Metaxas v. Gateway Bank F.S.B.

District Court, N.D. California·Decided March 31, 2022·No. 3:20-cv-01184·Unknown

Opinion

POPPI METAXAS, Case No. 20-cv-01184-EMC (DMR)

Plaintiff, ORDER ON JOINT DISCOVERY v. LETTER

GATEWAY BANK F.S.B., et al., Re: Dkt. No. 60 Defendants.

The parties filed a joint discovery letter brief in which Plaintiff Poppi Metaxas moves to supplement the administrative record. [Docket No. 60 (Jt. Letter).] This matter is suitable for resolution without a hearing. Civ. L.R. 7-1(b). For the following reasons, the motion is denied. This is an action for supplemental retirement benefits pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a). Metaxas filed this case against her former employer Defendant Gateway Bank, F.S.B. (“Gateway”) and the Gateway Bank Supplemental Executive Retirement Plan (“the Plan”). She alleges that she worked as the President and CEO of Gateway Bank and that she became “totally disabled under the terms of the plan” due to “prolonged sickness” and other “acute and chronic medical problems.” Compl. ¶¶ 7- 10. She filed a claim for disability and termination benefits on March 23, 2013, which Defendants denied on February 25, 2016. Id. Metaxas appealed the denial on August 15, 2016, and “sent defendants additional documentation of her disability” with her appeal. Defendants upheld the decision to deny benefits on May 22, 2017. Id. at ¶¶ 12, 13. Metaxas filed the complaint on February 17, 2020 seeking relief under ERISA §§ 502(a)(1)(B), (a)(3). See 29 U.S.C. §§ 1132(a)(1)(B), 1132(a)(3). undersigned. [Docket Nos. 38, 44.] Because the motion implicated the appropriate standard of review of the underlying determination, the Honorable Edward M. Chen ordered the parties to brief the issue and subsequently held that “Defendants’ decision to deny benefits to Plaintiff . . . is reviewed for abuse of discretion.” [Docket No. 58.] The undersigned then ordered the parties to meet and confer regarding Metaxas’s request to supplement the administrative record and to file a joint letter on any remaining disputes. [Docket No. 59.] The parties filed the instant joint letter in which Metaxas moves to supplement the administrative record with four categories of documents. Exhibit 1 to the joint letter comprises a table of contents and the 215 pages of documents Metaxas seeks to add to the administrative record. [Docket No. 60-1 (Supp. A.R.).] ERISA allows a participant in an employee benefit scheme to bring a civil action to recover benefits due under the terms of a plan. 29 U.S.C. § 1132(a)(1)(B). As previously noted, Judge Chen determined that he must apply the abuse of discretion standard in this case, which means that the court’s review is limited to the record before the plan administrator. Jebian v. Hewlett-Packard Co. Employee Benefits Org. Income Prot. Plan, 349 F.3d 1098, 1110 (9th Cir. 2003) (citation omitted). “In the ERISA context, the ‘administrative record’ consists of ‘the papers the insurer had when it denied the claim.’” Montour v. Hartford Life & Acc. Ins. Co., 588 F.3d 623, 632 n.4 (9th Cir. 2009) (quoting Kearney v. Standard Ins. Co., 175 F.3d 1084, 1086 (9th Cir. 1999)). Courts have determined that ERISA and its regulations determine the scope of the administrative record. See Nguyen v. Sun Life Assurance Co. of Canada, No. 3:14-cv-05295 JST (LB), 2015 WL 6459689, at *3-4 (N.D. Cal. Oct. 27, 2015). Under ERISA, “every employee benefit plan shall . . . afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim.” 29 U.S.C. § 1133(2); see also 29 C.F.R. § 2650.503(h)(1) (“a claimant shall have a reasonable opportunity to appeal an adverse benefit determination to an appropriate named fiduciary of the plan”). ERISA regulations state that claimants must be provided access to “all “[w]hether a document, record, or other information is relevant to a claim for benefits shall be determined by reference to paragraph (m)(8) of this section . . .” See 29 C.F.R. § 2650.503- 1(h)(2)(iii). In turn, 29 C.F.R. § 2650-503-1(m)(8) provides that “[a] document, record, or other information shall be considered ‘relevant’ to a” claim if it:

(i) Was relied upon in making the benefit determination;

(ii) Was submitted, considered, or generated in the course of making the benefit determination, without regard to whether such document, record, or other information was relied upon in making the benefit determination; (iii) Demonstrates compliance with the administrative processes and safeguards required pursuant to paragraph (b)(5) of this section in making the benefit determination; or (iv) In the case of a group health plan or a plan providing disability benefits, constitutes a statement of policy or guidance with respect to the plan concerning the denied treatment option or benefit for the claimant’s diagnosis, without regard to whether such advice or statement was relied upon in making the benefit determination. 29 C.F.R. § 2650.503-1(m)(8). Materials that fall into one of the foregoing categories should be considered “part of the administrative record.” Nguyen, 2015 WL 6459689, at *3-4. In addition, 29 U.S.C. § 1024(b)(4) mandates that upon request, plan administrators must provide participants with certain foundational plan documents:

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Metaxas v. Gateway Bank F.S.B., (N.D. Cal. 2022).

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