Benjamin Wise v. Monterey County Hospitality Association Health and Welfare Plan

District Court, N.D. California·Decided January 28, 2021·No. 5:18-cv-07454·Unknown

Opinion

NORTHERN DISTRICT OF CALIFORNIA SAN JOSE DIVISION

BENJAMIN WISE, Case No. 18-CV-07454-LHK

Plaintiff, ORDER GRANTING IN PART PLAINTIFF’S MOTION FOR v. ATTORNEY’S FEES AND REIMBURSEMENT OF COSTS ASSOCIATION HEALTH AND WELFARE PLAN, et al., Defendants. Plaintiff Benjamin Wise (“Plaintiff”) sued the Monterey County Hospitality Association Health and Welfare Plan; the Monterey County Hospitality Association; MVI Administrators Insurance Solutions, Inc. (“MVI”), UnitedHealthcare Insurance Company and United Healthcare Services, Inc. (collectively, “UHC”), and MAXIMUS Federal Services, Inc. (“MAXIMUS”) for denial of benefits to which Plaintiff claimed he was entitled under the Monterey County Hospitality Association Health & Welfare Plan. Before the Court is Plaintiff’s motion for attorney’s fees and reimbursement of costs, which Plaintiff seeks from Defendants UHC.1 ECF 1 Plaintiff’s motion for attorney’s fees and reimbursement of costs contains a notice of motion paginated separately from the points and authorities in support of the motion. ECF No. 233 at 1– 1 No. 233. Having considered the parties’ submissions, the relevant law, and the record in this case, the Court GRANTS in part Plaintiff’s motion. A. Factual Background Plaintiff’s employer, Eric Miller Architects, participates in the Monterey County Hospitality Association Health & Welfare Plan (the “Plan”). The Plan is covered by the Employee Retirement Income Security Act (“ERISA”), and provides medical benefits through Defendants UHC. UHC promulgates a Certificate of Coverage, which outlines which services will be covered by UHC. See Findings of Fact and Conclusions of Law, ECF No. 224, at 7. The Certificate of Coverage provides for an internal appeals process for adverse determinations made by UHC, as well as an “Independent External Review Program,” which is conducted through the California Department of Insurance. Id. at 11. The California Department of Insurance contracts with various third-party entities to perform that independent review process, including MAXIMUS. Id. In 2002, Plaintiff was involved in a vehicular accident that injured Plaintiff’s arm. Id. at 12. On September 19, 2017, Dr. Brandon Green, a physician consultant and Chief Medical Officer of Myomo, Inc., submitted a request for coverage of the MyoPro Motion G (“MyoPro”) for Plaintiff’s use, which is manufactured by Myomo. Id. at 13. On October 10, 2017, UHC denied Plaintiff’s request for coverage of the MyoPro. Id. at 14. On November 22, 2017, Dr. Green filed an appeal of UHC’s denial of benefits. On December 11, 2017, UHC denied Plaintiff’s appeal. Id. Plaintiff then filed a request for an independent medical review with the California Department of Insurance. Id. at 15. Dr. Green filed a letter in support of Plaintiff’s appeal. Id. MAXIMUS conducted the independent medical review. Id. After conducting a review, MAXIMUS upheld UHC’s decision. Id. at 16. B. Procedural History

