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

CourtDistrict Court, N.D. California
DecidedJanuary 28, 2021
Docket5:18-cv-07454
StatusUnknown

This text of Benjamin Wise v. Monterey County Hospitality Association Health and Welfare Plan (Benjamin Wise v. Monterey County Hospitality Association Health and Welfare Plan) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Benjamin Wise v. Monterey County Hospitality Association Health and Welfare Plan, (N.D. Cal. 2021).

Opinion

8 UNITED STATES DISTRICT COURT

9 NORTHERN DISTRICT OF CALIFORNIA 10 SAN JOSE DIVISION 11

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

13 Plaintiff, ORDER GRANTING IN PART PLAINTIFF’S MOTION FOR 14 v. ATTORNEY’S FEES AND REIMBURSEMENT OF COSTS 15 MONTEREY COUNTY HOSPITALITY ASSOCIATION HEALTH AND 16 WELFARE PLAN, et al., 17 Defendants. 18 Plaintiff Benjamin Wise (“Plaintiff”) sued the Monterey County Hospitality Association 19 Health and Welfare Plan; the Monterey County Hospitality Association; MVI Administrators 20 Insurance Solutions, Inc. (“MVI”), UnitedHealthcare Insurance Company and United Healthcare 21 Services, Inc. (collectively, “UHC”), and MAXIMUS Federal Services, Inc. (“MAXIMUS”) for 22 denial of benefits to which Plaintiff claimed he was entitled under the Monterey County 23 Hospitality Association Health & Welfare Plan. Before the Court is Plaintiff’s motion for 24 attorney’s fees and reimbursement of costs, which Plaintiff seeks from Defendants UHC.1 ECF 25 26 1 Plaintiff’s motion for attorney’s fees and reimbursement of costs contains a notice of motion 27 paginated separately from the points and authorities in support of the motion. ECF No. 233 at 1– 1 1 No. 233. Having considered the parties’ submissions, the relevant law, and the record in this case, 2 the Court GRANTS in part Plaintiff’s motion. 3 I. BACKGROUND 4 A. Factual Background 5 Plaintiff’s employer, Eric Miller Architects, participates in the Monterey County 6 Hospitality Association Health & Welfare Plan (the “Plan”). The Plan is covered by the Employee 7 Retirement Income Security Act (“ERISA”), and provides medical benefits through Defendants 8 UHC. UHC promulgates a Certificate of Coverage, which outlines which services will be covered 9 by UHC. See Findings of Fact and Conclusions of Law, ECF No. 224, at 7. The Certificate of 10 Coverage provides for an internal appeals process for adverse determinations made by UHC, as 11 well as an “Independent External Review Program,” which is conducted through the California 12 Department of Insurance. Id. at 11. The California Department of Insurance contracts with 13 various third-party entities to perform that independent review process, including MAXIMUS. Id. 14 In 2002, Plaintiff was involved in a vehicular accident that injured Plaintiff’s arm. Id. at 15 12. On September 19, 2017, Dr. Brandon Green, a physician consultant and Chief Medical 16 Officer of Myomo, Inc., submitted a request for coverage of the MyoPro Motion G (“MyoPro”) 17 for Plaintiff’s use, which is manufactured by Myomo. Id. at 13. On October 10, 2017, UHC 18 denied Plaintiff’s request for coverage of the MyoPro. Id. at 14. On November 22, 2017, Dr. 19 Green filed an appeal of UHC’s denial of benefits. On December 11, 2017, UHC denied 20 Plaintiff’s appeal. Id. Plaintiff then filed a request for an independent medical review with the 21 California Department of Insurance. Id. at 15. Dr. Green filed a letter in support of Plaintiff’s 22 appeal. Id. MAXIMUS conducted the independent medical review. Id. After conducting a 23 review, MAXIMUS upheld UHC’s decision. Id. at 16. 24 B. Procedural History 25

