Valencia v. Southwest Carpenters Pen., No. 3:2017cv01643 - Document 31 (S.D. Cal. 2018)
Court Description: ORDER Granting Defendants' Motion for Summary Judgment [Doc. No. 26 ]. Signed by Judge Cathy Ann Bencivengo on 5/31/2018.(All non-registered users served via U.S. Mail Service)(jjg)
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1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 10 SOUTHERN DISTRICT OF CALIFORNIA ROBERTO VALENCIA, Case No.: 3:17-CV-01643-CAB-AGS Plaintiff, 11 12 v. 13 SOUTHWEST CARPENTERS HEALTH AND WELFARE TRUST; SOUTHWEST CARPENTERS PENSION TRUST, 14 15 ORDER GRANTING DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT [Doc. No. 26] Defendants. 16 17 This matter is before the Court on the motion for summary judgment filed by 18 Defendants Southwest Carpenters Health and Welfare Trust, and Southwest Carpenters 19 Pension Trust, on April 6, 2018. [Doc. No. 26.]1 Plaintiff filed a one-page opposition to 20 Defendants’ motion for summary judgment on May 7, 2018. [Doc. No. 28.] The Court held 21 a hearing on this matter on May 30, 2018. Plaintiff appeared in pro se. Dennis Joseph 22 Murphy, Esq. appeared on behalf of Defendants. After hearing oral argument of the parties 23 and conducting a thorough review of the issues, Defendants’ motion is granted for the 24 reasons discussed below. 25 I. 26 Plaintiff Roberto Valencia (“Plaintiff”) is a member of the Southwest Carpenters Background 27 28 1 Document numbers and page references are to those assigned by CM.ECF for the docket entry. 1 3:17-CV-01643-CAB-AGS 1 Trust Fund. On December 11, 2017, Plaintiff filed an Amended Complaint, stating in its 2 entirety: “I want the Southwest Carpenters Pen [sic] Union to pay me pencion [sic] benefits 3 that I have earned I have proof of more hours worked then [sic] I was credited a pencion 4 [sic] for proof of disability Please see attached documents.” [Doc. No. 9 at 2.] 5 Defendants construed Plaintiff’s Amended Complaint as pleading a right to recover 6 long-term disability benefits from the Southwest Carpenters Health and Welfare Trust 7 (“Health Trust”) pursuant to § 1132(a)(1) of the Employee Retirement Income Security 8 Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq. [Doc. No. 26-1 at 2.] The Court agrees 9 with Defendants’ interpretation of Plaintiff’s Amended Complaint as being brought under 10 § 1132(a)(1)(B) for purposes of this motion. 11 A. Plan Language 12 The Southwest Carpenters Health and Welfare Plan for Active Carpenters Restated 13 January 1, 2015 (the “Plan”), states under Article VI, Section 1, Long Term Monthly 14 Disability Benefit: 15 16 17 18 19 20 21 22 23 24 25 26 27 28 3. SPECIAL DEFINITION OF ELIGIBLE INDIVIDUAL FOR LONG TERM MONTHLY DISABILITY BENEFIT PURPOSES For the purpose of eligibility for the long term monthly disability benefit set forth in this Section 1, “Eligible Individual” means an individual: 1) Who has accumulated at least 5 Pension Credits under the Southwest Carpenters Pension Plan without a Permanent Break in Service; . . . [Doc. No. 26-5 at 82.] (Emphasis added.) The Plan also states under Article IX, Section 5, Claims and Review Procedures: (a) The Board [“the Board of Trustees established by the Trust Agreement”] is the named fiduciary that has the discretionary authority to control and manage the administration and operation of the Plan and Trust. The Board shall have the full, exclusive and discretionary authority to prescribe such forms, make such Rules and Regulations, interpretations and computations, construe the terms of the Plan and determine all issues relating to coverage and eligibility for benefits and take such other action to administer the Plan as it may deem appropriate, including delegation of discretion to a Delegate. The Board’s decisions, computations, 2 3:17-CV-01643-CAB-AGS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 interpretations and actions shall be final and binding on all persons except as may be provided by law. In administering the Plan, the Board shall at all times discharge its duties with respect to the Plan in accordance with the standards set forth in Section 404(a)(1) of ERISA. .... (c) . . . Any dispute as to eligibility, type, amount or duration of benefits or any right or claim to payments from the Trust, shall be resolved by the Board or its Delegate, such as the Health Care Benefits Committee (which serves as the Appeals Committee pursuant