Masuda-Cleveland v Life Insurance Company of America

Filing 135

ORDER Granting Plaintiff's Motion for Judgment on the Expanded ERISA Administrative Record 120 . Signed by JUDGE LESLIE E. KOBAYASHI on 11/30/2020.(kob2)

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FILED IN THE
UNITED STATES DISTRICT COURT
DISTRICT OF HAWAII

UNITED STATES DISTRICT COURT

Nov 30, 2020, 7:53 pm
Michelle Rynne, Clerk of Court

DISTRICT OF HAWAII
MARNIE MASUDA-CLEVELAND,
CIV. NO. 16-00057 LEK-WRP
Plaintiff,
vs.
LIFE INSURANCE COMPANY OF NORTH
AMERICA,
Defendant.

ORDER GRANTING PLAINTIFF’S MOTION FOR JUDGMENT
ON THE EXPANDED ERISA ADMINISTRATIVE RECORD
Before the Court is Plaintiff Marnie MasudaCleveland’s (“Plaintiff”) Motion for Judgment on the Expanded
ERISA Administrative Record (“Motion”), filed on February 26,
[Dkt. no. 120 (redacted).1]

2020.

Defendant Life Insurance

Company of North America (“Defendant” or “LINA”) filed its
memorandum in opposition on March 20, 2020, and Plaintiff filed
her reply on April 20, 2020.

[Dkt. nos. 125, 129.]

came on for hearing on June 26, 2020.

This matter

Plaintiff’s Motion is

hereby granted for the reasons set forth below.

1

An unredacted version of the memorandum in support of the
Motion was filed under seal on February 27, 2020. [Dkt.
no. 122.]

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BACKGROUND
This matter comes before the Court on remand from the
Ninth Circuit.

[Memorandum, filed 5/8/19 (dkt. no. 77).2]

The

parties are familiar with the factual and procedural history,
and it will not be repeated here in full.

Plaintiff’s husband,

Harlan Masuda (“Masuda”) was a participant in Hawaiian Electric
Industries, Inc.’s Group Accident Plan (“the Plan”).
[Plaintiff’s Concise Statement in Support of Motion for Judgment
on the Expanded ERISA Administrative Record (“CSOF”), filed
2/26/20 (dkt. no. 121), at ¶ 1 (citing CSOF, Decl. of Jeffrey C.
Metzger (“Metzger Decl.”),3 Exh. 1 (Group Accident Policy OK
820810 (“the Policy”)), Exh. 2 (letter from Paula Fukuoka dated
April 15, 2014)).4]

Masuda passed away following a single car

2

The Ninth Circuit’s Memorandum disposition is also
available at 769 F. App’x 517 (9th Cir. 2019).
3 The CSOF and the Metzger Declaration were filed in
redacted form. Unredacted versions were filed on February 27,
2020. [Dkt. nos. 123, 123-1.]
4

Defendant’s concise statement of facts in opposition to
the Motion (“Defendant’s CSOF”), filed March 20, 2020, [dkt.
no. 126,] fails to comply with Local Rule 56.1 of the Local
Rules of Practice for the United States District Court for the
District of Hawaii. Specifically, Defendant’s CSOF does not
include “a separate document containing a single concise
statement that admits or disputes each fact set forth in the
movant’s concise statement.” See Local Rule LR56.1(e).
Therefore, unless specifically controverted in Defendant’s CSOF,
material facts set forth in Plaintiff’s CSOF are deemed
admitted. See Local Rule LR56.1(g) (stating that “material
facts set forth in the movant’s concise statement will be deemed
(. . . continued)
2

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collision on February 11, 2014.
¶ 3.]

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[CSOF at ¶ 2; Def.’s CSOF at

Lindsey Harle, M.D., Coroner’s Physician, performed the

autopsy on Masuda.

[CSOF at ¶ 4 (citing Metzger Decl., Exh. 6

(Maui County Police Department Request for Autopsy and Autopsy
Report)); Def.’s CSOF at ¶¶ 6-7 (citation omitted).]

