Some of our published cases
Rivkin v. Union Central Life Ins. Co., 528 Fed. Appx. 766, 2013 U.S. App. LEXIS 12377 (9th Cir. Cal. June 18, 2013), the Honorable Consuelo M. Callahan, Sandra S. Ikuta, and Andrew D. Hurwitz, Circuit Judges. (Held: Defendant abused its discretion in interpreting “Other Income Reductions” to be offset from LTD benefits as including employee’s current monthly earnings from part-time or temporary work: the interpretation was contrary to the plan’s definition of “Other Income Reductions” as such earnings were not benefits received due to his disability.)
Withrow V. Bache Halsey Stuart Shield, Inc., Salary Protection Plan (LTD), 655 F.3d 1032 (9th Cir. 2011) (8/23/11)(insurer: Reliance Standard Life Ins. Co.), the Honorable Kim McLane Wardlaw, William A. Fletcher, Circuit Judges, and Robert J. Timlin,* District Judge. Opinion by Judge Timlin. (Held: Plaintiff’s appeal of a statute of limitations bar of her suit for alleged undercalculation of her predisability earnings and thus monthly benefits. Plaintiff, who remained totally disabled and had been since 1987 and still receiving disability benefits, filed her action in February 2006, approximately two years after the administrator’s January 2004 final denial of the undercalculation/underpayment claim. The Court reversed the district court’s finding that the Plaintiff’s underclaculation claim accrued in 1990, remanding to the district court.
The court held: “Federal law governs the issue of when an ERISA cause of action accrues and thereby triggers the start of the limitation period. [citation omitted]. An ERISA cause of action accrues “either at the time benefits are actually denied, or when the insured has reason to know that the claim has been denied.” [citations omitted]. A claimant has a “reason to know” under the second prong of the accrual test when the plan communicates a “clear and continuing repudiation of a claimant’s rights under a plan such that the claimant could not have reasonably believed but that his or her benefits had been finally denied.’” [citations omitted].
Micha v. Sun Life Assurance Co., 789 F. Supp. 2d 1248 (S.D. Cal. 2011) (5/2/11), the Honorable Jeffrey T. Miller, United States District Judge. (Held, among other: “Sun Life’s claims review procedure was inadequate, calling into question the company’s impartiality,” and denying defendant Sun Life’s motion to limit the scope of the court’s de novo review to the ‘administrative record,’ and granting, in part, Plaintiff’s cross motion to admit extra-record evidence of: 1) the medical records of one of Plaintiff’s physicians that pre-dated the final denial that Sun Life never sought during the appeal process, and 2) an IME conducted by one of Plaintiff’s other disability insurers a year after Sun Life’s final denial, due to its detailed analysis compared to the “superficial reports of Sun Life’s reviewing physicians” since it “provides some insight into what the administrative record might look like had Sun Life done a more thorough job investigating Plaintiff’s claim.”)
Nash v. Life Insurance Co. of North America, 2011 U.S. Dist. LEXIS 67430, 2011 WL 2493738 (S.D. Cal. June, 22, 2011), the Honorable William Q. Hayes, United States District Judge. (Granting Plaintiff’s motion for attorney’s fees pursuant to 29 U.S.C. § 1132(g)(1), in the amount of $409,847.75.)
Nash v. Life Insurance Co. of North America, 2010 WL 5139087, 2010 U.S. Dist. LEXIS 134024 (S.D. Cal. Dec. 9, 2010), the Honorable William Q. Hayes, United States District Judge. (Held: Findings of Fact and Conclusions of Law in long term disability claim, finding LINA abused its discretion in denying Plaintiff’s claim for disability benefits whether viewed with skepticism due to LINA’s conflict or interest, or even under an abuse of discretion review without consideration of conflict of interest.)
Nash v. Life Insurance Co. of North America, 2010 WL 2044935, 2010 U.S. Dist. LEXIS 50089, (S.D. Cal. May 18, 2010), the Honorable William Q. Hayes, United States District Judge.
Nash v. Life Insurance Co. of North America, 2009 U.S. Dist. LEXIS 36285, *9 (N.D. Ill. Apr. 29, 2009). (Held: Granting in part Plaintiff’s request for production of documents from third party surveillance company, PhotoFax, Inc., retained by LINA.)
Kochenderfer v. Reliance Std. Life Ins. Co., 2010 WL 1912867, 2010 U.S. Dist. LEXIS 41330 (S.D. Cal. April 21, 2010), the Honorable Janis L. Sammartino, United States District Judge. (Held: Fee decision, awarding Plaintiff attorney’s fees in the amount of $409,646.50.