to the Plan), and its decision of the dispute, right or claim shall be final and binding upon all parties thereto except as may be required by law. . . . [Id. at 98–99.] B. Plaintiff’s Complaint Against Defendants On September 20, 2016, Plaintiff submitted an application for Long Term Disability Benefits to the Health Trust. [Doc. No. 26-2 ¶ 5.] The Health Trust reviewed his application and concluded that Plaintiff did not fulfill the eligibility requirements to receive Long Term Disability Benefits pursuant to Article VI, Section 1(c)(1) of the Southwest Carpenters Health and Welfare Plan for Active Carpenters as restated January 1, 2015. [Id. ¶¶ 6–7.] Specifically, Defendants contend that Plaintiff did not accumulate at least five Pension Credits required under the Southwest Carpenters Pension Plan, Article VI, Section 1(3)(1) above. [Id. ¶ 7.] As such, Defendants notified Plaintiff by letter dated November 15, 2016 that his application was denied. [Id. ¶ 8.] Plaintiff subsequently appealed the denial of Long Term Disability benefits, and later supplemented his appeal with check stubs to challenge the calculation of his Pension Credits. [Id. ¶ 9.] On June 16, 2017, Plaintiff’s appeal was considered by the Appeals Committee of the Board of Trustees, who reviewed a summary of the appeal, all relevant correspondence, and all supporting documents submitted by Plaintiff. [Id. ¶ 11.] The Committee denied Plaintiff’s appeal and provided him with written notice of the denial by letter dated June 20, 2017. [Id. ¶ 12.] On August 16, 2017, Plaintiff consequently filed his original Complaint with the Court to recover the benefits allegedly due to him under the Plan. [Doc. No. 1.] 28 3 3:17-CV-01643-CAB-AGS 1 2 II. Legal Standard of Review for an ERISA Plan Administrator’s Decision to Deny Benefits 3 Generally, district courts review an ERISA plan administrator’s decision to deny 4 benefits de novo, “unless the benefit plan gives the administrator . . . discretionary authority 5 to determine eligibility for benefits or to construe the terms of the plan.” Firestone Tire & 6 Rubber Co. v. Bruch, 489 U.S. 101, 115 (1989). If the plan “does confer discretionary 7 authority as a matter of contractual agreement, then the standard of review shifts to abuse 8 of discretion,” which is a “more lenient” standard of review. Abatie v. Alta Health & Life 9 Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006). 10 The Ninth Circuit has described the test for “abuse of discretion” as whether the 11 court is “left with a definite and firm conviction that a mistake has been committed.” 12 Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666, 676 (9th Cir. 2011). To 13 determine whether a plan administrator abused its discretion, the court must consider 14 whether the administrator’s decision was “(1) illogical, (2) implausible, or (3) without 15 support in inferences that may be drawn from the facts in the record.” See id. at 676 16 (quoting United States v. Hinkson, 585 F.3d 1247 (9th Cir. 2009) (en banc)). Further, the 17 Supreme Court has noted that this deferential standard of review means that the plan 18 administrator's decision “will not be disturbed if reasonable.” See id. at 674 (quoting 19 Conkright v. Frommert, 559 U.S. 506 (2010)). 20 In order to apply the “abuse of discretion” standard of review, the plan at issue must 21 “unambiguously provide discretion to the administrator.” Abatie, 458 F.3d at 963. While 22 there are no “magic” words to signal that this discretion exists, the Supreme Court has 23 suggested that discretion is provided if the administrator has the “power to construe 24 disputed or doubtful terms” in the plan. See id. at 963 (quoting Firestone, 489 U.S. at 111). 25 The Ninth Circuit has repeatedly found discretion granted in plans with similar wording. 26 See e.g. Grosz-Salomon v. Paul Revere Life Ins. Co., 237 F.3d 1154, 1159 (9th Cir. 2001) 27 (finding discretion where the plan at issue provided that the administrator “has the full, 28 final, conclusive and binding power to construe and interpret the policy under the plan . . . 4 3:17-CV-01643-CAB-AGS 1 and to make claims determinations”); Bergt v. Ret. Plan for Pilots Employed by MarkAir, 2 Inc., 293 F.3d 1139, 1142 (9th Cir. 2002) (finding discretion where the plan administrator 3 holds the “power” and “duty” to “interpret the plan and to resolve ambiguities, 4 inconsistencies and omissions” and to “decide on questions concerning the plan and the 5 eligibility of any Employee” (internal quotation marks omitted)). 