Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_05-cv-04693/USCOURTS-cand-3_05-cv-04693-8/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 28:1332 Diversity-Employment Discrimination

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United States District Court

For the Northern District of California

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

AIMEE SHEMANO-KRUPP,

Plaintiff,

 v.

MUTUAL OF OMAHA INSURANCE

COMPANY, et al.,

Defendants. /

No. C 05-04693 JSW

NOTICE OF TENTATIVE

RULING AND QUESTIONS RE

MOTIONS FOR SUMMARY

JUDGMENT

TO ALL PARTIES AND THEIR ATTORNEYS OF RECORD, PLEASE TAKE

NOTICE OF THE FOLLOWING TENTATIVE RULING AND QUESTIONS FOR THE

HEARING SCHEDULED ON AUGUST 18, 2006 AT 9:00 A.M.:

The Court has reviewed the parties’ papers and, thus, does not wish to hear the parties

reargue matters addressed in those pleadings. If the parties intend to rely on authorities not

cited in their briefs, they are ORDERED to notify the Court and opposing counsel of these

authorities reasonably in advance of the hearing and to make copies available at the hearing. If

the parties submit such additional authorities, they are ORDERED to submit the citations to the

authorities only, without argument or additional briefing. Cf. N.D. Civil Local Rule 7-3(d). 

The parties will be given the opportunity at oral argument to explain their reliance on such

authority.

The Court tentatively DENIES Plaintiff’s motion for summary adjudication re coverage

and DENIES Plaintiff’s motion for summary judgment re standard of review. The Court

tentatively GRANTS Defendants’ motion for partial summary judgment on state law causes of

action and the issue of controlling law and GRANTS Defendants’ motion for summary

judgment on the standard of review.

Case 3:05-cv-04693-JSW Document 65 Filed 08/23/06 Page 1 of 3
United States District Court

For the Northern District of California

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The parties shall have 30 minutes to address the following questions:

Standard of Review

1. Is there a question of material fact regarding whether the discretionary authority

Rider was subsequently added to the Policy as Plaintiff alleges or was integrated

into the original May 1988 Policy? How can Mr. Lilienstein’s hearsay

statements in his declaration create a dispute of fact? (See Declaration of David

M. Lilienstein in Support of Motion re Standard of Review, ¶16; contra

Declaration of Kathy Sands, ¶ 3.) 

2. Under what authority does Plaintiff contend that United was required to disclose

that the policy was governed by ERISA in their initial denial letters? What was

the effect, if any, of this early failure to disclose?

3. If the Court were to find that the abuse of discretion standard applies in this case,

are the apparent disputed facts regarding Mr. Shemano’s eligibility immaterial

because there is substantial evidence in the record to support United’s decision? 

(See Snow v. Standard Ins. Co., 87 F.3d 327, 331 (9th Cir. 1996) (holding that

the abuse of discretion standard does not permit the overturning of a decision

where there is relevant evidence that reasonable minds might accept as adequate

to support a conclusion even if it is possible to draw two inconsistent

conclusions from the evidence).)

4. What is Mutual of Omaha’s role in the administration of the subject policies? 

Does Mutual of Omaha qualify as an ERISA fiduciary? 

5. Do the parties have anything further they wish to address?

Applicable Law, Coverage Issues and State Law Causes of Action

1. Why are the letters of Mr. Shemano’s co-workers insufficient to establish at least

a question of fact regarding whether Mr. Shemano was working 30 hours or

more per week at his regular job and customary place of employment from June

2002 until June 2003? 

a. Under what authority does the insurer require copies of time cards,

timesheets, calendars, records of sale/securities transactions indicating he

traded securities, or commission, payroll or tax records reflecting

compensation paid to Mr. Shemano? Doesn’t this material merely go to

the weight of the evidence?

b. How is the fact that the letters were created later in time a basis for an

evidentiary objection? 

c. Does United have authority for the position that the Court may, at

summary judgment, assess the credibility of the allegedly contradictory

contemporaneous statements by Mr. Shemano? 

2. Plaintiff argues that the Policy certificate indicates that coverage continues –

even for an employee who would otherwise be ineligible – if the premiums are

paid. (Plaintiff’s Motion re Coverage at 15, citing section 10 of certificate.) 

What support does Plaintiff have for her contention that United’s claimed

entitlement to a late charge notice in the amount of unpaid premiums for a latenoticed ineligible person amounts to United’s concession that receipt of

premiums for an ineligible person compels coverage for that person?

Case 3:05-cv-04693-JSW Document 65 Filed 08/23/06 Page 2 of 3
United States District Court

For the Northern District of California

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3. Could Mr. Shemano be both totally disabled (i.e., unable to generate earnings

which exceeded 20% of his basic monthly earnings) and also work a minimum

of 30 hours per week? (There are facts in the record to demonstrate that Mr.

Shemano may have worked 30 hours a week, but was paid approximately

$25,000, less than 20% of his previous years earnings. See Declaration of David

M. Lilienstein in Support of Motion re Coverage, Exs. M, X.)

4. Does Plaintiff’s analysis of the ‘process of nature’ doctrine in the life insurance

context, require that anytime an insured is diagnosed with a terminal illness, that

person is covered upon death, regardless of whether the policy is still in force? 

Defendants contend that although the process of nature rule is saved from

ERISA, the rule does not apply in the life insurance context. How do

Defendants reconcile the holding in National Life and Accident Insurance Co. v.

Edwards, 119 Cal. App. 3d 326, 334 (1981), in which the rule was extended to

the double indemnity provision of accidental death policies? 

5. What is the effect of Defendants’ agent Rodger Benard’s opinion that Mr.

Shemano’s life insurance policy was in force at the date of his death? (See, e.g.,

Marsh & McLennan of California, Inc. v. City of Los Angeles, 62 Cal. App. 3d

108, 117 (1976).) Is there admissible evidence to the effect that Mr. Benard

informed Mr. Shemano that his life insurance policy would be in effect at the

time of his death?

6. Do the parties have anything further they wish to address?

IT IS SO ORDERED.

Dated: August 23, 2006 

JEFFREY S. WHITE

UNITED STATES DISTRICT JUDGE

Case 3:05-cv-04693-JSW Document 65 Filed 08/23/06 Page 3 of 3