Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_05-cv-03294/USCOURTS-cand-3_05-cv-03294-5/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1132 E.R.I.S.A.: Employee Benefits

---

U

nite

d

States District C

o

u

rt

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

SANDRA BREBER,

Plaintiff,

 v.

ARTHUR ANDERSEN LLP GROUP

ACCIDENT AND HEALTH INSURANCE

PLAN,

Defendant.

 /

No. C 05-03294 JSW

NOTICE OF TENTATIVE

RULING AND QUESTIONS

TO ALL PARTIES AND THEIR ATTORNEYS OF RECORD, PLEASE TAKE

NOTICE OF THE FOLLOWING TENTATIVE RULING AND QUESTIONS FOR THE

HEARING SCHEDULED ON AUGUST 25, 2006:

The Court tentatively DENIES the cross-motions for summary judgment filed by

plaintiff Sandra Breber (“Plaintiff”) and defendant Arthur Andersen LLP Group Accident and

Health Insurance Plan (“Defendant”) based on the existence of genuine issues of material fact. 

The Court has reviewed the parties’ memoranda of points and authorities 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 

Case 3:05-cv-03294-JSW Document 31 Filed 08/24/06 Page 1 of 3
U

nite

d

States District C

o

u

rt

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2

Rule 7-3(d). The parties will be given the opportunity at oral argument to explain their reliance

on such authority.

Each party will have fifteen minutes to address the following questions:

(1) If the Court determines there are questions of fact which preclude summary judgment for

either party and thus, that a trial is necessary, do the parties agree that the Court may

conduct a trial based on the administrative record? See Kearney v. Standard Ins., 175

F.3d 1084, 1094-95 (9th Cir. 1999). If the Court were to conduct a bench trial, does

either party contend that evidence beyond the administrative record may be submitted?

Assuming the Court conducts a bench trial, do the parties intend to file trial briefs or do

they prefer to have the court convert their cross-motions for summary judgment into trial

briefs? 

(2) What authority, if any, supports Plaintiff’s position that Defendant is precluded from

raising a new basis for denying benefits that it did not initially assert in its notice of

denial when the administrator’s decision is reviewed de novo?

(3) What support do the parties have in support of their respective positions regarding

whether endometriosis and post-concussive syndrome are diseases that can be confirmed

by medical tests?

(4) The Plan provides that Aetna will not pay benefits until it is given a written proof of

loss. (See Aetna 598.) The Plan then provides under the section entitled “Proof of Loss”

that:

1. A request for Initial Application for Group Long-Term Disability (LTD) Benefits

must be made to the Benefits Administrator ...

This request should be made:

a. Within 20 days after a disability occurs; or

b. As soon as reasonably possible.

If the covered individual does not receive the form within 15 days, he or she can

meet the proof of loss requirement by giving Aetna a written statement of what

happened. Aetna must receive a written statement with 90 days by not later than

one year after the disability occurs ...

...

3. The covered individual must return the form to the Benefits Administrator ....

The form is due within 90 days after the end of the Waiting Period .... If he or she

does not send Aetna the form when due, Aetna will still honor the claim if he or

she sends Aetna the form as soon as reasonably possible. The form must be sent

to Aetna not later than one year after it is otherwise required....

Case 3:05-cv-03294-JSW Document 31 Filed 08/24/06 Page 2 of 3
U

nite

d

States District C

o

u

rt

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

3

(See Aetna 598.) Does Defendant contend that Plaintiff failed to make the initial request for a

form, or that she failed to return the completed form, within the requisite time period? Is the

document entitled “Employee Request for Information” the “form” referred to in the Proof of

Loss section? (See Aetna 382.) 

(5) Do the parties have anything further to add?

Dated: August 24, 2006 

JEFFREY S. WHITE

UNITED STATES DISTRICT JUDGE

Case 3:05-cv-03294-JSW Document 31 Filed 08/24/06 Page 3 of 3