Michael Grossman et al v. Directors Guild of America Inc et al

Filing 310

JUDGMENT by Judge George H. Wu, in favor of Trustees of the DGA Producer Health Plan. Neither party is entitled to fees or costs. The case is now closed. Related to: Notice of Lodging 309 . SEE DOCUMENT FOR FURTHER INFORMATION. MD JS-6, Case Terminated. (twdb)

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UNITED STATES DISTRICT COURT

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CENTRAL DISTRICT OF CALIFORNIA – EASTERN DIVISION
MICHAEL GROSSMAN and, MICHAEL
LUDIN,

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in pro se Plaintiffs,
v.

Defendant.

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Honorable G.H. Wu,
PRESIDING JUDGE
JUDGMENT

TRUSTEES OF THE DGA PRODUCER
HEALTH PLAN,

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Case No.: EDCV 16-1840-GW-SPx

Complaint Filed:
Aug. 17, 2016
Fourth Amended Complaint
Filed: October 27, 2017
Discovery Deadline: January 31, 2019
Trial Date: N/A

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[PROPOSED] JUDGMENT
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Defendant Trustees of the Directors Guild of America-Producer Health Plan’s

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(“Trustees” or “Defendant”) moved for Summary Judgment or, in the alternative, for

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Summary Adjudication against Plaintiffs Michael Grossman and Michael Ludin

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(“Plaintiffs”). Plaintiffs moved for Partial Summary Judgment on the Standard of Review

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to be Used in Deciding the Case at Trial.

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After full consideration of the evidence, the separate statements submitted by each

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party, the authorities submitted by each party, as well as oral argument by counsel and

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pro se plaintiffs made and heard on April 1, 2019 and June 10, 2019, June 27, 2019, ad

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July 18, 2019, the issues having been duly heard and a decision duly rendered, the Court

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orders as follows:
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For the reasons stated in the Court’s April 1, 2019 Tentative Decision (Dkt.

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No. 294), June 10, 2019 Tentative Decision (Dkt. No. 293), June 13, 2019 Final Decision

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on Cross Motions for Summary Judgment (Dkt. No. 297), Plaintiffs’ Motion for Partial

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Summary Judgment on the Standard of Review to be Used in Deciding the Case at Trial

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is denied.

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2.

For the reasons stated in the Court’s April 1, 2019 Tentative Decision (Dkt.

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No. 294), June 10, 2019 Tentative Decision (Dkt. No. 293), June 13, 2019 Final Decision

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on Cross Motions for Summary Judgment (Dkt. No. 297), and August 9, 2019 Final

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Order re: Cross Motions for Summary Judgment (Dkt. No. 308), Defendant’s Motion for

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Summary Judgment or, in the alternative, for Summary Adjudication, is granted as to

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Count I (breach of fiduciary duty under ERISA Section 502(a)(3), 29 U.S.C.

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§ 1132(a)(3)) and Count III (ERISA procedural violations under ERISA Section

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502(a)(3), 29 U.S.C. § 1132(a)(3)). Counts I and III are hereby dismissed with

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prejudice.

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2.

For the reasons stated in the Court’s April 1, 2019 Tentative Decision (Dkt.

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No. 294), June 10, 2019 Tentative Decision (Dkt. No. 293), June 13, 2019 Final Decision

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on Cross Motions for Summary Judgment (Dkt. No. 297), and August 9, 2019 Final

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Order re: Cross Motions for Summary Judgment (Dkt. No. 308), Defendant’s Motion for
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[PROPOSED] Judgment
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Summary Judgment or, in the alternative, for Summary Adjudication is granted as to the

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following 89 of 92 separate claims for benefits included in Count II (ERISA Section

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502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B)): 14220E7532; 14220E7603; 4243E3104;

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14247E4951; 14233E5966; 14233E5922; 14233E6027; 14233E5897; 14243E3113;

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4243E3112; 14236E8228; 14241E0800; 14241E0802; 14243E3091; 4255E0636;

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14255E0411; 14255E0451; 14275E4116; 14275E4118; 14275E4499; 14275E4260;

