Rombeiro v. Unum Life Insurance Co. of America

761 F. Supp. 2d 862, 50 Employee Benefits Cas. (BNA) 1600, 2010 U.S. Dist. LEXIS 136076, 2010 WL 5608969
CourtDistrict Court, N.D. California
DecidedDecember 23, 2010
DocketC 02-04018 SI
StatusPublished
Cited by6 cases

This text of 761 F. Supp. 2d 862 (Rombeiro v. Unum Life Insurance Co. of America) 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
Rombeiro v. Unum Life Insurance Co. of America, 761 F. Supp. 2d 862, 50 Employee Benefits Cas. (BNA) 1600, 2010 U.S. Dist. LEXIS 136076, 2010 WL 5608969 (N.D. Cal. 2010).

Opinion

ORDER RE: NEXT LEVEL DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT; UNUM DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT; AND PLAINTIFF’S MOTION FOR LEAVE TO FILE FOURTH AMENDED COMPLAINT

SUSAN ILLSTON, District Judge.

On December 16, 2010, the Court heard argument on the three currently pending motions: (1) the motion for summary judgment filed by defendants Next Level Communications and Next Level Communications Group Long Term Disability Plan; (2) the motion for summary judgment filed by defendants Unum Life Insurance Company of America, Unumprovident Corp., Paul Revere Life Insurance Co., and Provident Life & Accident Insurance Co.; and (3) the motion for leave to file a fourth amended complaint filed by plaintiff. Having considered the arguments of counsel and the papers submitted, the Court hereby rules as follows.

*865 BACKGROUND

Plaintiff Edmundo M. Rombeiro participated in a long term disability insurance plan that his employer, defendant Next Level Communications (“Next Level”), established for the benefit of its employees. 1 Defendant Next Level established the Next Level Communications Group Long Term Disability Plan (“Plan”). The Plan then provided benefits and was funded through the purchase of an insurance policy from defendant Unum Life Insurance Company of America (“Unum Life”). Defendant Next Level paid defendant Unum Life the required policy premiums while Unum Life agreed to provide long term disability coverage, or a long term disability plan, to eligible Next Level employees.

Plaintiff filed suit because, he alleges, he became disabled within the terms of the Plan and policy of insurance, he notified defendants of his disability and complied with all other requirements of the Plan and policy, but defendant Unum Life denied his claim for disability benefits and terminated his coverage.

On July 15, 2002, plaintiff filed a complaint against defendant Unum Life in state court. Defendant Unum Life removed plaintiffs case to federal court, and on January 21, 2003, plaintiff filed a First Amended Complaint against defendant Unum Life and an allegedly affiliated entity, seeking class action certification and asserting four claims for relief under the Employment Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001, et seq. (“ERISA”). On April 30, 2003, the Court dismissed two of the claims. Doc. 25. On May 15, 2003, plaintiff filed a Second Amended Complaint, in which he named additional defendants, including Next Level and the Plan (“Next Level defendants”). Doc. 27. On October 1, 2003, the case was transferred to the Eastern District of Tennessee by the Judicial Panel on Multidistrict Litigation, Doc. 60, where it was consolidated with six other class actions, MDL Doc. 250 at 2.

On September 4, 2007, the MDL Court entered an order certifying a class action under Rule 23(b)(2), which was immediately appealed to the Sixth Circuit. MDL Docs. 230-32. The Sixth Circuit reversed, holding that the wrongful denial of benefits claim required an inquiry into causation that would prove too fact specific for the typicality requirement of class action certification to be met. MDL Doc. 234; Romberio v. Unumprovident Corp., 385 Fed.Appx. 423 (6th Cir.2009). On June 8, 2010, plaintiffs case was remanded to this Court. Doc. 62.

On August 31, 2010, the Court granted plaintiff leave to file a Third Amended Complaint (“3AC”), which he did on September 24. Docs. 75-76. Named as defendants in the complaint are the Next Level defendants, as well as Unum, Paul Revere Life Insurance Company, Provident Life & Accident Insurance Company, Unum Life Insurance Company of America, and UnumProvident Corporation (“Unum defendants”). Plaintiff makes three ERISA claims: (1) for benefits and reinstatement against the Next Level defendants, under 29 U.S.C. § 1132(a)(1); (2) for penalties for violation of claims procedures against the Next Level defendants, under 29 U.S.C. § 1132(c); and (3) for equitable and declaratory relief for violation of ERISA or the terms of the plan *866 against the Unum defendants, under 29 U.S.C. § 1132(a)(3).

In the meantime, several subsidiaries of Unum Group, including defendant Unum Life, entered into a Regulatory Settlement Agreement (“RSA”) with the U.S. Department of Labor and the insurance departments of 48 states. Griffin Decl. ¶¶ 2-3, Ex. A (“RSA”). Separately, subsidiaries of Unum Group, including defendant Unum Life, entered into a settlement agreement with the California Department of Insurance (“CSA”). Id. ¶¶ 7-88, Ex. B. These agreements require defendant Unum Life to implement new claims handing practices and also to provide certain claimants the opportunity to have their denied claims reassessed. RSA Section B. The CSA instituted requirements above and beyond those in the RSA, including providing for an opportunity for independent, third-party review of denied claims. CSA Sections III-V. Notice was sent to plaintiff of his opportunity to participate in the CSA reassessment, and he did not elect to participate. Griffin Decl. ¶¶ 9-10.

Currently before the Court are the motions for summary judgment filed by the Next Level defendants and the Unum defendants, as well as plaintiffs motion for leave to file a fourth amended complaint.

LEGAL STANDARD

1. Summary Judgment

Summary judgment is proper if the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law. See Fed.R.Civ.P. 56(c). 2 The moving party bears the initial burden of demonstrating the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). The moving party, however, has no burden to disprove matters on which the non-moving party will have the burden of proof at trial. The moving party need only demonstrate to the Court that there is an absence of evidence to support the non-moving party’s case. Id. at 325, 106 S.Ct. 2548.

Once the moving party has met its burden, the burden shifts to the non-moving party to “set out ‘specific facts showing a genuine issue for trial.’ ” Id. at 324, 106 S.Ct. 2548 (quoting Fed.R.Civ.P. 56(e)). To carry this burden, the non-moving party must “do more than simply show that there is some metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574

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761 F. Supp. 2d 862, 50 Employee Benefits Cas. (BNA) 1600, 2010 U.S. Dist. LEXIS 136076, 2010 WL 5608969, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rombeiro-v-unum-life-insurance-co-of-america-cand-2010.