Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_04-cv-00505/USCOURTS-caed-2_04-cv-00505-6/pdf.json

Nature of Suit Code: 110
Nature of Suit: Insurance
Cause of Action: 29:1132 E.R.I.S.A.-Employee Benefits

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

----oo0oo----

ALFRED J. ANTONINI,

NO. CIV. S-04-0505 WBS KJM

Plaintiff,

v. ORDER RE:MOTION FOR

SUMMARY JUDGMENT

THE PRUDENTIAL INSURANCE

COMPANY OF AMERICA; THE

PRUDENTIAL WELFARE BENEFITS

PLAN; and THE PRUDENTIAL

RETIREMENT PLAN,

Defendants.

----oo0oo----

This is an action under the Employee Retirement Income

Security Act (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), for review of

a decision by defendants (“Prudential”) terminating plaintiff’s

benefits under a long-term disability insurance plan. The matter

is before the court on defendants’ motion for summary judgment

pursuant to Federal Rule of Civil Procedure 56.

Generally, motions for summary judgment are not the

preferred procedure for resolution of ERISA claims. See Kearney

v. Standard Ins. Co., 175 F.3d 1084 (9th Cir. 1999).

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Summary judgment is proper only “if the pleadings, depositions,

answers to interrogatories, and admissions on file, together with

the affidavits, if any, show that there is 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). 

The ultimate issue here is whether plaintiff is

disabled within the meaning of the policy. There is ample

evidence in the administrative record that plaintiff suffers from

a large hiatus hernia, as well as esophagal stricture consistent

with chronic peptic esophagitis, worsening to the point of being

characterized as “severe hemorrhagic esophagitis.” Defendants do

not dispute that plaintiff suffers from the medical conditions

asserted, but deny that his illness has prevented from performing

his duties as District Manager. There are genuine issues of

material fact in the record as to whether plaintiff is wholly

prevented from performing any and every duty pertaining to his

occupation within the meaning of the policy.

Although it is undisputed that plaintiff owned and

managed a collection of real estate properties located in

California and Texas during the time in question, and that

plaintiff spent some time each day managing holdings in Texas and

California, plaintiff asserts that he had a secretary who worked

30 hours a week for him, and that he had hired full time

employees to manage the real estate investments. Plaintiff also

asserts that a majority of his time each day was spent engaged in

residential activities at his house. However, in the 1982

report, as well as in other Prudential documents, the claim

investigator noted his suspicion that plaintiff was “more active

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in his business activities then he was leading [the] investigator

to believe.” 

Moreover, the “Investigative Memorandum,” summarizing

the findings of Prudential’s SIU investigation of plaintiff’s

disability claim, contains evidence of a level of management and

involvement beyond that which plaintiff admitted. Specifically,

the report references documents, consisting of financial

statements and expense registers, internal Jarga Management

communications, and a Continental Airlines register, indicating

that plaintiff traveled between Houston and San Francisco over

110 times in roughly four years, that he claimed on numerous

financial statements that he was self-employed in “property

management and ownership,” and that he had consistently been

earning income. In addition, the report references statements,

taken during interviews at the FBI offices in Houston, Texas, of

twelve people who were employed by plaintiff for various periods

of time between 1987 and 1999. Overall, the statements indicate

that plaintiff was very actively involved with the day-to-day

management and operation of his real estate business, including

working long hours, making phone calls, writing memos, visiting

properties, holding meetings, and hiring and firing employees. 

In his November 15, 2001, letter to Prudential,

however, plaintiff vehemently disputes the interpretation,

reliability, and authenticity of the exhibits referenced in the

SIU’s memorandum. In particular, plaintiff states that during the

period in question he personally received no remuneration, but

that Jarga Management, operating at a loss, received the net

income from property sales. In addition, plaintiff notes that

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many of the memoranda reportedly written by him are in fact

unsigned, presumably implying that while his name was used, he

was not in fact doing the work. Plaintiff asserts that it was in

fact his assistant, Sherrie Taylor, who “ma[de] most of the

decisions and perform[ed] the majority of management and

supervision of the properties she was involved with.”

Furthermore, plaintiff attacks the credibility of the statement

given by Sherrie Taylor, the FBI’s primary witness in its

investigation, asserting various financial misdeeds on her part,

as well as attempted fabrication of crimes. Plaintiff

additionally accuses the government agents of threats and

intimidation in their questioning of his other former employees. 

It is clear to this court, and indeed the parties do

not dispute, that plaintiff played some part in the management

and operation of his real estate holdings between 1988 until the

present. It is not clear, however, what the true extent was of

plaintiff’s day-to-day involvement--plaintiff and defendants

continue to dispute this issue. Nor has it been shown beyond

dispute that the activities plaintiff apparently engaged in were

sufficiently similar so as to demonstrate that he was capable of

performing his job.

There is even a dispute as to whether plaintiff should

be required to return the benefits he received during the time he

was incarcerated. Plaintiff concedes that he was imprisoned from

June 1, 2001, to October 15, 2004, stemming from a guilty plea

for “conspiracy to commit wire fraud, mail fraud and bank fraud.”

Although it seems beyond dispute that this incarceration falls

within the exception to the definition of total disability under

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the LTD Plan “GZ-9600” submitted with this motion, the parties

continue to dispute whether the plan in place at all times

relevant to this action was the “GZ-9600” plan submitted with

this motion, or “Policy G-1690-LTD.” 

The Ninth Circuit has made clear that, even though a

subsequent trial on the administrative record might consist of

nothing more than “the trial judge rereading what he has already

read, and making findings of fact and conclusions of law instead

of a summary judgment decision,” it may nonetheless have “real

significance.” Kearney, 175 F.3d at 1095. Accordingly, summary

judgment is not proper at this time.

IT IS THEREFORE ORDERED that defendants’ motion for

summary judgment be, and the same hereby is, DENIED.

DATED: December 14, 2006

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