Murphy v. California Physicians Service

213 F. Supp. 3d 1238, 62 Employee Benefits Cas. (BNA) 2214, 2016 WL 5682567, 2016 U.S. Dist. LEXIS 137159
CourtDistrict Court, N.D. California
DecidedOctober 3, 2016
DocketCase No. 14-cv-02581-PJH
StatusPublished
Cited by1 cases

This text of 213 F. Supp. 3d 1238 (Murphy v. California Physicians Service) 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
Murphy v. California Physicians Service, 213 F. Supp. 3d 1238, 62 Employee Benefits Cas. (BNA) 2214, 2016 WL 5682567, 2016 U.S. Dist. LEXIS 137159 (N.D. Cal. 2016).

Opinion

ORDER RE STANDARD OF REVIEW

PHYLLIS J. HAMILTON, United States District Judge

Plaintiffs motion to determine the standard of review came on for hearing before this court on August 10, 2016. Plaintiff appeared by her counsel Corinne Chandler and Glenn Kantor, and defendants appeared by their counsel Linda Lawson. Having read the parties’ papers and carefully considered their arguments and the relevant legal authority, the court hereby GRANTS plaintiffs motion

BACKGROUND

This is an action under the Employee Retirement Security Act of 1974 [1241]*1241(“ERISA”) to recover long-term disability benefits. Plaintiff Cathleen Murphy was employed by Blue Shield of California (“Blue Shield”) and was a participant in Blue Shield’s Consolidated Group Welfare Benefit Plan (“the Plan”), which included the Long Term Disability Plan.

Plaintiff originally submitted her claim for benefits on December 23, 2013. She filed the complaint in the present action on June 4, 2014, alleging that the claims administrator, The Prudential Insurance Company of America (“Prudential”), had failed to timely respond to her claim. After the complaint was filed, Prudential issued a decision denying plaintiffs claim.

On June 20, 2014, plaintiff filed a first amended complaint (“FAC”), asserting a single cause of action for recovery of benefits, under 29 U.S.C. § 1132(a)(1)(B). Named as defendants are Prudential and California Physician Service d/b/a Blue Shield of California Long Term Disability Plan. Defendants answered the FAC on September 4, 2014.

After plaintiff filed a first appeal of the claim denial on October 21, 2014, the court informally stayed the present action pending resolution of the appeal. Prudential denied the first appeal on May 20, 2015, but offered plaintiff a second voluntary appeal, which plaintiff submitted on August 31, 2015. On December 9, 2015, Prudential issued a decision upholding its claim denial. On July 6, 2016, plaintiff filed the present motion for determination of the standard of review.

DISCUSSION

A.Legal Standard

A motion for determination of the standard of review in an ERISA case is brought under Federal Rule of Civil Procedure 12(c), or, if matters outside the pleadings are presented to and not excluded by the court, is brought as a motion for partial summary judgment under Federal Rule of Civil Procedure 56. See Fed. R. Civ. P. 12(d).

A party may move for summary judgment on a “claim or defense” or “part of.. .a claim or defense.” Fed. R. Civ. P. 56(a). Summary judgment is appropriate when there is no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law. Id. Here, the motion is directed solely at an issue of law, although both sides have submitted declarations with attached exhibits. Accordingly, the court treats the motion as one for partial summary judgment.

B. The Plan

Blue Shield’s eligible full-time employees, including plaintiff, are participants in the Plan, which is regulated by ERISA. Among the benefits offered through the Plan are short-term and long-term disability benefits. Prudential is the insurer of benefits for the Plan and acts as the Plan administrator. At issue in this case is plaintiffs application for long-term disability benefits.

Blue Shield established the Plan under Group Contract G-43995-CA. See Declaration of Corinne Chandler in support of plaintiff’s motion (“Chandler Decl.”), Exh. C. Prudential issued the Group Contract to Blue Shield as the Contract Holder. Id. at 1. The Contract date is September 1, 2004, and contract anniversaries are September 1 of each year, beginning in 2005. Id. at 2.

By its terms, the “entire” Group Contract consists of the Group Insurance Certificate(s) (or “Certificate of Coverage”) listed in the Schedule of Plans, attached to the Group Contract; all modifications and endorsements to the Certificate of Coverage which are attached to and made part of the Group Contract by amendment of [1242]*1242the Group Contract; the forms shown in the Table of Contents as of the Contract Date; the Contract Holder’s application, a copy of which is attached to the Group Contract; any endorsements or amendments to the Group Contract; and the individual applications, if any, of the persons insured. Id. at 6.

The Group Contract “may be amended at any time” without the consent of the insured employees, “through written request made by the Contract Holder and agreed to by Prudential.” Id. at 6-7. However, “[n]o change in the Group Contract is valid unless shown in: (1) an endorsement on it signed by an officer of Prudential, or (2) an amendment to it signed by the Contract Holder and by an officer of Prudential.” Id. at 7. An amendment may be made with only a Prudential officer’s signature if the amendment was automatically made to comply with state or federal law or regulation, or the amendment reflects a change in Prudential’s administration of group insurance benefits and is intended to apply to all group insurance contracts affected by the change. Id.

The current “Certificate of Coverage” for the short- and long-term disability plans is dated September 1, 2012. Chandler Decl., Exh. D at 2, 4. The Certificate of Coverage defines “Plan” as “a line of coverage under the Group Contract.” Id. at 43. A “Summary Plan Description” is appended to the Certificate of Coverage. The cover page of the Summary Plan Description states that it “is not part of the Group Insurance Certificate” and that it “has been provided by your Employer and included in your Booklet-Certificate upon the Employer’s request.” Chandler Decl., Exh. D. The Summary Plan Description also states that it is intended to comply with regulations issued by the U.S. Department of Labor under ERISA, which requires that plan participants be given a “Summary Plan Description” that describes the plan and informs participants of their rights under the plan. Id.

In addition, Blue Shield prepared a document entitled “Blue Shield of California Consolidated Group Welfare Benefit Plan - Summary Plan Description” (“employer Plan Description”), which is dated January 1, 2009. Chandler Decl., Exh. E. This employer Plan Description “describes the health and welfare benefits programs sponsored by Blue Shield of California and made available to eligible employees of Blue Shield of California through the Blue Shield of California Consolidated Group Welfare Plan....” Id. at 1. It states further that “if there is a conflict between what is written here, and the related benefit program materials or the Plan, the related benefit program materials and Plan will govern, unless otherwise governed by law.” Id. at 2.

C. Plaintiffs Motion

Plaintiff argues that the court should review her claim for long-term disability benefits de novo.

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Cite This Page — Counsel Stack

Bluebook (online)
213 F. Supp. 3d 1238, 62 Employee Benefits Cas. (BNA) 2214, 2016 WL 5682567, 2016 U.S. Dist. LEXIS 137159, Counsel Stack Legal Research, https://law.counselstack.com/opinion/murphy-v-california-physicians-service-cand-2016.