Wilkins v. UNUM Life Insurance Company of America et al

Filing 37

ORDER DENYING CROSS-MOTIONS FOR SUMMARY JUDGMENT. Bench Trial set for 4/26/2013 10:00 AM before Hon. Jeffrey S. White.. Signed by Judge Jeffrey S. White on 1/28/13. (jjoS, COURT STAFF) (Filed on 1/28/2013)

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1 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE NORTHERN DISTRICT OF CALIFORNIA 8 9 LOUIS WILKINS, 11 For the Northern District of California United States District Court 10 12 13 No. C 10-02940 JSW Plaintiff, v. UNUM LIFE INSURANCE COMPANY OF AMERICA; HSBC NORTH AMERICA HOLDINGS, INC. LONG TERM DISABILITY PLAN, ORDER DENYING CROSSMOTIONS FOR SUMMARY JUDGMENT 14 Defendants. 15 / 16 17 Now before the Court are the cross-motions for summary judgment in the above- 18 captioned matter. The Court has considered the parties’ papers, relevant legal authority, and it 19 finds these motions are suitable for disposition without oral argument. See N.D. Civ. L.R. 7- 20 1(b). Accordingly, the hearing set for February 1, 2013 is VACATED. 21 The parties agree that de novo review applies. Under de novo review, the Court must 22 determine whether Plaintiff Louis Wilkins (“Wilkins”) is disabled under the terms of the Plan 23 without deference to either party’s interpretation. See Abatie v. Alta Health & Life Ins. Co., 458 24 F.3d 955, 963 (9th Cir. 2006) (Under de novo review, “[t]he court simply proceeds to evaluate 25 whether the plan administrator correctly or incorrectly denied benefits.”). The Court must 26 determine whether Wilkins is “entitled to benefits based on the evidence in the administrative 27 record and other evidence as might be admissible under the restrictive rule of Mongeluzo [v. 28 Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938 (9th Cir. 1995)].” Opeta v. 1 Nw. Airlines Pension Plan for Contract Employees, 484 F.3d 1211, 1217 (9th Cir. 2007) 2 (internal quotation omitted). The Court determines that it cannot grant summary judgment in 3 favor of either party because the Court will need to evaluate the persuasiveness of conflicting 4 evidence. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir. 1999). Therefore, the 5 Court DENIES both parties’ motions for summary judgment. 6 “[T]he district court should exercise its discretion to consider evidence outside of the necessary to conduct an adequate de novo review of the benefit decision.” Opeta, 484 F.3d at 9 1217 (internal quotations omitted) (emphasis in original). In light of the similarity between the 10 policy language in the Plan and Wilkins’ individual disability policy and the fact that Defendant 11 For the Northern District of California administrative record only when circumstances clearly establish that additional evidence is 8 United States District Court 7 Unum Life Insurance Company of America (“Unum”) determined that Wilkins was disabled in 12 accordance with the individual disability policy, the Court finds that it is necessary to consider 13 the information in Unum’s file on Wilkins’ individual disability policy in order to conduct an 14 adequate de novo review. Accordingly, by no later than February 8, 2013, Unum shall 15 supplement the record in this case with its file on Wilkins’ individual disability policy. The 16 Court further Orders that Wilkins shall file his opening trial brief and supporting evidence by no 17 later than March 8, 2013. Unum shall file its responsive trial brief and supporting evidence by 18 no later than March 29, 2013. Wilkins may file a reply by no later than April 3, 2013. 19 The Court admonishes Wilkins to focus on demonstrating that the evidence before the 20 Court shows that he is disabled under the terms of the Plan, as opposed to whether Unum was 21 biased in making its determination. The Court notes that because it will review the disability 22 determination de novo, it is already established that Unum’s interpretation of the Plan is not 23 entitled to any deference. See Abatie, 458 F.3d at 963. Moreover, Wilkins bears the burden of 24 showing by a preponderance of the evidence that he is entitled to benefits under the group 25 policy. See Sabatino v. Liberty Life Assurance Co. of Boston, 286 F. Supp.2d 1222, 1232 (N.D. 26 Cal. 2003). 27 28 The Court HEREBY SETS the bench trial in this matter for April 26, 2013 at 10:00 a.m. If the Court finds that live testimony is necessary to conduct a de novo review, the Court will 2 1 give the parties notice in advance of the trial date. If the Court determines that the matter is 2 suitable for resolution without oral argument, it will so advise the parties in advance of the trial 3 date. 4 IT IS SO ORDERED. 5 6 Dated: January 28, 2013 JEFFREY S. WHITE UNITED STATES DISTRICT JUDGE 7 8 9 11 For the Northern District of California United States District Court 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 3

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