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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IN THE UNITED STATES DISTRICT COURT

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FOR THE NORTHERN DISTRICT OF CALIFORNIA
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LOUIS WILKINS,

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For the Northern District of California

United States District Court

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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

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Defendants.
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/

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Now before the Court are the cross-motions for summary judgment in the above-

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captioned matter. The Court has considered the parties’ papers, relevant legal authority, and it

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finds these motions are suitable for disposition without oral argument. See N.D. Civ. L.R. 7-

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1(b). Accordingly, the hearing set for February 1, 2013 is VACATED.

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The parties agree that de novo review applies. Under de novo review, the Court must

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determine whether Plaintiff Louis Wilkins (“Wilkins”) is disabled under the terms of the Plan

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without deference to either party’s interpretation. See Abatie v. Alta Health & Life Ins. Co., 458

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F.3d 955, 963 (9th Cir. 2006) (Under de novo review, “[t]he court simply proceeds to evaluate

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whether the plan administrator correctly or incorrectly denied benefits.”). The Court must

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determine whether Wilkins is “entitled to benefits based on the evidence in the administrative

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record and other evidence as might be admissible under the restrictive rule of Mongeluzo [v.

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Baxter Travenol Long Term Disability Benefit Plan, 46 F.3d 938 (9th Cir. 1995)].” Opeta v.

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Nw. Airlines Pension Plan for Contract Employees, 484 F.3d 1211, 1217 (9th Cir. 2007)

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(internal quotation omitted). The Court determines that it cannot grant summary judgment in

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favor of either party because the Court will need to evaluate the persuasiveness of conflicting

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evidence. Kearney v. Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir. 1999). Therefore, the

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Court DENIES both parties’ motions for summary judgment.

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“[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

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1217 (internal quotations omitted) (emphasis in original). In light of the similarity between the

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policy language in the Plan and Wilkins’ individual disability policy and the fact that Defendant

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For the Northern District of California

administrative record only when circumstances clearly establish that additional evidence is

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United States District Court

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Unum Life Insurance Company of America (“Unum”) determined that Wilkins was disabled in

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accordance with the individual disability policy, the Court finds that it is necessary to consider

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the information in Unum’s file on Wilkins’ individual disability policy in order to conduct an

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adequate de novo review. Accordingly, by no later than February 8, 2013, Unum shall

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supplement the record in this case with its file on Wilkins’ individual disability policy. The

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Court further Orders that Wilkins shall file his opening trial brief and supporting evidence by no

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later than March 8, 2013. Unum shall file its responsive trial brief and supporting evidence by

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no later than March 29, 2013. Wilkins may file a reply by no later than April 3, 2013.

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The Court admonishes Wilkins to focus on demonstrating that the evidence before the

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Court shows that he is disabled under the terms of the Plan, as opposed to whether Unum was

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biased in making its determination. The Court notes that because it will review the disability

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determination de novo, it is already established that Unum’s interpretation of the Plan is not

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entitled to any deference. See Abatie, 458 F.3d at 963. Moreover, Wilkins bears the burden of

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showing by a preponderance of the evidence that he is entitled to benefits under the group

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policy. See Sabatino v. Liberty Life Assurance Co. of Boston, 286 F. Supp.2d 1222, 1232 (N.D.

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Cal. 2003).

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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
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give the parties notice in advance of the trial date. If the Court determines that the matter is

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suitable for resolution without oral argument, it will so advise the parties in advance of the trial

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date.

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IT IS SO ORDERED.

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Dated: January 28, 2013
JEFFREY S. WHITE
UNITED STATES DISTRICT JUDGE

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For the Northern District of California

United States District Court

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