MORRISON C. ENGLAND, JR., Chief Judge.
On August 27, 2012, Plaintiff Steve Ira Armstrong ("Plaintiff') filed a Complaint pursuant to Section 502(a) of the Employee Retirement Income Security Act ("ERISA"). ECF No. 1. Presently before the Court is Defendant Hartford Life & Accident Insurance Company's ("Defendant") Motion for Summary Judgment ("Motion") on the grounds that Plaintiffs action is barred by a three-year contractual limitations period. ECF No. 13. Plaintiff opposes Defendant's Motion. ECF No. 31. For the following reasons, Defendant's Motion is GRANTED.
Plaintiff seeks payment of $250,000 in benefits under an ERISA-governed accidental death and dismemberment ("AD & D") policy (the "Policy") issued by Defendant to the California Correctional Peace Officers Association ("CCPOA") Benefit Trust Fund as part of a welfare benefit plan. Compl., ECF No. 1. Plaintiff's wife, Helen Armstrong ("Decedent"), participated in the plan as a dues-paying member of the CCPOA. ECF No. 10 at 2. Plaintiff was designated as the beneficiary under the Policy. Pl.'s Responses, ECF No. 31-2 ¶ 3. Decedent died on December 7, 2007. Id. ¶ 4. Plaintiff initiated the instant lawsuit on August 27, 2012. Compl., ECF No. 1.
Under the Policy, proof of loss "must be sent to [Defendant] in writing within 90 days after: a) the end of a period of [Defendant's] liability for periodic payment claims; or 2) the date of the loss for all other claims. If the claimant is not able to send it within that time, it may be sent as soon as reasonably possible without affecting the claim. The time allowed cannot exceed one year unless the claimant is legally incapacitated." Pl.'s Responses,
Thereafter, Defendant received and responded to multiple inquiries from the California Department of Insurance ("DOI") regarding Plaintiff's claim under the Policy. Pl.'s Responses, ECF No. 31-2 ¶¶ 12-15, 17-19. On January 5, 2012, Plaintiff's counsel attempted to submit additional information in support of Plaintiff's accidental death claim. Pl.'s Responses, ECF No. 31-2 ¶ 20. On February 16, 2012, Defendant advised Plaintiff it had already upheld its decision on appeal and that as of August 27, 2009, Plaintiff had exhausted all of his administrative remedies under the Policy, and it reminded Plaintiff that he had the right to file suit under ERISA. Id. ¶ 21.
Through the instant Motion, Defendant contends that Plaintiff's action is barred by the three-year contractual limitations period in the policy. Specifically, Defendant contends that because Plaintiff failed to file suit against Defendant by March 7, 2011 — within three years of his proof of loss deadline under the terms of the plan — the Court should find in its favor. The Court agrees, and Defendant's Motion is GRANTED.
The Federal Rules of Civil Procedure provide for summary judgment when "the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a); see also Celotex Corp. v. Catrett, 477 U.S. 317, 322, 106 S.Ct. 2548,
In a summary judgment motion, the moving party always bears the initial responsibility of informing the court of the basis for the motion and identifying the portions in the record "which it believes demonstrate the absence of a genuine issue of material fact." Celotex, 477 U.S. at 323, 106 S.Ct. 2548. If the moving party meets its initial responsibility, the burden then shifts to the opposing party to establish that a genuine issue as to any material fact actually does exist. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986); First Nat'l Bank v. Cities Serv. Co., 391 U.S. 253, 288-89, 88 S.Ct. 1575, 20 L.Ed.2d 569 (1968).
In attempting to establish the existence or non-existence of a genuine factual dispute, the party must support its assertion by "citing to particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits[,] or declarations ... or other materials; or showing that the materials cited do not establish the absence or presence of a genuine dispute, or that an adverse party cannot produce admissible evidence to support the fact." Fed.R.Civ.P. 56(c)(1). The opposing party must demonstrate that the fact in contention is material, i.e., a fact that might affect the outcome of the suit under the governing law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 251-52, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986); Owens v. Local No. 169, Assoc. of W. Pulp and Paper Workers, 971 F.2d 347, 355 (9th Cir.1992). The opposing party must also demonstrate that the dispute about a material fact "is `genuine,' that is, if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson, 477 U.S. at 248, 106 S.Ct. 2505. In other words, the judge needs to answer the preliminary question before the evidence is left to the jury of "not whether there is literally no evidence, but whether there is any upon which a jury could properly proceed to find a verdict for the party producing it, upon whom the onus of proof is imposed." Id. at 251, 106 S.Ct. 2505 (quoting Improvement Co. v. Munson, 81 U.S. 442, 448, 14 Wall. 442, 20 L.Ed. 867 (1871)) (emphasis in original). As the Supreme Court explained, "[w]hen the moving party has carried its burden under Rule [56(a)], its opponent must do more than simply show that there is some metaphysical doubt as to the material facts." Matsushita, 475 U.S. at 586, 106 S.Ct. 1348. Therefore, "[w]here the record taken as a whole could not lead a rational trier of fact to find for the nonmoving party, there is no `genuine issue for trial.'" Id. at 587, 106 S.Ct. 1348.