She

concluded that the cause of death was “‘blunt force trauma to
the face and neck’” and that the manner of death was accidental.
[CSOF at ¶ 4 (quoting Metzger Decl., Exh. 6 (Autopsy Report)).]
Dr. Harle also speculated that it was possible that an acute
medical event, such as a heart attack or seizure, caused Masuda
to lose consciousness and crash.

[Metzger Decl., Exh. 6

at

PageID #: 2903.5]
Defendant denied Plaintiff’s claim for benefits, first
taking the position that a medical event caused Masuda to crash.
[CSOF at ¶ 5; Def.’s CSOF at ¶ 9.]

In denying Plaintiff’s

claim, Defendant relied on its in-house medical director Dr. R.
Norton Hall who opined that,
[w]ith the history of bizarre, immediate events
prior to the crash, the past medical history of
prediabetes, [hypertension] and dyslipidemia and
the autopsy findings of severe atherosclerotic
admitted unless controverted by a separate concise statement of
the opposing party”).
5

Due to the presence of multiple page numbers on each of
the Exhibits themselves, Plaintiff’s Exhibits will be cited to
the page number assigned by the district court’s electronic case
filing system.
3

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narrowing of the “widow maker” coronary artery it
is concluded, with reasonable medical certainty,
that Mr. Masuda had an acute medical event that
was the etiology of his uncontrolled dash to his
death.
See Metzger Decl., Exh. 7 ( letter, dated May 20, 2014, from
Defendant denying Plaintiff’s claim (“Denial Letter”)) at PageID
#: 2917 (second page of Staffing Documentation Form signed by R.
Norton Hall, M.D., dated 5/19/14).

Defendant concluded that

“Harlan Masuda passed away on 2/11/2014 after sustaining blunt
force injuries in a single vehicle crash.

Information on file

supports that Mr. Masuda suffered a medical event while driving
which resulted in his crash.”

[Id. at PageID #: 2912.]

Therefore, Defendant denied payment of death benefits on the
basis that “his death was not caused by an accident as mandated
by the policy, but rather, a medical event which caused a motor
vehicle crash.”

[Id. at PageID #: 2913.]

Plaintiff appealed the denial.

In response to

Plaintiff’s first appeal, Defendant upheld its denial of
payment.

Defendant reasoned that
[a] medical event is the most likely explanation
for Mr. Masuda hitting the lifeguard’s truck, not
responding verbally when confronted by the
lifeguard, revving his engine while his vehicle
was against the barrier, and driving several
hundred feet with no avoidance maneuvers. This
is supported by the review by Dr. Hall that some
form of medical event was likely to a reasonable
degree of medical certainty and the pathology
report concludes the insured had atherosclerotic
cardiovascular disease and that some acute
4

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medical event, such as a myocardial infarction or
seizure, likely occurred to cause the crash.
Therefore, it would be reasonable to conclude
under this policy language that there is no
coverage for his death because an illness,
disease or bodily infirmity directly caused the
fatal accidental injury.
[Metzger Decl., Exh. 10 (appeal denial letter from Defendant,
dated December 18, 2014 (“First Appeal Denial Letter”)) at
PageID #: 2930.]
Plaintiff appealed the denial again.

In response to

the second appeal, Defendant partly adopted the opinion of
Dr. Scott Denton, a forensic pathologist hired by Defendant, who
concluded that Masuda suffered a heart attack which caused both
the crash and Masuda’s death, and that the cause of death was
not, as Dr. Harle found, blunt force trauma to the face and
neck.

[CSOF at ¶ 15 (citing Metzger Decl., Exh. 18 (letter from

Mike J., dated August 20, 2015 (“Second Appeal Denial Letter”));
Def.’s CSOF at ¶ 16 (citing same).]

Based on Dr. Denton’s

opinion that “the injuries to [Masuda’s] head and neck
documented during the autopsy would be insufficient to cause
sudden death in this witnessed manner,” Defendant decided that
the evidence in the file supports that
Mr. Masuda’s loss of ability to control his
vehicle on 02/11/2014 and the subsequent crash
was caused by a medical event due to his illness,
disease or body infirmity, and was not caused by
an accident, as required by the policy, and there
is no coverage.

