Klees v. Liberty Life Assurance Co.

110 F. Supp. 3d 978, 2015 U.S. Dist. LEXIS 81439, 2015 WL 3867659
CourtDistrict Court, C.D. California
DecidedJune 23, 2015
DocketCase No. CV 15-00992 DDP (AJWx)
StatusPublished
Cited by1 cases

This text of 110 F. Supp. 3d 978 (Klees v. Liberty Life Assurance 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
Klees v. Liberty Life Assurance Co., 110 F. Supp. 3d 978, 2015 U.S. Dist. LEXIS 81439, 2015 WL 3867659 (C.D. Cal. 2015).

Opinion

ORDER DENYING DEFENDANT’S MOTION TO DISMISS

DEAN D. PREGERSON, District Judge.

Presently before the Court is Defendant’s motion to dismiss the complaint as to both counts. (Dkt. No. 15.) Having heard oral arguments and considered the parties’ submissions, the Court adopts the following order.

I. BACKGROUND

Plaintiff is a former employee of the University of California (UC) system who alleges that she was provided disability insurance coverage by Defendant pursuant to an agreement with the university. (First Amended Complaint (“FAC”), ¶ 6.) Plaintiff alleges that she suffered “sickness and injury” “on or before January 1, 2012.” (Id. at ¶ 8.) She alleges that her conditions included seronegative inflammatory arthritis, fibromyalgia, and injuries from a car accident, and that these constitute a “loss compensable under the terms of the Policy.” (Id.) She further alleges that she had performed all obligations on her part, including paying premiums, that she submitted a timely long term disability claim to Defendant, and that Defendant initially approved the claim. (Id. at ¶¶ 7, 9.)

Plaintiff alleges she was examined, at Defendant’s request, by a Dr. Vlachos on May 8, 2014, and that Dr. Vlachos’ report indicated that she could not work full time due to side effects of medication related to her fibromyalgia, but that she might be able to work “24 hours per week.” (Id. at ¶ 12.) Defendant then had a Dr. Dennis, a separate medical reviewer, consult with Plaintiffs treating physicians, Drs. Ben-Artzi and Hui, who allegedly told Dennis that Plaintiff “might be capable of ‘light duty work.’ ” (Id. at ¶¶ 14-15.) Dennis allegedly wrote a report in which she stated that Plaintiff could work full time, but did not opine on whether Plaintiff “was capable of returning to her occupation or any occupation for which she was suited by her education, training, and experience.” (Id. at ¶ 16.)

Defendant’s vocational department then conducted a “Transferable Skills Analysis” and concluded that Plaintiff could perform several alternative occupations at a “ ‘light’ exertional level as defined by Social Security Regulations.” (Id. at ¶¶ 1718.) On August 11, 2014, Defendant terminated benefit payments, based on a determination that “Plaintiffs disability did not render her unable to perform ‘any occupation’ for which she was qualified by reason of her age, experience, [and] training.” (Id. at ¶ 20.)

Plaintiff appealed the decision, allegedly providing evidence that she suffered pain; swelling; fatigue and a sleep disorder; difficulty sitting, handling stressful situations, and performing repetitive hand movements; and that she still required medication. (Id. at ¶ 21.) Plaintiffs appeal was denied. (Id. at ¶¶ 21-22.)

Thereafter she filed this suit alleged breach of contract and breach of the covenant of good faith and fair dealing.

[982]*982II. LEGAL STANDARD

In order to survive a motion to dismiss for failure to state a claim, a complaint need only include “a short and plain statement of the claim showing that the pleader is entitled to relief.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957)). A complaint must include “sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face.” Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) (quoting Twombly, 550 U.S. at 570, 127 S.Ct. 1955). When considering a Rule 12(b)(6) motion, a court must “accept as true all allegations of material fact and must construe those facts in the light most favorable to the plaintiff.” Resnick v. Hayes, 213 F.3d 443, 447 (9th Cir.2000).

III. DISCUSSION

A. Defendant’s Request that the Court Consider Certain Documents Under the Incorporation by Reference Doctrine

Defendant asks the Court to consider certain documents allegedly related to the insurance policy and the decision to terminate benefits. (Deel. Paula McGee & Exs.) Plaintiff does not dispute the authenticity of these documents but argues that the Court should not consider most of them, as they are not attached to the complaint and do not fall within any relevant exception. (PL’s Obj. McGee Deck)

Generally, on a motion to dismiss, if “matters outside the pleadings are presented to and not excluded by the court, the motion must be treated as one for summary judgment.” Fed.R.Civ.P. 12(d). However, under the “incorporation by reference” doctrine, a court may consider documents “whose contents are alleged in a complaint” or that “plaintiffs claim depends on,” as long as the authenticity of the document is not disputed. Knievel v. ESPN, 393 F.3d 1068, 1076 (9th Cir.2005). The “depends on” language is also sometimes phrased as “central to,” id. (quoting Horsley v. Feldt, 304 F.3d 1125, 1135 (11th Cir.2002)), “crucial to,” Parrino v. FHP, Inc., 146 F.3d 699, 706 (9th Cir.1998), “integral to,” id. at 706, n. 4, or “the basis of’ the complaint. United States v. Ritchie, 342 F.3d 903, 908 (9th Cir.2003). By contrast, where the documents are not cited or referred to in the complaint, are not “integral to” the complaint, and serve only as evidence intended to undermine the factual basis of plaintiffs claims, consideration under the incorporation by reference doctrine is inappropriate. In re Jiffy Lube Int’l, Inc., Text Spam Litig., 847 F.Supp.2d 1253, 1259 (S.D.Cal.2012).

After reviewing the claims in the complaint, the Court concludes that it is appropriate to consider the following exhibits to the McGee declaration: Exhibit A, the insurance policy; Exhibit C, a July 29, 2011 letter approving short term total disability benefits; Exhibit D, a June 29, 2012 letter approving long term total disability benefits; Exhibit J, the August 11, 2014 letter terminating payment of benefits; and Exhibit K, the February 5, 2015, letter denying Plaintiffs appeal of the termination. Each of these is explicitly or implicitly referenced in the complaint, and Plaintiffs complaint depends on, at a minimum, the existence of a contract and the termination of benefits that are alleged to be owed under the contract. It is therefore appropriate to consider these documents along with the complaint in the motion to dismiss.

Many of the documents, however, are statements by doctors as to Plaintiffs ability to work, or communications between Defendant’s agent and certain examining doctors. There are good reasons [983]*983not to consider these.

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110 F. Supp. 3d 978, 2015 U.S. Dist. LEXIS 81439, 2015 WL 3867659, Counsel Stack Legal Research, https://law.counselstack.com/opinion/klees-v-liberty-life-assurance-co-cacd-2015.