6 Finally, when analyzing a plan administrator’s decision under an “abuse of 7 discretion” standard, a district court may only review the administrative record before the 8 plan administrator (though this limitation does not apply to de novo review). See Abatie, 9 458 F.3d at 970; see also Jebian v. Hewlett-Packard Co. Employee Benefits Org. Income 10 Prot. Plan, 349 F.3d 1098, 1110 (9th Cir. 2003). The only exception to this limitation is 11 when a court is deciding how much weight to give a conflict of interest in its analysis. 2 In 12 making that determination, the court may consider evidence outside the administrative 13 record. See Abatie, 458 F.3d at 969; see also Tremain v. Bell Indus., Inc., 196 F.3d 970, 14 976–77 (9th Cir. 1999) (holding that a court may consider extra-record evidence to 15 determine whether the administrator was plagued by a conflict of interest). 16 III. 17 Generally, a party is entitled to summary judgment “if the pleadings, depositions, 18 answers to interrogatories, and admissions on file, together with the affidavits, if any, show 19 that there is no genuine issue as to any material fact and that the moving party is entitled 20 to a judgment as a matter of law.” Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). To 21 avoid summary judgment, disputes must be both (1) material, meaning concerning facts 22 that are relevant and necessary and that might affect the outcome of the action under 23 governing law, and (2) genuine, meaning the evidence must be such that a reasonable jury 24 could return a verdict for the nonmoving party. Anderson v. Liberty Lobby, Inc., 477 U.S. Legal Standard of Review for Summary Judgment 25 26 27 28 2 The plaintiff has not alleged a conflict of interest or provided any evidence outside the record to support such a claim. 5 3:17-CV-01643-CAB-AGS 1 242, 248 (1986); Cline v. Indus. Maint. Eng’g & Contracting Co., 200 F.3d 1223, 1229 2 (9th Cir. 2000) (citing Anderson, 477 U.S. at 248). 3 Under the traditional rules of summary judgment, the initial burden of establishing 4 the absence of a genuine issue of material fact falls on the moving party. See Celotex 5 Corp., 477 U.S. at 322-23. If the moving party can demonstrate that its opponent has not 6 made a sufficient showing on an essential element of his case, the burden shifts to the 7 opposing party to set forth facts showing that a genuine issue of disputed fact remains. Id. 8 at 324. When ruling on a summary judgment motion, the court must view all inferences 9 drawn from the underlying facts in the light most favorable to the nonmoving party. 10 Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986). However, 11 “[t]he district court need not examine the entire file for evidence establishing a genuine 12 issue of fact, where the evidence is not set forth in the opposing papers with adequate 13 references so that it could conveniently be found.” Carmen v. S.F. Unified Sch. Dist., 237 14 F.3d 1026, 1031 (9th Cir. 2001). 15 However, in ERISA cases where a plan administrator’s decision to deny benefits is 16 reviewed for abuse of discretion, “a motion for summary judgment is merely the conduit 17 to bring the legal question before the district court and the usual tests of summary judgment, 18 such as whether a genuine dispute of material fact exists, do not apply.” Bendixen v. 19 Standard Ins. Co., 185 F.3d 939, 942 (9th Cir. 1999), abrogated on other grounds by 20 Montour, 588 F.3d at 631. This standard applies in situations where the district court’s 21 review is limited to the administrative record, and the claimant is not entitled to a jury trial. 22 Nolan v. Heald College, 551 F.3d 1148, 1154 (9th Cir. 2009). However, the traditional 23 rules of summary judgment still apply to evidence outside of the administrative record in 24 ERISA cases. Id. at 1155. 25 IV. 26 In the Amended Complaint, Plaintiff brings a single claim to recover Long Term 27 Disability benefits due to him under ERISA 29 U.S.C. § 1132(a)(1)(B). [Doc. No. 9.] 28 Section § 1132(a)(1)(B) states: “(a) Persons empowered to bring a civil action. A civil Discussion 6 3:17-CV-01643-CAB-AGS 1 action may be brought—(1) by a participant or beneficiary—. . . (B) to recover benefits 2 due to him under the terms of his plan, to enforce his rights under the terms of the plan, or 3 to clarify his rights to future benefits under the terms of the plan . . .” 