Barnett v. S. Cal. Edison Co.

Decision Date05 July 2016
Docket NumberCase No. 1:12-CV-00130-LJO-SAB
CourtU.S. District Court — Eastern District of California

(Docs. 85, 86)


Plaintiff William Barnett ("Barnett") commenced this action under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq., challenging the termination of his long-term disability benefits by Defendant Southern California Edison Long Term Disability Plan ("the Plan"). Judgment was previously entered in the Plan's favor. Doc. 55. Following Barnett's appeal, the Ninth Circuit vacated the Court's judgment and remanded for further proceedings on one issue. Barnett v. So. Cal. Edison Co. Long Term Disability Plan, 633 F. App'x 872 (9th Cir. 2015) (Doc. 77); Doc. 82. Upon remand, Barnett has filed a motion for attorney's fees, benefits and interest (Doc. 85) and the Plan has moved for summary judgment (Doc. 86). This matter is appropriate for resolution without oral argument. See E.D. Cal. Civ. L.R. 230(g). Having carefully considered the record in this case in light of the relevant law, the Court GRANTS the Plan's motion for summary judgment and GRANTS IN PART and DENIES IN PART Barnett's motion for attorney fees, benefits and interest.

I. Facts1

Southern California Edison Company ("Edison") provides a Long Term Disability ("LTD") Plan2 that is "designed to provide partial income replacement to eligible full-time employees who are disabled and unable to perform their regular and customary job for the first two years of disability, and any reasonable job for the company after two years." A.R. at 3553. Edison employees participating in the Plan become eligible for LTD benefits after they have been unable to perform their regular and customary job for six continuous months. Id. at 3555. After two years of disability, Plan participants must be "totally disabled in order to remain eligible for benefits." Id.

The Plan includes the following definitions:

Totally disabled means you are unable to perform any reasonable job for the company due to illness or injury. Your disability must be substantiated by medical evidence from a qualified physician specializing in the area of your disability ...
A reasonable job is any gainful activity in any job classification for which you are or may reasonably become fitted by education, training, or experience. However, the meaning of "reasonable job" varies among employee groups depending on where the job is located. For employees of Southern California Edison, a reasonable job is located at any of the company within the zone (Northwestern, Basin, Eastern) in which you were working on your last day of work.

Id. at 3355-56 (emphasis added). Under the Plan, the Southern California Edison Company BenefitsCommittee ("the Benefits Committee") "has the full and final power and discretionary authority to determine eligibility for benefits, to determine covered benefits, and to construe the terms and provisions of the plans ... [and] may ... [i]nterpret, construe and apply the plan provisions to decide all questions that arise." Id. at 3735.3 The Benefits Committee delegated its authority to Sedgwick Claims Management Services, Inc. ("Sedgwick" or "the Administrator"), which administered the Plan's LTD claims at all relevant times. Id. at 104-06, 2512-29, 3729. Sedgwick has the discretion to review and evaluate all medical evidence for Plan participants and make factual determinations as to eligibility for LTD benefits. Id. at 3556. The contract between the Plan and Sedgwick was overseen by Deborah Jacobs ("Jacobs"), a manager in Edison's Disability Management department. Jacobs 4/29/13 Decl. ¶¶ 1-2; PRMF ¶ 15.

From 1991 until June 2000, Barnett was employed by Edison as a program manager at the San Onofre Nuclear Generating Station ("SONGS"), located at 500 Pacific Coast Highway, San Clemente, California 92674. A.R. at 1917-18, 2047-48. In June 2000, Barnett left work because he had lower back problems, which had led to surgery during the prior year. PRMF ¶¶ 1-2. Barnett was certified as disabled, and was eligible to participate in the Plan because he was unable to perform his job for six consecutive months. PRMF ¶ 3; A.R. at 904, 3553.

A letter from the Plan, dated March 13, 2001, informed Barnett that his application for LTD benefits had been approved effective December 20, 2000. A.R. at 1244-45. The letter provided, in relevant part:

You will continue to qualify for LTD benefits providing you remain totally disabled, which is defined as unable to perform any reasonable job for the Company. Periodically, you will be required to submit medical evidence of your total disability status. This may include a physical examination by a doctor of the Company's choice - one who specializes in the area of your disability.

Id. at 1244.