Kochenderfer v. Reliance Std. Life Ins. Co., 2009 WL 4722831, 2009 U.S. Dist. LEXIS 112954 (S.D. Cal. Dec. 4, 2009), the Honorable Janis L. Sammartino, United States District Judge. (Held: Decision on the merits, granting Plaintiff’s and denying Defendant’s cross-motions for summary judgment: Held, Defendant Reliance Standard Life Insur. Co. abused its discretion in denying Plaintiff’s disability claim in multiple ways itemized by the court, whether applying “a moderate level of skepticism to Defendant’s claim denial based on its conflict of interest” or without consideration of the insurer’s conflict of interest.)
Donndelinger v. Schmidt, 2009 WL 506859, 2009 U.S. Dist. LEXIS 15342 (S.D. Cal. Feb. 27, 2009), the Honorable William Q. Hayes, United States District Judge. (Held: Granting default judgment against Defendants Doerring & Associates, Inc. Profit Sharing Plan, and Plan Trustee Schmidt).
Neathery v. Chevron Texaco Corp. Group Accident Policy, 2009 WL 3199173, 2009 U.S. Dist. LEXIS 96031 (S.D. Cal. Aug. 11, 2009), the Honorable Jeffrey T. Miller, United States District Judge. (Bench trial decision under de novo standard of review. Held: for Plaintiff, reversing denial of accidental death benefits by Life Insur. Co. of No. Am. [LINA].)
Neathery v. Chevron Texaco, etc., 303 Fed. Appx. 485, 2008 WL 5233207, 2008 U.S. App. LEXIS 26106 (9th Cir. Dec.15, 2008) (unpub), the Honorable John T. Noonan, Jr., Barry G. Silverman, Carlos T. Bea, Circuit Judges. (Vacating and remanding. Held: Plaintiff had properly brought suit after her administrative remedies were deemed exhausted. The district court erred in admitting defendant’s expert report, submitted in litigation after the administrative record closed.)
Neathery v. Chevron Texaco, etc., 2006 WL 4690828, 2006 U.S. Dist. LEXIS 96586 (S.D. Cal. July 7, 2006). (Granting and denying in part Plaintiff’s motion to compel production of documents that defendant claimed were “privileged”. Held: LINA’s in-house legal advise and communications with its claim or appeals department prior to litigation were not ‘privileged’ under the fiduciary exception to the attorney-client privilege; communications after the litigation was filed are privileged as the interests of the parties had diverged.)
Neathery v. Chevron Texaco, etc., 2006 WL 4690829, 2006 U.S. Dist. LEXIS 96585 (S.D. Cal. Feb. 13, 2006), aff’d 303 Fed. Appx. 485, 2008 WL 5233207, 2008 U.S. App. LEXIS 26106 (9th Cir. 12/15/08). (Granting Plaintiff’s motion, finding Plaintiff’s administrative remedies under the Plan were “deemed exhausted” by law prior to filing the Complaint) (aff’d)
Withrow v. Bache Halsey Stuart Shields, Inc., 2008 WL 1836696, 2008 U.S. Dist. LEXIS 35900 (S.D. Cal. April 22, 2008), the Honorable John A. Houston, United States District Judge. (Ruling on motions in limine on the issue of the scope of the court’s de novo review denying Reliance Standard Life’s desire to have Plaintiff and one of its own representative who handled Plaintiff’s claim testify at trial.)
Withrow v. Bache Halsey Stuart Shields, Inc., 2007 WL 1993816, 2007 U.S. Dist. LEXIS 48533 (S.D. Cal. July 5, 2007), the Honorable Ruben B. Brooks, United States Magistrate Judge. (Denying defendant’s request to depose plaintiff).
Perez v. Cozen & O’Connor Group Long Term Disability Coverage (Perez II), 2008 WL 6693714, 2008 U.S. Dist. LEXIS 109878 (S.D. Cal Aug 19, 2008), the Honorable Dana M. Sabraw, United States District Judge. (Awarding 10% interest on LTD benefits under the equities of the case.)
Perez v. Cozen & O’Connor Group Long Term Disability Coverage (Perez I), 2007 WL 2142292, 2007 U.S. Dist. LEXIS 53996 (S.D. Cal. Mar. 27, 2007), the Honorable Dana M. Sabraw, United States District Judge. (Awarding $303,347.50 fees at the market rates of $375 and $425 respectively, for attorneys Susan L. Horner and Thomas M. Monson).
Perez v. Cozen & O’Connor, etc., 2006 U.S. Dist. LEXIS 90356 (S.D. Cal. Dec. 13, 2006), the Honorable Dana M. Sabraw, United States District Judge. (Bench Trial, de novo review, findings of fact/conclusions of law; entry of judgment for Plaintiff).