5

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[Metzger Decl., Exh. 18 (Second Appeal Denial) at PageID
#: 3022-23.]

Defendant also “concluded that Mr. Masuda’s sudden

cardiac event, which was caused by his severe coronary artery
atherosclerosis, significantly contributed to the crash as well
as his death, and his loss is specifically excluded from
payment.”

[Id. at PageID #: 3023.]
On February 9, 2016, Plaintiff filed her complaint.

[Dkt. no. 1.]

On August 31, 2017, this Court issued its Order:

(1) Granting Defendant’s Motion for Summary Judgment on
Plaintiff Marnie Masuda-Cleveland’s Complaint Filed on
February 9, 2016 [DOC. #1]; and (2) Denying Plaintiff’s Motion
for Judgment on the Administrative Record (“8/31/17 Order”).
[Dkt. no. 67.]

Plaintiff filed an appeal from, inter alia, the

8/31/17 Order.

[Notice of Appeal, filed 10/20/17 (dkt.

no. 69).]

The Ninth Circuit vacated the 8/31/17 Order, holding

that this Court erred in disallowing Plaintiff’s rebuttal
evidence and that this Court should have applied a higher level
of skepticism in its review of whether Defendant abused its
discretion in denying Plaintiff’s insurance claim.6

6

Masuda-

The standard of review is not in dispute, as stated by the
Ninth Circuit, “[w]hen a district court reviews an
administrator’s discretionary decision regarding a welfare plan
pursuant to [Employee Retirement Income Security Act (‘ERISA’)],
it must decide on the level of skepticism it should bring to
that review, and whether the administrator reached its decision
in a procedurally sound fashion.” Masuda-Cleveland, 769 F.
(. . . continued)
6

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Cleveland, 769 F. App’x at 518-19.
submitted additional evidence.
25, 27-31.7

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On remand, Plaintiff

See Metzger Decl., Exhs. 20-23,

Therefore, the discrete issue before this Court is,

whether, when considered with a higher level of skepticism,
Defendant’s denial of Plaintiff’s claim for benefits was an
abuse of discretion.
STANDARD
Plaintiff filed the instant Motion under Fed. R. Civ.
P. 52.
Where review is de novo, a Rule 52 motion appears
to be the appropriate mechanism for resolving the
dispute. See, e.g., Rabbat v. Standard Ins. Co.,
894 F. Supp. 2d 1311, 1314 (D. Or. 2012) (“[W]hen
applying the de novo standard in an ERISA
benefits case, a trial on the administrative
record, which permits the court to make factual
findings, evaluate credibility, and weigh
evidence, appears to be the appropriate
proceeding to resolve the dispute.”); Lee v.
Kaiser Found. Health Plan Long Term Disability
Plan, 812 F. Supp. 2d 1027, 1032 n.2 (N.D. Cal.
2011) (“De novo review on ERISA benefits claims
is typically conducted as a bench trial under
Rule 52.”) (citation omitted). However, where
review is for abuse of discretion, it appears
that [Fed. R. Civ. P.] 56 is the appropriate
“conduit to bring the legal question before the
district court.” Harlick v. Blue Shield of Cal.,
686 F.3d 699, 706 (9th Cir. 2012) (citing Nolan
App’x at 518 (some citations omitted) (citing Abatie v. Alta
Health & Life Ins. Co., 458 F.3d 955, 968–69, 971–72 (9th Cir.
2006) (en banc)).
7

Exhibits 27-29 were filed under seal. [Dkt. nos. 123-2 to
123-4.] Although the CSOF stated Exhibit 30 would be filed
under seal, Exhibit 30 was never filed.
7

