Gray v. United of Omaha Life Insurance Co.

251 F. Supp. 3d 1317, 2017 WL 1654077, 2017 U.S. Dist. LEXIS 73111
CourtDistrict Court, C.D. California
DecidedMay 1, 2017
DocketCase No. CV 16-7383 MWF (JCx)
StatusPublished
Cited by2 cases

This text of 251 F. Supp. 3d 1317 (Gray v. United of Omaha Life Insurance Co.) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gray v. United of Omaha Life Insurance Co., 251 F. Supp. 3d 1317, 2017 WL 1654077, 2017 U.S. Dist. LEXIS 73111 (C.D. Cal. 2017).

Opinion

Proceedings (In Chambers): ORDER RE MOTION TO DISMISS [22]

The Honorable MICHAEL W. FITZGERALD, U.S. District Judge

Before the Court is Defendant United of Omaha Life Insurance Company’s (“United”) Motion to Dismiss Plaintiffs First Amended Complaint (the “Motion”), filed January 23, 2017.. (Docket No. 22). Plaintiff Gannon Gray filed his Opposition on February 8, 2017., (Docket No. 26). United replied on February 22, 2017. (Docket No. 27). The Court has read and considered the papers filed on the Motion and held a hearing on March 13, 2017.

For the reasons set forth below, the Motion is DENIED. The Court agrees with Plaintiff that binding authority in this jurisdiction does not require that, under the language of the model statute enacted in California, a claim for disability benefits accrues at the onset of the disability. The Court further agrees with the majority of courts outside this jurisdiction, which interpret the model language to require that a claim for disability benefits accrues at the termination of a period of covered disability.

I. BACKGROUND

The First Amended Complaint alleges the following facts, which the Court takes as true and construes in the light most favorable to Plaintiff. See, e.g., Schueneman v. Arena Pharm., Inc., 840 F.3d 698, 704 (9th Cir. 2016) (restating generally-accepted principle that “[ojrdinarily, when we review a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), we accept a plaintiffs allegations as true ‘and construe them in the light most favorable’ to the plaintiff’) (quoting Zucco Partners, LLC v. Digimarc Corp., 552 F.3d 981, 989 (9th Cir. 2009)).

[1319]*1319Plaintiff was an employee of -southern California television station KSCI-TV (“KSCI”) for 15 years, eventually'becoming Vice President of Sales. (FAC ¶ 11). In May 2011, Plaintiff was severely injured in a car accident. (Id. ¶ 13). As a result of the accident, Plaintiff has only limited use of his right and left legs, left arm; and shoulder. (Id.). He uses a wheelchair to travel more than a short distance, has limited lifting capabilities, and suffers from chronic pain in his back, shoulder, and left leg. (Id.). Since the accident, Plaintiff:has had five corrective surgeries in addition to a number of other procedures, none of which has resolved his symptoms. (Id.).

Plaintiff remained bedridden for two months following the accident. (FAC ¶ 14). However, in August 2011, KSCI threatened to fire Plaintiff if he did not return to work. (Id,). Plaintiff attempted to work part-time, but was prevented by his medical condition from working effectively. (Id.). In November 2011, Plaintiff, left his employment at KSCI .agaiii to. undergo further surgeries, (Id.. ¶ 15). In April 2012, KSCI terminated Plaintiff. (Id. ¶ 16).

KSCI provided its employees with a welfare benefit plan, governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 'U.S.C. §§ 1001' et seq, that included a long term disability plan (the “Plan”). (FAC ¶¶3-5). United issued the group policy of insurance (the “Group Policy”) that funded the Plan⅛ benefits. (Id. ¶ 5). Plaintiff alleges that KSCI never informed him that he was covered under the Plan, and because he never received an exit interview upon termination, Plaintiff left KSCI without knowledge of his coverage. (Id. ¶ 17). .

The First Amended Complaint refers frequently to the Group Policy. Per United’s unopposed request, the Court takes judicial notice of the Group Policy (Declaration of Bobbi Burns-Bierwirth ’ (“Burns Deck”) ¶ 2, -Ex. A (Docket No. 22-2)) under the incorporation by reference doctrine. See Sams v. Yahoo! Inc., 713 F.3d 1175, 1179 (9th Cir. 2013) (repeating rule that courts may “consider documents that were not physically attached to the complaint where the documents’ authenticity is not contested, and the plaintiffs complaint necessarily relies on them”); Scharff v. Raytheon Co. Short Term Disability Plan, No. EDCV07-134PSG(OPX), 2007 WL 2947566, at *4 (C.D. Cal. June 22, 2007), aff'd, 581 F.3d 899 (9th Cir. 2009) (applying incorporation by reference doctrine to plan documents governed by ERISA). For the same reasons, the Court takes judicial notice of the Certificate of Insurance, titled “Your Group Long-Term Disability Benefits.” (Burns Decl. ¶ 2, Ex. B). -

■ In January 2013, a former coworker finally told Plaintiff that he had long term disability coverage through KSCI and that United was the insurer. (FAC ¶ 18). When Plaintiff called KSCI’s Personnel Director to obtain a copy of the Policy; however, the •Personnel Director informed Plaintiff that she had been instructed not to speak with him, and referred him to KSCI’s lawyers. (Id.).. When Plaintiff contacted the lawyers, they too failed to pass on a copy of the Policy. (Id.).

In addition to asking for a copy of the Policy from KSCI, starting in* January 2013 Plaintiff contacted United to inquire about filing a disability claim. (FAC ¶ 19). Plaintiff alleges that United informed him that he could not file a claim without-a Group Policy number. (Id.). In fact, the Group Policy states that a claimant may submit a claim simply by sending in a written statement detailing the disability, job duties, and any medical treatment received. (See Burns Deck, Ex. B at ■ 43). KSCI refused even to share the Group Policy number with Plaintiff. (Id.), The FAC contends that Plaintiff gave United [1320]*1320sufficient information that it could have verified he was covered under KSCI’s Group Policy but, like KSCI, United “stonewalled” him instead. (Id. ¶20). The. FAC does not supply details regarding Plaintiffs attempts to prove his membership in KSCI’s Group Policy with United, or what actions United took that amounted to stonewalling.

In May 2013, Plaintiff sued KSCI for retaliation and wrongful discharge. During the litigation, Plaintiff sought to discover the Group Policy, but KSCI refused to produce it. (FAC ¶22). Finally, in about July 2015, Plaintiff’s counsel succeeded in obtaining the Group Policy number. (Id.). Accordingly, on August 18, 2015, Plaintiff filed a claim for long term disability benefits with United. (Id. ¶'23).

■ United responded with a request for certain documents to process the claim. (FAC ¶ 24-25). Plaintiff was unable to produce all.of the requested information. (Id. ¶ 26). On January 4, 2015, United denied Plaintiffs claim.. (Id.).

Six months later, on June 27, 2016, Plaintiff- appealed United’s denial of his claim. (FAC ¶ 28). On September 23, 2016, United issued a final denial of Plaintiffs claim. (Id. ¶40). United explained that Plaintiffs claim was denied because he had failed to provide all of the requested documents- and because Plaintiffs claim was not timely filed. (Id.). United explained that because it had denied Plaintiffs claim on eligibility ground, United did not complete “a full investigation into whether ...

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251 F. Supp. 3d 1317, 2017 WL 1654077, 2017 U.S. Dist. LEXIS 73111, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gray-v-united-of-omaha-life-insurance-co-cacd-2017.