26 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. 27 2 1 On December 11, 2018, Plaintiff filed suit against MVI, Monterey County Hospitality 2 Association Health and Welfare Plan, Monterey County Hospitality Association, UHC, and 3 MAXIMUS. Complaint, ECF No. 1. Plaintiff’s initial complaint alleged three causes of action 4 against all Defendants: (1) wrongful denial of benefits under ERISA § 502(a)(1)(B), 28 U.S.C. § 5 1132; (2) breach of fiduciary duty under ERISA § 502(a)(3), 29 U.S.C. § 1132(a)(3); and (3) 6 denial of full and fair review under ERISA § 503, 29 U.S.C. § 1133. Id. 7 On April 26, 2019, MVI filed a motion to dismiss the complaint. ECF No. 55. On July 2, 8 2019, the Court granted MVI’s motion to dismiss the complaint without prejudice. ECF No. 93. 9 On August 1, 2019, Plaintiff filed a first amended complaint, alleging the same three 10 causes of action. ECF No. 101 (“FAC”). On August 30, 2019, MVI filed a motion to dismiss the 11 FAC. ECF No. 128. 12 On November 15, 2019, the Court granted a stipulation between Plaintiff and Monterey 13 County Hospitality Association and Monterey County Hospitality Association Health and Welfare 14 Trust that dismissed Plaintiff’s claims against those two entities with prejudice. ECF No. 145. 15 With that stipulation Monterey County Hospitality Association and Monterey County Hospitality 16 Association Health and Welfare Trust were no longer parties to the instant case. 17 On January 21, 2020, the Court granted MVI’s motion to dismiss with prejudice as to the 18 three causes of action against MVI. ECF No. 154. With that order, MVI was no longer a party to 19 the instant case. 20 On January 24, 2020, UHC and MAXIMUS each filed a motion for summary judgment. 21 ECF Nos. 157, 159. Plaintiff also filed a motion for partial summary judgment on January 24, 22 2020. ECF No. 162. On April 8, 2020, the Court ruled on the parties’ motions for summary 23 judgment. ECF No. 181. The Court denied Plaintiff’s motion for partial summary judgment. Id. 24 The Court also denied the motions for summary judgment of UHC and MAXIMUS as to 25 Plaintiff’s claim for improper denial of benefits under ERISA § 502(a)(1)(B). Id. The Court 26 granted the motions for summary judgment of UHC and MAXIMUS as to Plaintiff’s claim for 27 3 1 breach of fiduciary duty under ERISA § 502(a)(3) to the extent Plaintiff sought restitution. Id. 2 The Court denied the motions for summary judgment of UHC and MAXIMUS as to Plaintiff’s 3 claim for breach of fiduciary duty under ERISA § 502(a)(3) to the extent it sought injunctive 4 relief. Id. Finally, the Court granted the motions for summary judgment of UHC and MAXIMUS 5 as to Plaintiff’s claim for denial of a full and fair review under ERISA § 503. Id. 6 On June 5, 2020, UHC, MAXIMUS, and Plaintiff filed trial briefs. ECF Nos. 198, 199, 7 201. On June 19, 2020, UHC, MAXIMUS, and Plaintiff filed responses to the trial briefs. ECF 8 Nos. 209, 210, 211. On August 12, 2020, the Court filed a Findings of Fact and Conclusions of 9 Law, finding that UHC improperly denied coverage of the MyoPro to Plaintiff under ERISA § 10 502(a)(1)(B); UHC did not breach its fiduciary duty under ERISA § 502(a)(3); MAXIMUS did 11 not improperly deny coverage of the MyoPro to Plaintiff under ERISA § 502(a)(1)(B); and 12 MAXIMUS did not breach its fiduciary duty under ERISA § 502(a)(3). ECF No. 224. The Court 13 entered judgment the same day. ECF No. 225. 14 On September 9, 2020, Plaintiff filed the instant motion for attorney’s fees and 15 reimbursement of costs, seeking $156,645.00 in attorney’s fees and $846.39 in costs from UHC. 16 Motion for Attorney’s Fees and Reimbursement of Costs. ECF No. 233, at 1 (“Mot.”). Plaintiff 17 also filed declarations from Plaintiff’s attorneys and an exhibit documenting hours billed during 18 litigation. See ECF No. 233-1 (“Jason Davis Decl.”); ECF No. 233-3 (“Zoila Davis Decl.”); ECF 19 No. 233-2 (“Ex. A”). On September 23, 2020, UHC filed an opposition. ECF No. 236. UHC also 20 filed a declaration from attorney Courtney C. Hill. See ECF No. 236-1 (“Courtney C. Hill 21 Decl.”). On September 23, 2020, MAXIMUS filed a statement clarifying that Plaintiff had agreed 22 in writing and on the phone that MAXIMUS was the prevailing party and therefore Plaintiff was 23 not seeking fees and costs from MAXIMUS. ECF No. 237.

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Benjamin Wise v. Monterey County Hospitality Association Health and Welfare Plan, Counsel Stack Legal Research, https://law.counselstack.com/opinion/benjamin-wise-v-monterey-county-hospitality-association-health-and-welfare-cand-2021.