Sousa v. Unilab Corp. Class II Group Benefit Plan

• Decision Date: 14 August 2002
• Docket Number: No. CV F 01 6060 AWI DLB.,CV F 01 6060 AWI DLB.
• Citation: 252 F.Supp.2d 1046
• Court: U.S. District Court — Eastern District of California
• Parties: Allison SOUSA, as Executor of the Will of Christopher SOUSA, deceased; Brendan Sousa, Evan Sousa, and Zackery Sousa, minors, by Allison Sousa guardian ad litem, Plaintiffs, v. UNILAB CORPORATION CLASS II (NON-EXEMPT) MEMBERS GROUP BENEFIT PLAN; Principal Mutual Life Insurance Company; and 1 through 20 inclusive, Defendants

Page 1046

252 F.Supp.2d 1046

Allison SOUSA, as Executor of the Will of Christopher SOUSA, deceased; Brendan Sousa, Evan Sousa, and Zackery Sousa, minors, by Allison Sousa guardian ad litem, Plaintiffs, v. UNILAB CORPORATION CLASS II (NON-EXEMPT) MEMBERS GROUP BENEFIT PLAN; Principal Mutual Life Insurance Company; and 1 through 20 inclusive, Defendants

No. CV F 01 6060 AWI DLB.

United States District Court, E.D. California.

August 14, 2002.

Michael Eldon Vergara, Somach, Simmons and Dunn, Sacramento, CA, for Allison Sousa, As Executor of the Will of Christopher Sousa, deceased aka Christopher Sousa, Brendan Sousa, minor by Allison Sousa guardian ad litem, Evan Sousa, minor by Allison Sousa guardian ad litem, Zackery Sousa, minor by Allison Sousa guardian ad litem.

Henry Chi-Jen Wang, Manatt, Phelps and Phillips, Los Angeles, CA, for Unilab Corporation Class II (Non-Exempt) Members Group Benefit Plan, Principal Mutual Life Insurance Company.

MEMORANDUM OPINION AND ORDER GRANTING DEFENDANTS' MOTION FOR SUMMARY JUDGMENT AND DENYING PLAINTIFFS' MOTION FOR SUMMARY JUDGMENT

ISHII, District Judge.

This action arises under the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461 ("ERISA"). This court has jurisdiction under 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e). Plaintiffs Allison Sousa, as Executor of the Will of Christopher Sousa, Brendan Sousa, Evan Sousa, and Zachery Sousa, minors by Allison Sousa guardian ad litem, ("Plaintiffs") are the family of Christopher Sousa. Defendant Unilab Corporation Class II (Non-Exempt) Members Group Benefit Plan ("Plan") is an employee group benefit plan established by decedent Christopher Sousa's employer. Defendant Principal Mutual Life Insurance Company ("Principle") was the insurer of the Plan and administered claims for the Plan. Pending before the court are cross motions for summary judgment. At issue is whether this action is barred by the statute of limitations and whether Decedent Christopher Sousa's death was a result of a willful self injury.

PROCEDURAL HISTORY

On August 9, 2001, Plaintiffs filed a complaint. Plaintiffs contend that Defendants denied them accidental death benefits wrongfully, unreasonably, irrationally, and contrary to the evidence, terms of the Plan, and law. Plaintiffs contend they are entitled to payment of the accidental death benefits.

On April 5, 2002, the court held a pretrial conference with the parties. The court and the parties agreed that this case would be resolved by cross motions for summary judgment. On April 8, 2002, the court vacated the trial date and set a briefing schedule for the cross motions for summary judgment.

On May 6, 2002, Defendants filed a motion for summary judgment. Defendants contend that this action is barred by the limitations period contained in the Plan. Assuming the action is not barred, Defendants contend Plaintiffs are not entitled to accidental death benefits. Defendants claim decedent's death was not an accident because death was a foreseeable event and an expectation of survival was not objectively reasonable.

On May 6, 2002, Plaintiffs filed a motion for summary judgment. Plaintiffs contend their claim is not barred by the applicable statute of limitations. Plaintiffs contend their claim for accidental death benefits is not precluded by the Plan's willful self injury exclusion.

On May 20, 2002, Defendants filed an opposition to Plaintiffs' motion for summary judgment.

On May 20, 2002, Plaintiffs filed an opposition to Defendants' motion for summary judgment.

On May 28, 2002, Defendants filed a reply to Plaintiffs' opposition to Defendants' motion.

On May 28, 2002, Plaintiffs filed a reply to Defendants' opposition to Plaintiffs' motion.

On June 6, 2002, the court vacated the hearing on the parties' motions. The court's order allowed the parties to provide the court with a letter brief containing any arguments in response to the reply briefs that would have been made at the hearing. On June 13, 2002, the court received a letter brief from Plaintiffs. On June 28, 2002, the court received a notice of a new Ninth Circuit case from Plaintiffs.