29 U.S.C. § 4 1132(a)(1)(B). 5 Defendants move for summary judgment on grounds that: (1) Defendants acted in 6 accordance with ERISA § 404(a)(1)(D) (29 U.S.C. § 1104(a)(1)(D)), which requires a 7 fiduciary to administer benefits in accordance with the terms of the documents governing 8 the plan; (2) Defendants properly denied Long Term Disability benefits to Plaintiff, as he 9 did not qualify for benefits as required by the terms of the Health Plan; and (3) under an 10 “abuse of discretion” standard of review, Defendants’ decision to deny Plaintiff’s claim 11 must be upheld. [Doc. No. 26-1.] 12 As a preliminary matter, the Court finds that the applicable standard of review in this 13 matter is the “abuse of discretion” standard, as the Health Plan clearly confers discretion 14 on the Board. In Article IX, Section 5 of the Health Plan, entitled “Claims and Review 15 Procedures” (detailed above), the Plan explicitly and unambiguously grants discretionary 16 authority to the Board to “control and manage the administration and operation of the Plan 17 and Trust.” [Doc. No. 26-5 at 98.] The Board is granted full and exclusive authority to 18 construe the terms of the Plan, make interpretations and computations, determine all issues 19 relating to coverage and eligibility for benefits, and take any other action to administer the 20 Plan as it may deem appropriate. [Id. at 98.] Further, its decisions regarding disputes as to 21 eligibility, type, amount or duration of benefits are final and binding upon all parties, except 22 as may be required by law. [Id. at 99.] Accordingly, the Court finds that the requisite 23 discretion to the plan administrator exists here so as to apply the “abuse of discretion” 24 standard of review. 25 The Court further finds that Defendants are entitled to summary judgment, as 26 Plaintiff has failed to provide sufficient evidence to support his claim as a matter of law. 27 The evidence within the administrative record before the Court does not reflect Plaintiff’s 28 contention that Defendants’ decision to deny him benefits was illogical, implausible, or 7 3:17-CV-01643-CAB-AGS 1 without support. See Salomaa, 642 F.3d at 676. To the contrary, Defendants reviewed 2 Plaintiff’s original application for benefits, issued their decision with an explanation for 3 their conclusion, reexamined Plaintiff’s claim with the Appeals Committee upon receiving 4 notice of his appeal and supplemental documentation, and again reached the same 5 conclusion. [Doc. No. 26-2 at 4–5.] Defendants’ administrative staff compared Plaintiff’s 6 check stubs provided with his appeal (to dispute his hours worked and/or reported to the 7 Health Trust) to the Trust’s records, and found that his check stubs matched Trust records 8 but not the hours indicated by Plaintiff. [Doc. No. 26-3 at 2.] Further, while not necessary 9 under this standard, the Court has reviewed the administrative record in its entirety, 10 including the supplemental documents submitted by Plaintiff, and conducted its own 11 analysis of Plaintiff’s claim of eligibility for benefits. The Court did not find any evidence 12 to support Plaintiff’s contentions that he has greater than five Pension Credits, nor did it 13 find evidence of any misconduct or abuse of discretion on Defendants’ part. The record 14 instead appears to reflect that the Board and the Appeals Committee reasonably reviewed 15 Plaintiff’s claim and appeal, and provided Plaintiff with adequate support for their decision. 16 [Doc. No. 26-4.] 17 In sum, the evidence in the administrative record does not leave the Court with a 18 “definite and firm conviction that a mistake has been committed,” but rather with the 19 impression that the Trust’s decision in this case was reasonable and correct. Salomaa, 642 20 F.3d at 674, 676. Accordingly, the Court finds no abuse of discretion, and summary 21 judgment is warranted. 22 V. 23 For the foregoing reasons, Defendants’ motion for summary judgment [Doc. No. 26] 24 ///// 25 ///// 26 ///// 27 ///// Conclusion 28 8 3:17-CV-01643-CAB-AGS 1 is GRANTED. Judgment shall be entered for Defendants and the Clerk of the Court shall 2 CLOSE the case. 3 4 It is SO ORDERED. Dated: May 31, 2018 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 9 3:17-CV-01643-CAB-AGS
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