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v. Heald College, 551 F.3d 1148, 1154 (9th Cir.
2009) ); see also Bartholomew v. Unum Life Ins.
Co. of Am., 588 F. Supp. 2d 1262, 1265-66 (W.D.
Wash. 2008) (“The administrative record submitted
in conjunction with [the] litigation exists as a
body of undisputed facts,” although “the
conclusions to be drawn from those facts are
definitely in dispute.”).
Gallupe v. Sedgwick Claims Mgmt. Servs. Inc., 358 F. Supp. 3d
1183, 1190 (W.D. Wash. 2019) (some alterations in Gallupe).
Because the standard of review is for abuse of discretion,
Plaintiff’s Motion is construed as a motion for summary judgment
brought under Rule 56.
As the Ninth Circuit has stated,
where the abuse of discretion standard applies in
an ERISA benefits denial case, a motion for
summary judgment is merely the conduit to bring
the legal question before the district court and
the usual tests of summary judgment, such as
whether a genuine dispute of material fact
exists, do not apply.
Nolan, 551 F.3d at 1154 (citation and internal quotation marks
omitted).

Importantly,
while the abuse of discretion standard generally
applies in cases where plan administrators have
discretionary authority to determine eligibility
for benefits, the precise standard in cases where
the plan administrator is also burdened by a
conflict of interest is only discernable by
carefully considering the conflict of interest,
including evidence outside of the administrative
record that bears upon it.

Id. at 1153–54.

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DISCUSSION
I.

Abuse of Discretion
“Abatie requires a district court to consider the

precise contours of the abuse of discretion standard in every
case before determining whether the applicable standard was
violated.”

Id. at 1154 (citing Abatie, 458 F.3d at 969).

A

plan administrator abuses its discretion if the plan
administrator “render[s a] decision[] without any explanation,[]
construe[s] provisions of the plan in a way that conflicts with
the plain language of the plan, or rel[ies] on clearly erroneous
findings of fact.”

Day v. AT&T Disability Income Plan, 698 F.3d

1091, 1096 (9th Cir. 2012) (citation and quotation marks
omitted).

The language of the plan is interpreted in its

ordinary and popular sense, in accordance with how a person of
average intelligence and experience would do.

Tapley v. Locals

302 & 612 of Int’l Union of Operating Eng’rs-Emps Constr. Indus.
Ret. Plan, 728 F.3d 1134, 1140 (9th Cir. 2013) (citation
omitted).

“A finding is ‘clearly erroneous’ when although there

is evidence to support it, the reviewing [body] on the entire
evidence is left with the definite and firm conviction that a
mistake has been committed.”

Concrete Pipe & Prods. of Cal. v.

Constr. Laborers Pension Tr. for S. Cal., 508 U.S. 602, 622
(1993) (alteration in Concrete Pipe) (citation and some
quotation marks omitted).
9

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A.

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Level of Skepticism
The deference granted to a plan administrator pursuant

to an abuse of discretion review is tempered by the level of
skepticism.

Abatie, 458 F.3d at 968.

As the Ninth Circuit has

noted,
The level of skepticism with which a court views
a conflicted administrator’s decision may be low
if a structural conflict of interest is
unaccompanied, for example, by any evidence of
malice, of self-dealing, or of a parsimonious
claims-granting history. A court may weigh a
conflict more heavily if, for example, the
administrator provides inconsistent reasons for
denial, Lang[ v. Long-Term Disability Plan of
Sponsor Applied Remote Tech., Inc.], 125 F.3d
[794,] 799 [(9th Cir. 1997)]; fails adequately to
investigate a claim or ask the plaintiff for
necessary evidence, Booton v. Lockheed Med.
Benefit Plan, 110 F.3d 1461, 1463–64 (9th
Cir.1997); fails to credit a claimant’s reliable
evidence, Black & Decker Disability Plan v. Nord,
538 U.S. 822, 834, 123 S. Ct. 1965, 155 L. Ed. 2d
1034 (2003); or has repeatedly denied benefits to
deserving participants by interpreting plan terms
incorrectly or by making decisions against the
weight of evidence in the record.
Id. at 968–69.
The abuse of discretion review here is augmented by a
higher level of skepticism because:
(a) LINA never directly contacted the original
physician forensic-pathologist who conducted the
autopsy. That would have been the most prudent
course and, indeed, was suggested in an internal
manual that, at least at one time, was used by
LINA.
(b) LINA obtained a new report after the prior
reviews and used that report to reject the claim
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on a basis quite different from the previously
used basis.
(c) The evidence that the decedent actually had
a fatal cardiac event was weak.
Masuda-Cleveland, 769 F. App’x at 518–19.
Defendant gave multiple reasons for denial of payment,
and therefore it is not the case that Defendant rendered its
decision without any explanation.