LEGAL STANDARD

Summary judgment is appropriate when it is demonstrated that there exists no genuine issue as to any material fact, and that the moving party is entitled to judgment as a matter of law. Fed.R.Civ.P. 56(c); Adickes v. S.H. Kress & Co., 398 U.S. 144, 157, 90 S.Ct. 1598, 26 L.Ed.2d 142 (1970); Poller v. Columbia Broadcasting System, 368 U.S. 464, 467, 82 S.Ct. 486, 7 L.Ed.2d 458 (1962); Jung v. FMC Corp., 755 F.2d 708, 710 (9th Cir.1985); Loehr v. Ventura County Community College Dist, 743 F.2d 1310, 1313 (9th Cir. 1984).

Under summary judgment practice, the moving party [A]lways bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions of "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any," which it believes demonstrate the absence of a genuine issue of material fact.

Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986).

"[W]here the nonmoving party will bear the burden of proof at trial on a dispositive issue, a summary judgment motion may properly be made in reliance solely on the pleadings, depositions, answers to interrogatories, and admissions on file." Id. Indeed, summary judgment should be entered, after adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial. Id. at 322, 106 S.Ct. 2548. "[A] complete failure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial." Id. In such a circumstance, summary judgment should be granted, "so long as whatever is before the district court demonstrates that the standard for entry of summary judgment, as set forth in Rule 56(c), is satisfied." Id. at 323,106 S.Ct. 2548.

When the moving party has the burden of proof at trial, that party must carry its initial burden at summary judgment by presenting evidence affirmatively showing, for all essential elements of its case, that no reasonable jury could find for the nonmoving party. United States v. Four Parcels of Real Property, 941 F.2d 1428, 1438 (11th Cir.1991) (en banc); Calderone v. United States, 799 F.2d 254, 259 (6th Cir. 1986); see also E.E.O.C. v. Union Independiente De La Autoridad De Acueductos Y Alcantarillados De Puerto Rico, 279 F.3d 49, 55 (1st Cir.2002) (stating that if "party moving for summary judgment bears the burden of proof on an issue, he cannot prevail unless the evidence that he provides on that issue is conclusive.")

If a motion for summary judgment calls for the court to apply law to undisputed facts, it is a mixed question of law and fact. HIH Marine Insurance Services, Inc. v. Virgin Atlantic Airways, 105 F.Supp.2d 1083, 1091 (N.D.Cal.2000). A mixed question of fact and law occurs when the facts are undisputed, the relevant law is accepted, and the issue for the court is whether the facts satisfy the legal rule. Pullman-Standard v. Swint, 456 U.S. 273, 289 n. 19, 102 S.Ct. 1781, 72 L.Ed.2d 66 (1982). "When a mixed question of fact and law involves undisputed underlying facts, summary judgment is appropriately granted." Han v. Mobil Oil Corp., 73 F.3d 872, 874 (9th Cir.1995); In re Software Toolworks, Inc., 789 F.Supp. 1489, 1495 (N.D.Cal. 1992). Thus, where the case turns on a mixed question of fact and law and the only dispute relates to the legal significance of the undisputed facts, the controversy for trial collapses into a question of law suitable for disposition on summary judgment. See Union Sch. Dist. v. Smith, 15 F.3d 1519, 1523 (9th Cir.1994); Graham v. City of Chicago, 828 F.Supp. 576, 583 (N.D.Ill.1993). Finally, if a motion for summary judgment questions only issues of law, the resolution of which does not involve disputed material facts, summary judgment is also appropriate. Delbon Radiology v. Turlock Diagnostic Center, 839 F.Supp. 1388,1391 (E.D.Cal.1993).

In resolving the summary judgment motion, the court examines the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any. Rule 56(c); Poller, 368 U.S. at 468, 82 S.Ct. 486; SEC v. Seaboard Corp., 677 F.2d 1301, 1305-06 (9th Cir. 1982).

UNDISPUTED FACTS¹

Beginning in February 20, 1990, Christopher Sousa was employed by Unilab as a phlebotomist. As part of his employment compensation package, Mr. Sousa was covered under the Plan. The Plan is an employee benefit plan established by Unilab and governed by ERISA.

On or about March 1, 1996, Principal Financial Group issued to Unilab Corporation, Group Policy No. GL 88375 ("Policy"). Part IV of the Policy provides the life insurance benefit and accidental death benefits for non-exempt employees as follows:

Subject to the Effective Date provisions of PART III, Section B, and the qualifying provisions of the Section A, the Scheduled Benefit for an insured Member will be:

Class II (Non-Exempt) ... The amount that is equal to the Member's Basic Annual Compensation multiplied by Vk (this amount will be rounded to the next higher $1,000 if it is not already an exact multiple of $1,000) ....

Accidental Death and Dismemberment Insurance, ....

Article 3—Benefits Payable

If all of the benefit qualifications are met, the Company will pay:

a. The Scheduled Benefit (or approved amount, if applicable) in force for loss of life;

Under the Terms of the Policy, accidental death benefits are payable when certain terms are met. Specifically, the Policy Provides:

Benefit Qualifications

To qualify for benefit payment, all of the following must occur. The Member must be injured while insured for Accidental Death and Dismemberment Insurance...