashion. See id. § 2560.503-1(i).

II.

We must first consider our jurisdiction over the instant appeal. Ordinarily, the dismissal of an action with prejudice is necessary to provide us with jurisdiction. Griffin v. Arpaio, 557 F.3d 1117, 1119 (9th Cir.2009). However, our precedent carves out an exception. When a district court terminates an action for a claimant's failure to exhaust administrative remedies, we will treat the matter as final unless the claimant could begin anew or continue the administrative process. Id.; see also Eastman Kodak Co. v. STWB, Inc., 452 F.3d 215, 219 (2d Cir.2006) (dismissal of an ERISA claim "without prejudice, absent some retention of jurisdiction, is a final decision within the meaning of 28 U.S.C. § 1291, and hence, appealable").

While the district court dismissed Barboza's claims without prejudice, there is no indication that he could begin the administrative process again or somehow continue it. Rather than retain jurisdiction, the district court dismissed Barboza's claims in their entirety and entered judgment in the Plan's favor. Under these circumstances, we hold that for all practical purposes the district court has terminated Barboza's action, which constitutes a final appealable judgment and gives us appellate jurisdiction pursuant to section 1291. See Arpaio, 557 F.3d at 1119; Pension Benefit Guar. Corp. v. Carter & Tillery Enters., 133 F.3d 1183, 1185 (9th Cir.1998).

III.

We turn now to Barboza's contention that he should have been excused from pursuing his administrative remedies. As a general rule, an ERISA claimant must exhaust available administrative remedies before bringing a claim in federal court. See Vaught v. Scottsdale Healthcare Corp. Health Plan, 546 F.3d 620, 626 (9th Cir.2008). However, when an employee benefits plan fails to establish or follow "reasonable claims procedures" consistent with the requirements of ERISA, a claimant need not exhaust because his claims will be deemed exhausted. 29 C.F.R. § 2560.503-1(l); see also Vaught, 546 F.3d at 633 (remanding where an employee benefits plan failed to satisfy ERISA's procedural requirements); Eastman Kodak, 452 F.3d at 223 (holding that plaintiff's ERISA claim should have been deemed exhausted under section 2560.503-1(l) and concluding that "substantial compliance" is insufficient).

In resolving this appeal, it is important to clarify the appropriate standard of review. In Diaz v. United Agricultural Employee Welfare Benefit Plan & Trust, we held that the "applicability vel non of exhaustion principles is a question of law" that "we consider ... de novo." 50 F.3d 1478, 1483 (9th Cir.1995). We then stated that a district court's refusal "to grant an exception to the application of those principles is reviewed for abuse of discretion." Id. As stated before, the issue presented here is whether Barboza's claims should have been deemed exhausted under section 2560.503-1(l). This question of law thus turns on the potential applicability of exhaustion principles, not a discretionary exception to the application of those principles. Accordingly, our review is de novo. Id.

*1077 A.

To determine if Barboza's claims should have been deemed exhausted, we must ask whether the Plan complied with ERISA. The answer to that question turns on whether the Plan satisfied 29 C.F.R. § 2560.503-1(i)(1)-(3), the ERISA provision in dispute. That section requires a plan administrator to resolve a claimant's request for benefits within certain time limits. Crucially, the length of time depends upon the nature of the claim (whether or not it is a disability claim) and the type of plan involved (whether or not it is a multiemployer plan).

The general time period for claim resolution is set forth in subparagraph (i)(1)(i). This provision gives a plan administrator 60 days to notify a claimant of any benefit determination after receiving the claimant's request:

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651 F.3d 1073, Counsel Stack Legal Research, https://law.counselstack.com/opinion/barboza-v-cal-assn-of-professional-firefighters-ca9-2011.