The Court turns next to the

questions of whether Defendant improperly construed the
provisions of the plan or relied on clearly erroneous findings
of fact.
B.

Plain Language of the Plan and Findings of Fact
The Policy states, in pertinent part:
We agree to insure those Eligible Persons who are
within the covered classes listed in the
Organization’s application (each herein called
the Insured) for whom the required premium is
paid and an application made. We will insure the
dependent(s) of an Insured provided the correct
premium is paid and the eligibility requirements
are met.
We agree to pay benefits for loss from bodily
injuries:
a)

caused by an accident which happens
while an insured is covered by this
policy; and

b)

which, directly and from no other
causes, result in a covered loss.
the Description of Coverage)

(See

We will not pay benefits if the loss was caused
by:

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a)

sickness, disease, or bodily infirmity;
or

b)

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any of the Exclusions listed in the
policy.

[Metzger Decl., Exh. 1 (Policy) at PageID #: 2878.]

In a

section titled “Exclusions,” the Policy also notes that,
No benefits will be paid for loss resulting from:
. . . .
6.

sickness, disease, bodily or mental
infirmity, or medical or surgical treatment
thereof or bacterial or viral infection,
regardless of how contracted. This does not
include bacterial infection that is the
natural and foreseeable result of an
accidental external cut or wound, or
accidental food poisoning.

[Id., Exh. 7 (Denial Letter) at PageID #: 2915.8]
1.

Loss Caused by an Accident

As the Ninth Circuit has stated:
In McClure v. Life Ins. Co. of N. Am., 84
F.3d 1129 (9th Cir. 1996), we determined that
where the applicable plan language is less than
obvious (“inconspicuous”), the “policy holder
reasonably would expect coverage if the accident
were the predominant or proximate cause of the
disability.” Id. at 1135–36. If, however, the
applicable language is conspicuous, recovery
could be barred if a preexisting condition
8

The page of the Policy titled “Exclusions” was not
included in Exhibit 1 to the CSOF. However, Defendant attached
it to the Denial Letter and specifically relied on the
exclusionary provision in rejecting Plaintiff’s claim. See
Metzger Decl., Exh. 7 (Denial Letter) at PageID #: 2912-13
(denying Plaintiff’s claim on the basis that “his loss of life
is specifically excluded under the terms of the policy”).
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substantially contributed to the loss, “even
though the claimed injury was the predominant or
proximate cause of the disability.” Id. at 1136.
Dowdy v. Metro. Life Ins. Co., 890 F.3d 802, 808 (9th Cir.
2018).

Assuming that the applicable language here was

conspicuous, “[i]n order to be considered a substantial
contributing factor for the purpose of a provision restricting
coverage to ‘direct and sole causes’ of injury, a pre-existing
condition must be more than merely a contributing factor.”
id. at 809.

See

The medical record does not support Defendant’s

conclusion that a medical event substantially contributed to
Masuda’s death; at most, it was a contributing factor.

See,

e.g., Metzger Decl., Exh. 6 at PageID #: 2903.
Plaintiff is entitled to recovery if Masuda’s death
was directly, and from no other causes, caused by an accident.
The term “accident” is used by Defendant inconsistently.
Defendant’s inconsistent of the term “accident” and shifting
causation explanation are indicative of how it construed the
provisions of the plan in a way that conflicts with a plain
reading of the provisions.
In the First Appeal Denial Letter, Defendant explains
that: “‘[A]ccidental Injury’ is interpreted to mean unexpected
or unforeseen bodily harm” and that “benefits are payable only
if the predominate cause of loss was unexpected bodily harm.”
[Metzger Decl., Exh. 10 (First Appeal Denial Letter) at PageID
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#: 2930 (alteration in original).]

