Rampton v. Anthem Blue Cross Life and Health Ins. Co.

CourtDistrict Court, N.D. California
DecidedJanuary 29, 2024
Docket3:23-cv-03499
StatusUnknown

This text of Rampton v. Anthem Blue Cross Life and Health Ins. Co. (Rampton v. Anthem Blue Cross Life and Health Ins. Co.) 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
Rampton v. Anthem Blue Cross Life and Health Ins. Co., (N.D. Cal. 2024).

Opinion

1 w 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 EUREKA DIVISION 7 8 CHERYL RAMPTON, Case No. 23-cv-03499-RFL (RMI)

9 Plaintiff, ORDER RE: DISCOVERY DISPUTE 10 v. Re: Dkt. No. 30 11 ANTHEM BLUE CROSS LIFE AND HEALTH INS. CO., 12 Defendant. 13 14 Now pending before the court is a discovery dispute letter brief through which Plaintiff 15 requests to compel certain information which Defendant has redacted based on the attorney-client 16 privilege and work-product doctrine given that those portions of the pertinent documents were 17 included in communications with Defendant’s in-house legal department and because the 18 communications were made in anticipation of litigation. See generally Ltr. Br. (dkt. 30) at 1, 3. 19 Plaintiff submits, inter alia, that the information should nevertheless be produced pursuant to the 20 fiduciary exception to the attorney-client privilege and work-product doctrine. Id. at 1-3. Pursuant 21 to Federal Rule of Civil Procedure 78(b) and Civil Local Rule 7-1(b), the court finds the matter 22 suitable for disposition without oral argument. For the reasons stated below, Plaintiff’s request to 23 compel the information is granted in part and denied in part. 24 As the widow of Mr. Audie Roldan, Plaintiff Cheryl Rampton is the beneficiary of a group 25 life insurance policy underwritten and issued by Defendant Anthem. See Compl. (dkt. 1) at 2. 26 Before his passing, while he was an employee of Celigo, Inc., Mr. Roldan had participated – as an 27 insured employee – in a group life insurance plan (the “Plan”) created to provide life insurance 1 insurance benefits to Plaintiff in the event that Mr. Roldan died while insured under the Plan. Id. at 2 3. Plaintiff has further alleged that Mr. Roldan’s coverage included $25,000.00 in basic life 3 insurance benefits and $300,000.00 in voluntary life insurance benefits. Id. 4 In late 2022, Mr. Roldan passed away, and Plaintiff filed a claim for benefits. Id. at 3. 5 Anthem agreed to pay the basic life insurance benefits, but denied the voluntary life insurance 6 claim, stating that “in order, to be eligible for the voluntary coverage, evidence of insurability was 7 needed since he was late enrolling for this benefit. According to our records no application was 8 submitted to our Medical Underwriting department.” Id. Plaintiff appealed the denial and 9 explained that Mr. Roldan had never been informed that eligibility for voluntary life benefits 10 required any evidence of insurability and that neither Anthem nor Celigo had ever provided him 11 with an evidence of insurability application for him to complete. Id. Instead, Plaintiff contended 12 that Mr. Roldan had been advised during the enrollment process that he was not on Anthem’s list 13 of enrollees who were required to provide evidence of insurability. Id. Plaintiff alleges that she 14 then provided Anthem with evidence that Mr. Roldan had paid, and Anthem had accepted, 15 premium payments for voluntary life insurance coverage – in light of which, she contended that an 16 insurer cannot collect premiums on a life insurance policy and then subsequently deny a claim 17 under that policy based on a failure to provide evidence of insurability. Id. (citing Salyers v. 18 Metropolitan Life Ins. Co., 871 F.3d 934, 941 (9th Cir. 2017)1. Anthem upheld the denial of the 19 claim and Plaintiff instituted this litigation in July of 2023. 20

21 1 See id. (“Providence knew or should have known that Salyers’s 2014 coverage election required evidence 22 of insurability, because Providence's system showed $250,000 in coverage. Despite having not received evidence of insurability from Salyers in 2014 or earlier, Providence began deducting premiums from 23 Salyers’s paycheck every two weeks between September 2013 and February 2014, in amounts corresponding to $500,000 in coverage for 2013 and $250,000 for 2014. Plus, just five days after Gary’s death, having still 24 not received evidence of insurability, Providence sent a letter to Salyers confirming coverage of $250,000. The deductions of premiums, MetLife and Providence’s failure to ask for a statement of health over a period 25 of months, and Providence’s representation to Salyers that she had $250,000 in coverage were collectively so inconsistent with an intent to enforce the evidence of insurability requirement as to induce a reasonable 26 belief that it had been relinquished.”); see also id. at n.4 (explaining that while “[s]everal district courts in our circuit have held that waiver ‘cannot be used to create coverage beyond that actually provided by an 27 employee benefit plan[,]’ [] [b]ut where, as here, premium payments have been accepted despite the plan participant’s alleged noncompliance with policy terms, ‘giving effect to the waiver . . . does not expand the 1 In November of 2023, Defendant produced a number of documents constituting the 2 administrative record in this case. See Ltr. Br. (dkt. 30) at 1. Some of the documents were attended 3 with redactions – as a result of which, Defendant submitted a privilege log, basing the redactions 4 on assertions of the attorney-client privilege and the work-product doctrine. Id. at 9. Plaintiff 5 contends that she is nevertheless entitled to the withheld information “because the documents were 6 generated during the ERISA claims process when Anthem was acting as a fiduciary . . . [and] 7 [t]here is no attorney-client privilege or work product protection for documents generated during 8 an ERISA claim.” Id. at 1 (citing United States v. Mett, 178 F.3d 1058, 1063 (9th Cir. 1999)).2 9 Plaintiff’s argument turns on the suggestion that Defendant was an ERISA fiduciary at the time it 10 denied Plaintiff’s life insurance claim because, “ERISA defines a fiduciary with respect to a plan 11 to include a person who exercises any discretionary authority or discretionary control respecting 12 management of such plan or has any discretionary authority or discretionary responsibility in the 13 administration of such plan.” See Ltr. Br. (dkt. 30) at 2-3 (quoting King v. Blue Cross & Blue 14 Shield of Illinois, 871 F.3d 730, 745 (9th Cir. 2017) (internal quotations and citations omitted). 15 Plaintiff then adds that “‘[w]hen an insurance company administers claims for an employee 16 welfare benefit plan and has authority to grant or deny the claims, the company is an ERISA 17 ‘fiduciary’ under 29 U.S.C. §1002(21)(A)(iii).’” See id. at 3 (quoting Aetna Life Ins. Co. v. 18 Bayona, 223 F.3d 1030, 1033 (9th Cir. 2000)3 (citing Pacificare Inc. v. Martin, 34 F.3d 834, 837 19 20 2 Mett explains the principle that, “[a]s applied in the ERISA context, the fiduciary exception provides that ‘an employer acting in the capacity of ERISA fiduciary is disabled from asserting the attorney-client privilege 21 against plan beneficiaries on matters of plan administration.’” Mett, 178 F.3d at 1063 (quoting Becher v. Long Is. Lighting Co. (In re Long Is. Lighting Co.), 129 F.3d 268, 272 (2d Cir. 1997)).

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Bluebook (online)
Rampton v. Anthem Blue Cross Life and Health Ins. Co., Counsel Stack Legal Research, https://law.counselstack.com/opinion/rampton-v-anthem-blue-cross-life-and-health-ins-co-cand-2024.