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14275E4500; 14275E4419; 14292E6181; 14275E4393; 14275E4487; 14275E4456;

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14292E6113; 14306E6662; 14275E4370; 14275E4436; 14275E4183; 14275E4185;

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14275E4159; 14275E4246; 14275E6145; 16128MJ195; 16128MJ196; 16128MJ197;

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16236E4437; 16234E3799; 16236E4439; 17227ML079; 17227ML076; 1722ML077;

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17277ML078; 16299CA8098; 16244BV9515; 16175BT4774; 16235BN3381;

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16284BP1346; 17002BH7626; 16098BQ6670; 16350BX5187; 16314BV3181;

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16291BV0752; 16277BR3000; 16270BR6450; 16175BT4773; 16175BT4776;

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16166BS9129; 16166BS9130; 16124BY4356; 1612BY4359; 16124BY332;

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16124BY4342; 16120JS170; 16127JS191 04/16/2014; 07/02/2014; 08/08/2014;

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08/15/2014; 09/03/2014; 09/12/2014; 10/07/2014; 10/18/2014; 10/14/2014; 11/11/2014;

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11/14/2016; 04/25/2017; 06/20/2017; 06/27/2017; 10/20/2014; 10/31/2014; 11/17/2014;

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12/08/2014; 1/12/2015; 2/9/2015; and 9/17/2015. These 89 claims under Count II are

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hereby dismissed with prejudice.

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3.

For the reasons stated in the Court’s April 1, 2019 Tentative Decision (Dkt.

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No. 294), June 10, 2019 Tentative Decision (Dkt. No. 293), June 13, 2019 Final Decision

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on Cross Motions for Summary Judgment (Dkt. No. 297), and August 9, 2019 Final

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Order re: Cross Motions for Summary Judgment (Dkt. No. 308), Defendant’s Motion for

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Summary Judgment or, in the alternative, for Summary Adjudication, is granted in part

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and denied in part as to the following three claims under ERISA Section 502(a)(1)(B),

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29 U.S.C. § 1132(a)(1)(B) -- Claim Nos. 16133JS231, 16133JS228, and 16133JS217.

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The Court grants Defendant’s Motion for Summary Judgment as to Defendant’s decision

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to deny the portions of these claims related to specific treatments, services, and medical
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[PROPOSED] Judgment
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supplies. The Court denies Defendant’s Motion for Summary Judgment as to

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Defendant’s decision to deny the portions of these claims related to office visits. As to the

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portions of Claim Nos. 16133JS231, 16133JS228, and 16133JS217 related to specific

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treatment, services, and medical supplies, they are dismissed with prejudice.

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4.

On June 26, 2019, Defendant voluntarily paid for the office visit portions of

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claim numbers 16133JS231, 16133JS228, and 16133JS217. For the reasons stated in the

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Court’s August 9, 2019 Final Order re: Cross Motions for Summary Judgment (Dkt. No.

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308), the Court: (1) denies Plaintiffs’ request for “an accounting [on these claims] that

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would indicate the treatment codes and source for determining reasonable and customary

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charges that would be verified and agreed to by the Plaintiffs as correct”; and (2) denies

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Plaintiffs’ request for prejudgment interest on Claim Nos. 16133JS231, 16133JS228, and

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16133JS217.

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5.

Because Defendant has paid Plaintiffs the full amount of benefits related to

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the office visit portions of Claim Nos. 16133JS231, 16133JS228, and 16133JS217, these

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claims are moot. Therefore, the Court dismisses with prejudice Claim Nos. 16133JS231,

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16133JS228, and 16133JS217 related to office visits.

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6.

Judgement, in its entirety, is entered in favor of Defendant Trustees of the

Directors Guild of America-Producer Health Plan.

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7.

Neither party is entitled to fees or costs.

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8.

The case is now closed.

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IT IS ORDERED AND ADJUDGED.

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DATED: August 19, 2019

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Hon. George H. Wu
United States District Judge

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[PROPOSED] Judgment
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