Perez v. Cozen & O’Connor, etc., 459 F. Supp. 2d 1018 (S.D. Cal. 2006) (8/22/2006), the Honorable Dana M. Sabraw, United States District Judge. (Held: genuine issues of material fact required denial of summary judgment to Plaintiff on her claim of total disability from Chronic Fatigue Syndrome, and denied defendant’s motion that Plaintiff had failed to exhaust her administrative remedies by refusing a second individualized medical exam which Reliance Standard sought only after Plaintiff had already completed the three required levels of review.)
Perez v. Cozen, etc., 2005 U.S. Dist. Lexis 29370 (S.D. Cal. 11/3/2005), the Honorable Dana M. Sabraw, United States District Judge. (Held: policy language that states disability exists “when Prudential determines that all of these conditions are met” is not a clear an unabmgious grant of discretion, requiring a de novo standard of review.)
Hemenway v. Unum Life Ins. Co. of Am., 89 Fed. Appx. 630, 2004 U.S. App. LEXIS 4011 (9th Cir. Mar. 1, 2004) (unpub.), the Honorable William C. Canby, Jr., John T. Noonan, Jr., Sidney R. Thomas, Circuit Judges.
Rodolff v. Provident Life & Accid. Ins. Co., 256 F.Supp. 2d 1137 (S.D. Cal. 2003). The Honorable Marilyn L. Huff, Chief Judge, United States District Court.
Mogck v. Unum Life Ins. Co. of America, 289 F. Supp.2d 1181 (S.D. Cal. 2003), the Honorable Leo S. Papas, United States Magistrate Judge. (Granting in part plaintiff’s motion for fees, awarding fees and costs of action in amount of $295,775 at market rates of, respectively, $325 and $350 for attorneys Susan L. Horner, Thomas M. Monson.)
Mogck v. Unum Life Ins. Co. of America, 292 F.3d 1025 (9th Cir. 2002), the Honorable Edward Leavy, Thomas G. Nelson, William A. Fletcher, Circuit Judges. (Reversing dismissal of action under contractual suit limitations time bar and finding insurance company’s letter informing the insured that it was discontinuing disability payments was not a proof or “request for proof” and therefore, the insurance company never took the steps necessary to trigger the running of the contractual time limitation under the policy.)
Mogck v. Unum Life Ins. Co. of America, 2001 WL 34084379, 2001 U.S. Dist. LEXIS 25129 (S.D. Cal. Jan. 8, 2001). (Costs decision, finding that Federal Rule 54(d)(1) governs the award of costs unless Congress has specifically provided for cost shifting pursuant to separate rule or statute, and in the case of an ERISA claim, Congress specifically provided for cost shifting under § 502(g), which allows the Court “in its discretion” to award a reasonable attorney’s fee and costs of action to “either party,” after applying the 5-factor Hummel test, special circumstances rule and the underlying purposes of ERISA.)
Russo v. Hartford Life & Accid. Ins. Co., 2002 WL 32138296, 2002 U.S. Dist. LEXIS 26566 (S.D. Cal. 2/5/2002), the Honorable Leo S. Papas, United States Magistrate Judge. (Decision on Plaintiff’s 60(b)(6) motion for reconsideration whether the court committed clear error in finding Hartford had no duty to provide the insured with new evidence that it developed during the investigation Hartford had conducted after the insured’s appeal. Held: the court found that this holding was clear error pursuant to 29 C.F.R. § 2560.503-1(g)(1), that Hartford owed the insured a duty to make available to the insured, for his review and response before any final decision was rendered, those documents that Hartford had developed during its post-appeal investigation, and that to remedy Hartford’s breach of fiduciary duty, the court, in its de novo review, will consider comments and evidence submitted by Russo in response to the withheld documents.)
Meoli v. American Medical Services of San Diego, 35 F.Supp. 2d 761 (S.D. Cal. 1999)
Enslow ex rel. Enslow v. United States, 42 F.3d 1399, 1994 U.S. App. LEXIS 39444 (9th Cir. Cal. 1994)(reported in full at Enslow ex rel. Enslow v. United States, 1994 U.S. App. LEXIS 32765 (9th Cir. Nov. 15, 1994) (unpub), the Honorable D.W. Nelson, Robert R. Beezer and Alex Kozinski, Circuit Judges.
O’Brien v. AMBS Diagnostics, LLC
246 Cal. App. 4th 942, 2016 Cal. App. LEXIS 310 (Cal. App. 2d Dist. 2016)