In July 2009, based upon its review of Barnett's medical records, the Plan exercised its right to certify Barnett's eligibility for LTD benefits by having him undergo an independent medical examination by Dr. Aubrey A. Swartz, an orthopedic surgeon. PRMF ¶ 17; Neylan Decl. ¶ 3. Dr.Swartz prepared an Independent Medical Evaluation detailing Barnett's medical condition that was subsequently forwarded to John C. Meyers, a vocational rehabilitation consultant, who prepared a Transferable Skills Analysis ("TSA") report, dated August 2, 2009. Neylan Decl. ¶ 4; A.R. at 1563-73 (copy of Dr. Swartz's report); A.R. at 1607-11 (copy of Meyers's TSA report). According to the referral letter, Sedgwick requested a TSA report to help "make a determination as to whether [Barnett] would be eligible for continuing LTD benefits ... [meaning that he] must be unable to perform in any occupation as it may be performed within their company based on certain criteria that will ultimately be evaluated by [Edison]." A.R. at 1607. After reviewing Barnett's medical condition and possible work accommodations, and comparing Edison's "library of job descriptions" to Barnett's profile, the TSA concluded Barnett could "reasonably become fitted to perform the following occupation: Customer Specialist 1." Id. Additionally, "[w]ith an adjustable work station which can be raised or lowered ... [Barnett] could perform other office occupations such as Telephone Operator, Joint Pole Clerk and Administrative Aide." Id.

In a letter dated August 26, 2009, Sedgwick informed Barnett that it had determined that he was no longer eligible for LTD benefits. Id. at 606-09. The letter explained that pursuant to Dr. Swartz's report, Barnett had "a permanent incapacity that would require permanent work restrictions," and the TSA, taking into consideration these work restrictions, as well as Barnett's training, education, and experience, concluded that Barnett was capable of performing the positions of Customer Specialist 1, Telephone Operator, Joint Pole Clerk, or Administrative Aide at Edison. Id. at 608-09. Thus, as Barnett was no longer "precluded from performing any reasonable job at [Edison] ... [he] no longer [met] the definition of disability." Id. at 609. Finally, the letter noted that Barnett's LTD benefits claim would be terminated effective October 1, 2009, and apprised him of his right to appeal the decision. Id.

On November 16, 2009, Barnett formally appealed the termination of his benefits. Id. at 1320-21. As part of the appeals process, a panel of six doctors reviewed Barnett's medical records, and Sedgwick requested that Myers prepare a supplemental TSA report, which compared the updated information on Barnett's medical condition with Edison's library of job descriptions. Id. at 1043-45. The updated TSA, dated March 30, 2010, found that Barnett could "reasonably becomefitted to perform" two occupations: Customer Service Specialist 1 and Telephone Operator. Id. at 1045.

On March 29, 2010, Dorene Barker ("Barker"), an Appeals Specialist with Sedgwick emailed Bob Kowal, who was at SONGS, to see if SONGS could accommodate Barnett's work restrictions. Id. at 1352. At some point, it was confirmed that SONGS could accommodate Barnett's work restrictions, but a job was not immediately available at that time. Id. at 1356. In an email dated April 5, 2010, Jacobs informed Barker that the statement that SONGS could accommodate Barnett could be used as a basis to find that Barnett was no longer disabled, under the Plan. Id. Jacobs further wrote, "[t]he letter does not need to mention anything about job availability - but maybe modify it a bit to not say he is expected to report back to work right away and just that he needs to contact his work location about his return to work." Id. Barker subsequently prepared a letter upholding the denial of Barnett's LTD benefits. Id.

In a letter dated April 7, 2010, Sedgwick denied Barnett's appeal. Id. at 766-69. The letter noted the TSA's finding that Barnett could reasonably become fitted to perform the positions of Customer Specialist 1 and Telephone Operator, and that "it was confirmed that Mr. Barnett's restrictions could be accommodated by his work location." Id. at 768. The letter continued: "Based on the Independent Medical Examination, the [TSA], the Panel Reviews and the medical documentation in Mr. Barnett's file, the objective medical evidence failed to support an impairment that precluded him from performing 'any reasonable job' at Edison International as of October 1, 2009." Id. at 769. The letter concluded that because Barnett was no longer precluded from performing any "reasonable job" with Edison, and was no longer eligible to receive LTD benefits, the denial of his LTD benefits was in accordance with the Plan. Id. Finally, the letter apprised Barnett of his right to file a civil action under ERISA § 502(a). Id.

II. Procedural...

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