2. Civil Local Rule 7-2(b) provides that the notice of motion and points and authorities must be contained in one document with the same pagination. 2 On December 11, 2018, Plaintiff filed suit against MVI, Monterey County Hospitality Association Health and Welfare Plan, Monterey County Hospitality Association, UHC, and MAXIMUS. Complaint, ECF No. 1. Plaintiff’s initial complaint alleged three causes of action against all Defendants: (1) wrongful denial of benefits under ERISA § 502(a)(1)(B), 28 U.S.C. § 1132; (2) breach of fiduciary duty under ERISA § 502(a)(3), 29 U.S.C. § 1132(a)(3); and (3) denial of full and fair review under ERISA § 503, 29 U.S.C. § 1133. Id. On April 26, 2019, MVI filed a motion to dismiss the complaint. ECF No. 55. On July 2, 2019, the Court granted MVI’s motion to dismiss the complaint without prejudice. ECF No. 93. On August 1, 2019, Plaintiff filed a first amended complaint, alleging the same three causes of action. ECF No. 101 (“FAC”). On August 30, 2019, MVI filed a motion to dismiss the FAC. ECF No. 128. On November 15, 2019, the Court granted a stipulation between Plaintiff and Monterey County Hospitality Association and Monterey County Hospitality Association Health and Welfare Trust that dismissed Plaintiff’s claims against those two entities with prejudice. ECF No. 145. With that stipulation Monterey County Hospitality Association and Monterey County Hospitality Association Health and Welfare Trust were no longer parties to the instant case. On January 21, 2020, the Court granted MVI’s motion to dismiss with prejudice as to the three causes of action against MVI. ECF No. 154. With that order, MVI was no longer a party to the instant case. On January 24, 2020, UHC and MAXIMUS each filed a motion for summary judgment. ECF Nos. 157, 159. Plaintiff also filed a motion for partial summary judgment on January 24, 2020. ECF No. 162. On April 8, 2020, the Court ruled on the parties’ motions for summary judgment. ECF No. 181. The Court denied Plaintiff’s motion for partial summary judgment. Id. The Court also denied the motions for summary judgment of UHC and MAXIMUS as to Plaintiff’s claim for improper denial of benefits under ERISA § 502(a)(1)(B). Id. The Court granted the motions for summary judgment of UHC and MAXIMUS as to Plaintiff’s claim for 3 breach of fiduciary duty under ERISA § 502(a)(3) to the extent Plaintiff sought restitution. Id. The Court denied the motions for summary judgment of UHC and MAXIMUS as to Plaintiff’s claim for breach of fiduciary duty under ERISA § 502(a)(3) to the extent it sought injunctive relief. Id. Finally, the Court granted the motions for summary judgment of UHC and MAXIMUS as to Plaintiff’s claim for denial of a full and fair review under ERISA § 503. Id. On June 5, 2020, UHC, MAXIMUS, and Plaintiff filed trial briefs. ECF Nos. 198, 199, 201. On June 19, 2020, UHC, MAXIMUS, and Plaintiff filed responses to the trial briefs. ECF Nos. 209, 210, 211. On August 12, 2020, the Court filed a Findings of Fact and Conclusions of Law, finding that UHC improperly denied coverage of the MyoPro to Plaintiff under ERISA § 502(a)(1)(B); UHC did not breach its fiduciary duty under ERISA § 502(a)(3); MAXIMUS did not improperly deny coverage of the MyoPro to Plaintiff under ERISA § 502(a)(1)(B); and MAXIMUS did not breach its fiduciary duty under ERISA § 502(a)(3). ECF No. 224. The Court entered judgment the same day. ECF No. 225. On September 9, 2020, Plaintiff filed the instant motion for attorney’s fees and reimbursement of costs, seeking $156,645.00 in attorney’s fees and $846.39 in costs from UHC. Motion for Attorney’s Fees and Reimbursement of Costs. ECF No. 233, at 1 (“Mot.”). Plaintiff also filed declarations from Plaintiff’s attorneys and an exhibit documenting hours billed during litigation. See ECF No. 233-1 (“Jason Davis Decl.”); ECF No. 233-3 (“Zoila Davis Decl.”); ECF No. 233-2 (“Ex. A”). On September 23, 2020, UHC filed an opposition. ECF No. 236. UHC also filed a declaration from attorney Courtney C. Hill. See ECF No. 236-1 (“Courtney C. Hill Decl.”). On September 23, 2020, MAXIMUS filed a statement clarifying that Plaintiff had agreed in writing and on the phone that MAXIMUS was the prevailing party and therefore Plaintiff was not seeking fees and costs from MAXIMUS. ECF No. 237. On September 30, 2020, Plaintiff filed a reply, along with a declaration from attorney Jason Davis and an exhibit. ECF No. 238; ECF No. 238-1. 4 Pursuant to 29 U.S.C. § 1132(g)(1), the Court “in its discretion may allow a reasonable attorney’s fee and costs of action to either party.” The United States Su

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