In resolving a summary judgment motion, the evidence of the opposing party is to be believed, and all reasonable inferences that may be drawn from the facts placed before the court must be drawn in favor of the opposing party. Anderson, 477 U.S. at 255, 106 S.Ct. 2505. Nevertheless, inferences are not drawn out of the air, and it is the opposing party's obligation to produce a factual predicate from which the inference may be drawn. Richards v. Nielsen Freight Lines, 602 F.Supp. 1224, 1244-45 (E.D.Cal.1985), aff'd, 810 F.2d 898 (9th Cir.1987).
For the purposes of the instant Motion, the Court need only determine whether Plaintiff's action is barred by the three-year contractual limitations period. Defendant contends that Plaintiff's action
"There are two parts to the determination of whether a claimant's ERISA action is timely filed: ... first whether the action is barred by the applicable statute of limitations, and second whether the action is contractually barred by the limitations provision in the policy." Withrow v. Halsey, 655 F.3d 1032, 1035 (9th Cir.2011). Here, Defendant does not argue that Plaintiff's action is barred by the applicable statute of limitations; rather, Defendant argues only that Plaintiff's action is contractually barred by the limitations provision in the Policy. Mot., ECF No. 13 at 15.
"Absent a controlling statute to the contrary, a participant and a plan may agree by contract to a particular limitations period, even one that starts to run before the cause of action accrues, as long as the period is reasonable." Heimeshoff v. Hartford Life & Acc. Ins. Co., ___ U.S. ___, 134 S.Ct. 604, 610, 187 L.Ed.2d 529 (2013). The parties may "agree not only to the length of a limitations period but also to its commencement." Id. at 611. Thus, the contractual limitations "begins to run as defined by the plan's terms." Koblentz v. UPS Flexible Employee Ben. Plan, 2013 WL 4525432 at *3 (S.D.Cal. Aug. 23, 2013), appeal dismissed (Feb. 28, 2014). "Terms in ERISA insurance policies should be interpreted in an ordinary and popular sense as would a person of average intelligence and experience. Ambiguous language is construed in favor of the insured and against the insurer. However, if a reasonable interpretation favors the insurer and finding another interpretation would be strained, the court is not to torture or twist the language of the policy." Id. (internal citations and quotation marks omitted).
Here, as set forth above, Decedent's policy provided that no legal action may be brought "after 3 years following the date proof of loss is due." Pl.'s Responses, ECF No. 31-2 ¶ 6; see Exh. 1 to Rose Decl., ECF No. 13-3 at 37 (AR 213).
The parties do not dispute the relevant dates. See Pl.'s Responses, ECF No. 312 ¶¶ 22-24. Decedent died on December 7, 2007, making the ninetieth day after the date of her passing March 7, 2008. Three years after March 7, 2008 was Monday, March 7, 2011. Plaintiff filed this lawsuit on August 27, 2012. ECF No. 1. Therefore, the undisputed facts demonstrate that Plaintiff did not file the instant lawsuit within the three-year Policy period. Because the Court finds that the contractual limitations period at issue is not unreasonably short and is not controlled by any other statute, Plaintiff's ERISA action is untimely.
As an initial matter, under the facts of this case, the three-year period at issue is not unreasonably short. Indeed, Plaintiff appears to concede this point. See Opp'n, ECF No. 31 at 7-8. On April 14, 2009, Defendant denied Plaintiff's claim and informed him of his right to appeal. Pl.'s Responses, ECF No. 31-2 ¶ 8. Under the Policy, Plaintiff was not required to bring the instant action until March 7, 2011 — giving him approximately 690 days to commence legal action. Id. ¶ 23. In fact, as of August 27, 2009, when Defendant denied Plaintiff's final appeal and informed Plaintiff that he had exhausted his administrative remedies, Plaintiff still had approximately 555 days to commence legal action. See Reply, ECF No. 32 at 10-11 (explaining that "[Plaintiff] had 17 months to file suit after [Defendant] issued its final denial on the claim, but, despite already being represented by counsel, he chose not to do so").
