MICHAEL M. ANELLO, District Judge.
This action involves a claim for accidental death benefits arising under the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et. seq. Plaintiff Debra Cerone and Defendants Reliance Standard Life Insurance Company and The Picerne Group Health & Welfare Plan (collectively "Defendants") have filed cross motions for partial summary judgment on the applicable standard of review. Doc. Nos. 37, 38. The Court, in its discretion, found the motions suitable for determination on the papers and without oral argument, pursuant to Civil Local Rul 7.1(d)(1). For the reasons set forth below, the Court
Plaintiff Debra Cerone ("Plaintiff") brings this action for accidental death benefits under ERISA. The relevant group life and accidental benefit insurance policy was issued by Defendant Reliance Standard
Plaintiff's husband, Donald Cerone, was an employee of Picerne and covered under the Policy. In the event of Donald Cerone's accidental death, the Policy provided benefits in the amount of $250,000.
On August 8, 2011, Donald Cerone died in a car crash. Plaintiff then filed a claim for accidental death benefits under the Policy. The Policy grants Reliance discretionary authority to interpret the Policy and determine eligibility for benefits. On January 10, 2012, Reliance denied Plaintiff's claim, citing two policy exclusions in which either alcohol intoxication or voluntary consumption of a controlled substance is a contributing factor. Plaintiff timely appealed the denial of benefits. On August 20, 2012, Reliance denied Plaintiff's appeal.
On January 23, 2013, Plaintiff filed this ERISA action, seeking review of Reliance's denial of benefits. The parties now move for partial summary judgment on the applicable standard of review.
A motion for summary judgment should be granted if there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law. Fed. R.Civ.P. 56(a). The purpose of summary judgment "is to isolate and dispose of factually unsupported claims or defenses." Celotex v. Catrett, 477 U.S. 317, 323-24, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). The moving party bears the initial burden of informing the court of the basis for the motion, and identifying portions of the pleadings, depositions, answers to interrogatories, admissions, or affidavits that demonstrate the absence of a triable issue of material fact. Id. at 323, 106 S.Ct. 2548. The evidence and all reasonable inferences therefrom must be viewed in the light most favorable to the non-moving party. T.W. Elec. Serv., Inc. v. Pac. Elec. Contractors Ass'n, 809 F.2d 626, 630-31 (9th Cir.1987).
If the moving party meets its initial burden, the burden then shifts to the nonmoving party to present specific facts showing that there is a genuine issue of material fact for trial. Celotex, 477 U.S. at 324, 106 S.Ct. 2548. The opposing party "must do more than simply show that there is some metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co. v. Zenith Radio, 475 U.S. 574, 588, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). If the motion and supporting materials, including facts considered undisputed, show the movant is entitled to summary judgment, the court may grant the motion. Fed. R.Civ.P. 56(e)(3).
A court reviews the denial of benefits de novo unless the plan or policy confers discretion on the administrator to determine eligibility for benefits. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). Where the plan or policy grants such discretion, the standard of review becomes abuse of discretion. Saffon v. Wells Fargo & Co. Long Term Disability Plan, 522 F.3d 863, 866 (9th Cir.2008).
Here, it is undisputed that the Policy confers discretion on Reliance to determine eligibility for benefits under the Policy:
The Policy at 11.0. Defendants therefore maintain that the applicable standard of review is abuse of discretion. Plaintiff, however, asserts that California Insurance Code section 10110.6 effectively voids the grant of discretionary authority, which in turn makes the applicable standard of review de novo.
Section 10110.6, which became effective on January 1, 2012, provides in relevant part:
Cal. Ins.Code § 10110.6. The statute defines renewed as "continued in force on or after the policy's anniversary date." Id. In addition, the statute defines discretionary authority as "a policy provision that has the effect of conferring discretion on an insurer . . . to determine entitlement to benefits or that, in turn, could lead to a deferential standard of review by any reviewing court." Id.
Thus, pursuant to section 10110.6, an insurance policy that is "continued in force on or after the policy's anniversary date" is therefore renewed under the terms of the statute. A renewal of an insurance policy is significant because "[t]he law in effect at the time of renewal of a policy governs the policy . . ." Stephan v. Unum Life Ins. Co. of Am., 697 F.3d 917, 927 (9th Cir.2012). "Each renewal incorporates any changes in the law that occurred prior to the renewal." Id. Thus, any relevant changes in the statutory or decisional law in force at the time the insurance policy is renewed "are read into each policy thereunder, and become a part of the contract with full binding effect upon each party." Id.
