Doe v. Prudential Insurance Co. of America

258 F. Supp. 3d 1089
District Court, C.D. California·Decided July 7, 2017·No. Case No. CV-15-04089-AB (FFMx)·Published·Cited by 2 cases

Opinion

ORDER (1) GRANTING DEFENDANT’S MOTION TO CLARIFY AND (2) GRANTING PLAINTIFF’S MOTION FOR ENTRY OF JUDGMENT AND AWARD OF BENEFITS, FEES, AND COSTS

HONORABLE ANDRÉ BIROTTE JR., UNITED STATES DISTRICT COURT JUDGE

Before the Court is Defendant Prudential Insurance Company of America’s (“Prudential”) Motion for Clarification and/or Modification (Dkt. No. 98) and Plaintiff John Doe’s Motion for. Entry of Judgment, Award of Benefits, Prejudgment Interest, Attorneys’ Fees, and Costs of Suit (Dkt. No. 99). Oppositions and replies were filed with respect to both Motions. For the following reasons, the Court GRANTS both Motions.

I. BACKGROUND

This is an action for .benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001, et seq. Following a bench trial, on March 27, 2017, the Court entered findings of fact and conclusions of law in Plaintiffs favor, finding that Prudential improperly terminated his long-term disability benefits, and ordering Prudential to reinstate them. See Order (Dkt. No. 89). The instant- motions follow. The Court will address them in turn.

II. PRUDENTIAL’S MOTION , TO CLARIFY/MODIFY

Prudential points out that two terms of the Order’s declaratory and injunctive relief are inconsistent with each other and with the Plan. The two terms are: “the [1092]*1092Court ... - (3) DECLARES that Plaintiff is entitled to receive future monthly disability benefit payments under the terms of the Plan; and (4) ORDERS Prudential to issue monthly benefit payments until Plaintiff reaches the maximum benefit duration without subjecting Plaintiff to further claims procedures with respect to his claim for benefits under the Plan.” See Order 30:4-15 (emphasis added).

Prudential contends that the italicized language is inconsistent. The Plan requires Prudential to terminate Plaintiffs benefits if he is “no longer disabled” and to reduce his benefits if he returns to work or receives other 'deductible income. See Mot. 6:12-24 (quoting Plan). Thus,' insofar as the Order’s term 4 can be read to mean that Plaintiff is unconditionally entitled to future benefit payments and that Prudential cannot apply its ordinary claims procedures, it is inconsistent with the Plan and with term 3, which states that Plaintiffs entitlement is “under the terms of the Plan.”

The Court cannot award Plaintiff any benefits beyond what the Plan allows. See, e,g., Stout v. Hartford Life & Acc. Ins. Co., 2012 WL 762024, at *1 (N.D. Cal. Mar. 8, 2012) (“Plaintiff may not obtain an order that she is entitled to an unconditional award of future benefits.”); Welsh v. Burlington N., Inc., Employee Benefits Plan, 54 F.3d 1331, 1340 (8th Cir. 1995) (affirming award of past disability benefits due and declaration that plaintiff “is entitled to disability benefits in the future for as long as he is disabled or until he is 65 years old, whichever occurs first ... We note, in addition, that nothing prevents the health • insurance plan from evaluating whether Mr. Welsh continues to be disabled in the future and continues to provide the documentation of that disability required under the terms of the contract.”). Term 4 of the Order was not intended to establish Plaintiffs unconditional entitlement, to future benefits because that would be inconsistent with the Plan. Term 4 was merely intended to reflect that whether Plaintiffs disability was subject to the mental health limitation is a closed question that shall not be subject to further dispute. Term 4 was not intended to bar Prudential from applying its ordinary claim administration procedures to Plaintiff. Indeed, Plaintiff appears to agree that Prudential can continue to monitor his employment status to determine his continuing eligibility.

Plaintiff takes issue with whether Prudential can monitor his medical condition to determine whether he continues to be medically eligible. The Plan requires Prudential to terminate benefits when Plaintiff is “no longer disabled”; this necessarily means that Prudential can continue to monitor Plaintiffs medical condition. Despite Plaintiffs argument, the language he proposes in his Revised Proposed Judgment is appropriate and the Court will adopt it in its Judgment. Ree.Dkt. No.103-2, 2:10-16.

The Court will therefore modify the relief ordered, which will be reflected in the Final-Judgment.

III. PLAINTIFF’S MOTION FOR JUDGMENT, FEES, AND COSTS

A. Benefits Due.

Plaintiff calculates his past benefits due to equal $1,071,936. Prudential argues that this amount should be reduced by $47,717 for payments Plaintiff received from Social Security Disability Insurance (“SSDI”), and which Plaintiff agreed to reimburse Prudential. See Mot. 24:1-16. Plaintiff does not dispute the amount of his SSDI award or that he agreed to reimburse Prudential for such payments; rather, he .argues that [1093]*1093this is the first time. Prudential raised this issue, and that Prudential consistently argued that the court should not consider the SSDI proceedings in deciding this case.

Plaintiffs arguments aré unavailing. Prudential previously raised the offset issue in its fourth affirmative defense, which states that any benefits' due are subject to applicable offsets. See Answer (Dkt, No. 24) 14:1-4. And that Prudential argued that the Court should not consider the SSDI proceedings for purposes of assessing Plaintiffs medical condition does not bar Prudential from enforcing Plaintiffs obligation to reimburse it for SSDI payments he received. The Court therefore finds that the award must be reduced by $47,717 to account for the reimbursable SSDI payments. Therefore, the Plaintiffs benefits due total $1,025,219.

B. Prejudgment Interest

Plaintiff seeks prejudgment interest and proposes several alternative rates. Plaintiff first seeks an annual rate of 14.75%, Prudential’s average annual return on equity since July 2013, as disclosed in its annual report. This amount would keep Prudential from receiving a windfall from its failure to pay benefits. In the alternative, Plaintiff seeks a rate of 11.5% to compensate for lost income he would have earned from investing his unpaid benefits 'in funds he has historically invested ⅛. Finally* Plaintiff says the 10% rate authorized by Cal. Ihs. Code §' 10111.2 for payments insurers withhold longer than 30 days should be the minimum rate. Prudential argues that prejudgment interest should be limited to the default rate under 28 U.S.C. § 1961, which corresponds to the weekly average Treasury bill rate. During the relevant period, this rate ranged from about 0.1% to 1.18%

Although ERISA does not specifically authorize an award of prejudgment interest, the district court has discretion to award it. See, e.g., Dishman v. UNUM Life Ins. Co. of Am., 269 F.3d 974, 988 (9th Cir.2001). Generally, the interest rate set by 28 U.S.C. § 1961

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Doe v. Prudential Insurance Co. of America, 258 F. Supp. 3d 1089 (C.D. Cal. 2017).

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