However, the Court must also determine whether a "controlling statute" prevents the contractual limitations provision from taking effect. Heimeshoff, 134 S.Ct. at 606. Here, Plaintiff neither claims that ERISA's text or regulations preclude the Policy's limitation provision nor points to any authority that contradicts the Policy's limitation provision. Further, the Court is not aware of any authority suggesting that a "controlling statute" prevents the Policy's three-year limitations provision from taking effect. Accordingly, the Court finds that no controlling statute prevents the Policy's three-year limitations provision from taking effect.
In his Opposition, Plaintiff makes several disjointed attempts to argue that Defendant has waived the enforcement of the contractual limitations period and that the period did not begin until August 27, 2009, when Defendant denied Plaintiff's final appeal. Plaintiff is incorrect.
First, Plaintiff argues that because Defendant did not reject his October 29, 2008, proof of loss as "untimely," Defendant waived its right to enforce the three-year period commencing on March 7, 2008, the 90th day after Decedent's death. Opp'n, ECF No. 31 at 6. Specifically, Plaintiff alleges that Defendant's "failure to insist upon the proof of loss being filed in a timely fashion and the fact that no reference had ever been made to the claim being rejected for that reason" is tantamount to misconduct that results in waiver. Opp'n, ECF No. 31 at 9. However, as Defendant points out, Plaintiff's argument that Defendant should have "objected to his self-described `late' claim, submitted after the initial 90-day time frame for filing proof of loss, is a red herring." Reply, ECF No. 32 at 6. Whether Plaintiff's proof of loss was timely is not at issue, but rather whether the instant matter — the resulting legal action — is timely. Under the Policy's provisions, Plaintiff's October 29, 2008, proof of loss, although not submitted within the 90-day period after Decedent's death, was submitted within the one-year grace period. See Pl.'s Responses, ECF No. 31-2 ¶ 5. Thus, as Defendant explains, Plaintiff's proof of loss was never considered late.
Accordingly, the Gordon court did not find waiver where a statute of limitations was never the basis for insurer's denial of an ERISA claim. Id. Similarly, here, as Plaintiff admits, that Defendant denied the claim on the grounds that Decedent's death did not result directly from accident and independently of all other causes. Thus, Defendant did not waive its contractual limitations.
Next, Plaintiff's argument that Defendant misled him and invited detrimental reliance by allegedly referring him to the statute of limitations rather than the contractual limitations period is easily dispatched. Plaintiff's argument finds no support in fact or law. Defendant's initial denial letter merely advised Plaintiff of his ERISA appeal rights, and the final denial letter stated that Plaintiff had exhausted his administrative remedies and could file suit under ERISA Section 502(a). The letters never referenced any statute of limitations nor invited Plaintiff to disregard the Policy language. Moreover, as Defendant points out, the ERISA regulations required Defendant to notify Plaintiff of his right to sue under ERISA Section 502(a) in the final denial. See 29 C.F.R. § 2560.503-1(j) (explaining that "[i]n the case of an adverse benefit determination, the notification shall set forth ... [among other things:] [t]he specific reason or reasons for the adverse determination [and]... a statement of the claimant's right to bring an action under section 502(a) of the Act"). In addition, the ERISA regulations did not require Defendant to remind Plaintiff of the contractual limitations period and courts have refused to require that administrators inform participants separately of time limits already contained within the plan. See id.; Scharff v. Raytheon Co. Short Term Disability Plan, 581 F.3d 899, 907-908 (9th Cir.2009); Freeman v. Am. Airlines, Inc. Long Term Disability Plan, 2014 WL 690207 at *4-5 (C.D.Cal. Feb. 20, 2014) (explaining that ERISA regulations did not require that a provider supply notice of the plan's two-year contractual limitations period for filing a civil action under ERISA).
Finally, Plaintiff now contends that his lawsuit is timely because it was filed within three years of "Defendant's final decision that the proof of loss/claim was being denied," which he contends is a reasonable interpretation of the Policy language. Opp'n, ECF No. 31 at 3-4 (emphasis added). More specifically, Plaintiff asserts that "[a] reasonable interpretation of the policy and the conduct of the insured and the insurer indicates that if a three-year statute were applied, it would be applied to when the proof of loss was finally denied by insurer which was August 27, 2009, and Plaintiff's Complaint would be timely under that interpretation."
In sum, because the Policy's three-year contractual limitations period is not unreasonably short, and there is no controlling statute preventing the limitations provision from taking effect, the Court finds that the Policy's three-year contractual limitations period is enforceable. Defendant has met its burden of showing that Plaintiff's action is contractually barred by the limitations provision in the Policy. Accordingly, the Court GRANTS Defendant's Motion for Summary Judgment (ECF No. 13). The Clerk of the Court is DIRECTED to close this case.
IT IS SO ORDERED.