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“Therefore, it would be

reasonable to conclude under this policy language that there is
no coverage for his death because an illness, disease or bodily
infirmity directly caused the fatal accidental injury.”
(emphasis added).]

[Id.

Thus, up to but not including the Second

Appeal Denial Letter, Defendant considered the car crash to be
an accident and the injuries sustained therein to be Masuda’s
cause of death, although benefits were denied because an
unspecified medical event substantially contributed to his death
by causing the crash.

However, in the Second Appeal Denial

Letter, Defendant upheld the decision to deny payment because
“the subsequent crash was caused by a medical event due to his
illness, disease or bodily infirmity, and was not caused by an
accident, as required by this policy, and there is no coverage,”
and that “[s]ince we have determined that no accident, as
required by this policy, has occurred, and that losses caused by
or resulting from sickness, disease or bodily infirmity are not
payable, the documentation provided supports our original
determinations to deny payment. . . .”

[Metzger Decl., Exh. 18

(Second Appeal Denial Letter) at PageID #: 3023.]

Therefore, it

appears Defendant changed its position and determined that the
crash itself was no longer an “accident” and also was no longer
the cause of death.

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“Congress intended for ERISA to protect the interests
of plan participants and their beneficiaries.
§§ 1001(b), 1001b(c)(3).

See 29 U.S.C.

Consistent with that policy choice,

federal courts have developed a body of common law that
construes coverage provisions in a manner that does not
unreasonably limit coverage.”

Dowdy, 890 F.3d at 810 (brackets,

citation, and internal quotation marks omitted).

Defendant’s

changing explanation for denial created a moving target for
Plaintiff during the appeals process.

To that end, Defendant

did not allow Plaintiff to respond to the theory that Masuda
died from a heart attack and that the blunt force trauma he
experienced was insufficient to cause death within the appeals.
[Metzger Decl., Exh. 18 (Second Appeal Denial Letter) at PageID
#: 3023.]

Viewed with the appropriately elevated level of

skepticism, Defendant’s inconsistent use of “accident,” in the
first instance to attribute Masuda’s death to fatal injuries
received in an accident, and in the second instance, to deny the
existence of an accident and assert a new cause of death
suggests that in at least one of those instances, Defendant did
not construe the terms “accident” and “cause” in accordance with
the plain language of the policy.
2.

Medical Evidence

Plaintiff and Defendant procured the opinions of four
physicians in addition to Dr. Harle.
15

Of those five, only

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Dr. Harle actually examined the body and performed the autopsy.
Four of the five physicians, including Dr. Harle, and Dr. Hall
(Defendant’s own in-house medical director) concluded that
Masuda died from the injuries he received to the face and neck
as a result of blunt force trauma in the car crash.
Metzger Decl., Exh. 7 at PageID #: 2916.

See, e.g.,

Only Dr. Denton

concluded that Masuda died of a heart attack, and not the
injuries received in the collision.

See, e.g., Metzger Decl.,

Exh. 19 (letter from J. Scott Denton, M.D., dated August 13,
2015) at PageID #: 3030.

Dr. Joana Magno and Dr. Peter W. Rossi

both opined that there was no evidence of a heart attack
(Myocardial infarction) occurred, as would be expected following
a heart attack, and that cause of death the motor vehicle
accident.

[Metzger Decl., Exh. 12 (letter from Joana Magno,

M.D., F.A.C.C., dated June 3, 2015) at PageID #: 2946; Exh. 13
(letter from Peter W. Rossi, M.D. F.A.A.N., dated April 21,
2015) at PageID #: 2971.]

In the Second Appeal Denial Letter,

Defendant disregarded the opinion of its own medical director,
which it had relied upon in its Denial Letter and First Appeal
Denial Letter, in favor of the opinion of Dr. Denton, a
pathologist it hired late in the appeals process and who did not
perform an autopsy.
3029-30.