Here, the Policy clearly confers discretion on Reliance as the policy administrator and was delivered in California, and therefore is subject to section 10110.6. When the Policy "continued in force on and after" its January 1, 2012 anniversary date, the Policy was "renewed" under the terms of the statute on January 1, 2012. Upon such renewal, the Policy incorporated all relevant statutory and decisional law in place at the time of renewal, including California Insurance Code section 10110.6. See Stephan, 697 F.3d at 927. In other words, when the Policy continued in force on its January 1, 2012 anniversary date—the same date section 10110.6 became effective—section 10110.6 applied to the Policy, thereby voiding the discretionary clause. See Cal. Ins.Code § 10110.6. In the absence of a valid discretionary clause, the standard of review for an ERISA claim is de novo. See Firestone, 489 U.S. 101, 109 S.Ct. 948; Saffon, 522 F.3d at 866.
The Court's analysis, however, does not end there. Section 10110.6 only applies to the Policy as of January 1, 2012. Defendants assert that because Plaintiff's claim arose in August 2011 prior to this change,
Thus, in order to determine the applicable standard of review, the Court must first determine which version of the Policy governs Plaintiff's ERISA claim.
To determine which version of the Policy governs, the Court must consider whether Plaintiff's benefits have vested. See Grosz-Salomon v. Paul Revere Life Ins. Co., 237 F.3d 1154, 1159-60 (9th Cir. 2001). Under ERISA, accidental death benefits are classified as welfare benefits. 29 U.S.C. § 1002(1). "Welfare benefits, unlike pension benefits, do not vest unless and until the employer says they do." Alday v. Raytheon Co., 693 F.3d 772, 781-82 (9th Cir.2012) (internal citation omitted). Where benefits have not vested, the controlling policy is the one in existence when benefits are denied. Grosz-Salomon, 237 F.3d at 1159-60. The reason is that:
Hackett v. Xerox Corp. Long-Term Disability Income Plan, 315 F.3d 771, 774 (7th Cir.2003) (citing Grosz-Salomon, 237 F.3d at 1159). The Ninth Circuit has held that an ERISA claim for wrongful termination of benefits accrues at the time benefits are denied. Grosz-Salomon, 237 F.3d at 1159. Thus, "absent any language suggesting ambiguity on the vesting question, the controlling plan must be the plan in effect at the time the benefits were denied." Hackett, 315 F.3d at 774.
Defendants claim that Plaintiff's benefits under the Policy were vested at the time Plaintiff filed her claim for accidental death benefits. For this to be true, Defendants must have contractually agreed to grant vested benefits. See Grosz-Salomon, 237 F.3d at 1160. "Contractual vesting of a welfare benefit, moreover, is an extra-ERISA commitment that must be stated in clear and express language." Id. Defendants, however, do not argue—and there is nothing in the Policy to suggest—that Defendants purportedly granted vested benefits to Plaintiff either prior to or upon filing a claim for benefits.
Because there is no language in the Policy or elsewhere suggesting that Defendants agreed to grant vested benefits, the Court finds that Plaintiff's benefits were not vested at the time Plaintiff filed her claim in 2011. The Court therefore looks to the Policy as it existed at the time benefits were denied. See Grosz-Salomon, 237 F.3d at 1160. Reliance denied Plaintiff's initial claim on January 10, 2012 and the appeal on August 20, 2012, both of which occurred after section 10110.6 voided the discretionary clause.
Lastly, Defendants contend that section 10110.6 is preempted because it conflicts with ERISA's Administrative Scheme for amending insurance policies.
Thus, the Court finds the controlling Policy to determine the standard of review for Plaintiff's ERISA claim is the Policy as it existed at the time Reliance denied Plaintiff's claim in 2012. Pursuant to California Insurance Code section 10110.6, the Policy was renewed on the Policy's January 1, 2012 anniversary date. Upon renewal, the Policy was subject to California Insurance Code section 10110.6, which thereby rendered the Policy's discretionary clause void and unenforceable. See Cal. Ins.Code § 10110.6. As such, the Court finds that the applicable standard of review for Plaintiff's ERISA claim is de novo.
Based on the foregoing, the Court