DANA M. SAB RAW, District Judge.
In this action for review of termination of Plaintiffs long term disability benefits, Defendants filed a motion to establish the applicable standard of review under the Employee Retirement Income Security Act, 29 U.S.C. § 1001 et seq. ("ERISA"). Defendants argue that an abuse of discretion standard applies. Plaintiff filed an opposition arguing the applicable standard is de novo, and Defendants replied. With leave of Court, Plaintiff filed a sur-reply. For the reasons stated below, Defendants' motion is denied.
Denial of benefits under an ERISA plan "is reviewed under a de novo standard unless the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits...." Firestone Tire and Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). Defendants bear the burden of proving the plan's grant of discretionary authority. Thomas v. Or. Fruit Products Co., 228 F.3d 991, 994 (9th Cir.2000). It is undisputed the only document conferring discretionary authority is the Summary Plan Description ("SPD"). Defendants argue this is sufficient to warrant discretionary review.
SPDs "provide communication with beneficiaries about the plan, but ... their statements do not themselves constitute
According to Defendants, the Group Policy and the plan booklet, which includes the certificate of insurance and the SPD, are the relevant plan documents.
(Docket no. 25 (Administrative Record ("AR")) at RS000636.) Consistently, the Group Policy contains an integration clause:
(Second Aff. of Mary Kay Racette at RS001563.) Defendants do not contend the Group Policy has been amended to confer discretionary authority, but argue the SPD's grant of authority provision is a part of the Group Policy. Part B of the Group Policy incorporates specified provisions of listed certificates:
(Id. at RS001569.) Included in the list is Certificate No. B-6260 (7-05), referring to Full-Time Employees of Saddleback Memorial Medical Center. (Id.) This is the plan booklet referenced by Defendants. (AR at RS000632-61). Part B also lists the provisions of each certificate which are incorporated into the Group Policy. Those provisions are titled Schedule of Benefits, Employee's Insurance, Disability Income Insurance, Claim Procedures, General Provisions, and Definitions. (Second Aff. of Mary Kay Racette at RS001569.) Although the SPD is included in the plan booklet, it is contained in its own provision, which is not listed among the provisions incorporated into the Group Policy. (Cf. id. & AR at RS000633 (plan booklet table of contents).)
While it is possible for an ERISA plan to incorporate an SPD and its terms,
Defendants rely on Langlois v. Metropolitan Life Insurance Company, 833 F.Supp.2d 1182 (N.D.Cal.2011), and Gonzales v. Unum Life Insurance Company of America, 861 F.Supp.2d 1099 (S.D.Cal. 2012) (Battaglia, J.), both of which are distinguishable. In Langlois, the SPD included a provision that its terms were intended to be legally enforceable. See 833 F.Supp.2d at 1185-86. This is not present in Defendants' SPD. In Gonzales, the governing plan document (the policy), contained a provision conferring discretionary authority. 861 F.Supp.2d at 1108-09. By contrast, in this case, the governing document (the Group Policy) does not include the provision. When the plan does not confer discretion, de novo review applies. Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir.2006) (en banc). Accordingly, Defendants have not met their burden to establish that the applicable standard is abuse of discretion.
Because the provision conferring discretionary authority is not incorporated into the ERISA plan, Defendants' motion is denied. Termination of Plaintiffs benefits is reviewed de novo.