See Metzger Decl., Exh. 19 at PageID #:

Defendant did not offer any explanation as to why

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Dr. Denton’s opinion was of greater credibility than Dr. Hall’s,
Dr. Harle’s, or the other physicians’.
Clearly, something happened to cause Masuda to crash,
and his witnessed pre-crash behavior was unusual.

However, at

first, Defendant could not explain what happened before the
crash beyond an unspecified medical event such as a heart attack
or seizure.

Defendant later relied Dr. Denton’s opinion in

concluding that a heart attack definitively occurred, and that
the trauma to Masuda’s face and head did not cause his death.
See Metzger Decl., Exh. 18 (Second Appeal Denial Letter) at
PageID #: 3022.

While the assumed medical event, or aberrant

behavior, was possibly a contributing factor to the collision,
it did not substantially contribute to the loss.

Viewed

skeptically, Defendant’s factual finding that Masuda’s death was
caused by a heart attack and not the injuries to his face and
body was clearly erroneous because the Court is left with the
firm and definite conviction that Defendant made a mistake in
reaching that decision.
Based on Defendant’s failure to construe the
provisions of the plan in accordance with their plain language
and reliance on clearly erroneous findings of fact, Defendant
abused its discretion in denying Plaintiff’s claim for benefits.

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II.

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Remedies
A.

Remand
Although remand to the plan administrator is generally

available in cases when the plan administrator abuses its
discretion, here remand is not appropriate because no factual
determinations remain unresolved.

Canseco v. Constr. Laborers

Pension Tr. for S. Cal., 93 F.3d 600, 609 (9th Cir. 1996)
(citation omitted).

Therefore, judgment will be entered in

Plaintiff’s favor, and Defendant is ordered to grant Plaintiff’s
claim for benefits.
B.

Request for Attorney’s Fees
In case brought to recover unpaid ERISA benefits, “the

court in its discretion may allow a reasonable attorney’s fee
and costs of action to either party.”

29 U.S.C. § 1132(g)(1).

“‘[A] plan participant or beneficiary, if he prevails in his
suit under § 1132 to enforce his rights under his plan, should
ordinarily recover an attorney’s fee unless special
circumstances would render such an award unjust.’”

Carpenters

Health & Welfare Tr. for S. Cal. v. Vonderharr, 384 F.3d 667,
674 (9th Cir. 2004) (quoting Smith v. CMTA–IAM Pension Tr., 746
F.2d 587, 589 (9th Cir. 1984)).

If Plaintiff intends to recover

attorney’s fees and costs, she shall file her motion to do so by
no later than December 22, 2020.

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Case 1:16-cv-00057-LEK-WRP Document 135 Filed 11/30/20 Page 19 of 19
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CONCLUSION
For the foregoing reasons, Plaintiff’s Motion for
Judgment on the Expanded ERISA Administrative, filed
February 26, 2020, construed as indicated, is HEREBY GRANTED.
Defendant is HEREBY ORDERED to grant Plaintiff’s claim for
accidental death benefits.

Plaintiff and Defendant are ORDERED

to meet and confer regarding applicable interest, the form and
substance of a proposed judgment, and any other outstanding
issues by December 11, 2020.

Plaintiff is HEREBY ORDERED to

submit the proposed judgment by December 18, 2020.

In the

unlikely event the parties are unable to come to an agreement on
the terms of the proposed judgment, Defendant may submit an
optional response to Plaintiff’s proposed judgment by
December 23, 2020.

Plaintiff’s motion for attorney’s fees and

costs must be filed by no later than December 22, 2020.
IT IS SO ORDERED.
DATED AT HONOLULU, HAWAII, November 30, 2020.

MARNIE MASUDA-CLEVELAND VS. LIFE INSURANCE COMPANY OF NORTH
AMERICA; CV 16-00057 LEK-WRP; ORDER GRANTING PLAINTIFF’S MOTION
FOR JUDGMENT ON THE EXPANDED ERISA ADMINISTRATIVE RECORD

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