Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_12-cv-01373/USCOURTS-caed-2_12-cv-01373-0/pdf.json

Nature of Suit Code: 110
Nature of Suit: Insurance
Cause of Action: 12:635 Breach of Insurance Contract

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

DANIELA ROBINSON,

Plaintiff,

v.

METROPOLITAN LIFE INSURANCE 

COMPANY,

Defendant.

No. 12-cv-01373-JAM-AC

MOTION DENYING 

DEFENDANT/COUNTERCLAIMANT’S 

MOTION FOR SUMMARY JUDGMENT

METROPOLITAN LIFE INSURANCE 

COMPANY,

Counterclaimant,

v.

DANIELA ROBINSON,

Counterdefendant.

Presently before the Court is Defendant/Counterclaimant

Metropolitan Life Insurance Company’s (“Defendant”) Motion for 

Summary Judgment (Doc. #16).1 Plaintiff/Counterdefendant Daniela 

Robinson (“Plaintiff”) opposes the motion (Doc. #19). 

 

1 This motion was determined to be suitable for decision without 

oral argument. E.D. Cal. L.R. 230(g). The hearing was 

originally scheduled for March 6, 2013.

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BACKGROUND

This matter concerns the payment of disability benefits 

under a long term disability plan sponsored by Catholic 

Healthcare West (the “CHW Plan”). Defendant is the plan 

administrator. Plaintiff participated in the CHW Plan as a 

nurse employee at St. Joseph’s Medical Center, a subsidiary or 

division of Catholic Healthcare West, now known as Dignity 

Health (“CHW”). Plaintiff stopped working on June 18, 2007. On 

April 18, 2008 she submitted a claim to Defendant for benefits 

under the CHW Plan. Defendant approved the claim and paid 

benefits for over two years. 

The CHW Plan became effective January 1, 2002 and continued 

through the relevant time period. The CHW Plan contains the 

following definition of disability:

“Disabled” or “Disability” means that, due to Sickness or 

as a direct result of accidental injury: 

You are receiving Appropriate Care and Treatment 

and complying with the requirements of such 

treatment; and

You are unable to earn:

During the [180 day] Elimination Period 

[during which no benefits are paid] and the 

next 24 months of Sickness or accidental 

injury, more than 80% of Your Predisability 

Earnings . . . .

Broadwater Decl. (Doc. 16-1) Ex. A, Administrative Record 

(hereinafter cited as “Admin.”), at 23. The 180 day elimination 

period is the 180 days after the onset of disability. Admin. 

21. Unless a claimant is continuously disabled for 180 days, he 

or she will not receive payments under the CHW Plan. 

///

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Plaintiff’s claim was initially approved in April 2008 with 

an initial payment date of December 16, 2007. Admin. 769. This 

is because under the CHW Plan, the elimination period ran from 

her last day of work in June 2007 through December 2007. 

On October 15, 2007, CHW elected pursuant to 26 U.S.C. 

§ 410(d) (“§ 410(d)”) to treat the CHW Plan as governed by and 

subject to the provisions of the Employee Retirement Income 

Security Act of 1974 (“ERISA”). The election was attached to 

CHW’s Internal Revenue Service (“IRS”) Form 5500 for the 2006 

plan year.

Plaintiff’s complaint (Doc. #1) contains two state law 

claims against Defendant for 1) Breach of the Duty of Good Faith 

and Fair Dealing, and 2) Breach of Contract. Defendant answered 

the complaint and included counterclaims for 1) Equitable Relief 

Under ERISA, 2) Declaratory Relief, 3) and Unjust Enrichment. 

Defendant’s motion for summary judgment only references 

Plaintiff’s claims, not Defendant’s counterclaims. Accordingly, 

the only issue presently before the Court is whether or not 

Defendant is entitled to judgment on Plaintiff’s affirmative 

claims. This Court has jurisdiction pursuant to either 28 

U.S.C. § 1331 if Defendant is correct that ERISA preempts 

Plaintiff’s state law claims or 28 U.S.C. § 1332 based on the 

diversity of citizenship of the parties. 

OPINION

Legal Standard

Summary judgment is proper “if the pleadings, depositions, 

answers to interrogatories, and admissions on file, together 

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with affidavits, if any, show that there is no genuine issue of 

material fact and that the moving party is entitled to judgment

as a matter of law.” Fed. R. Civ. P. 56(c). The purpose of 

summary judgment “is to isolate and dispose of factually 

unsupported claims or defenses.” Celotex v. Catrett, 477 U.S. 

317, 323-324 (1986). 

The moving party bears the initial burden of demonstrating 

the absence of a genuine issue of material fact for trial. 

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248-49 (1986). 

If the moving party meets its burden, the burden of production 

then shifts so that “the non-moving party must set forth, by 

affidavit or as otherwise provided in Rule 56, ‘specific facts

showing that there is a genuine issue for trial.’” T.W. 

Electrical Services, Inc. v. Pacific Electric Contractors Ass’n, 

809 F.2d 626, 630 (9th Cir. 1987) (quoting Fed. R. Civ. P. 

56(e)). The Court must view the facts and draw inferences in 

the manner most favorable to the non-moving party. United 

States v. Diebold, Inc., 369 U.S. 654, 655 (1962). “[M]ere 

disagreement or bald assertion that a genuine issue of material 

fact exists will not preclude the grant of summary judgment”.

Harper v. Wallingford, 877 F. 2d 728, 731 (9th Cir. 1987).

The mere existence of a scintilla of evidence in support of 

the non-moving party’s position is insufficient: “There must be 

evidence on which the jury could reasonably find for [the nonmoving party].” Anderson, 477 U.S. at 252. This Court thus 

applies to either a defendant’s or plaintiff’s motion for 

summary judgment the same standard as for a motion for directed 

verdict, which is “whether the evidence presents a sufficient 

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disagreement to require submission to a jury or whether it is so 

one-sided that one party must prevail as a matter of law.” Id.

Discussion

1. Applicability of the CHW Plan’s 26 U.S.C.

§ 410(d) Waiver

For purposes of the present motion only, the parties agree 

that the CHW Plan is a “church plan” as defined by 29 U.S.C. 

§ 1002(33)(A), and that church plans are generally exempt from 

ERISA pursuant to 29 U.S.C. § 1003(b)(2). The parties also 

agree that under certain circumstances, an election made 

pursuant to 26 U.S.C. § 410(d) permits a church plan to opt in 

to the ERISA regulatory scheme. It is undisputed that such an 

election would operate along with ERISA’s broad preemption 

provision to bar state law claims such as Plaintiff’s if they 

relate to the CHW Plan. See Ingersoll-Rand Co. v. McClendon, 

498 U.S. 133, 139 (1990). 

Defendant argues in support of this motion that the CHW 

Plan operates under a valid election, that the election applies 

to Plaintiff’s benefits, and therefore ERISA is the only 

authority that applies to this dispute. Plaintiff, on the other 

hand, argues that a church plan can only make an election 

pursuant to § 410(d) if it is a pension plan, not a welfare 

benefit plan like the CHW Plan at issue in this case. Plaintiff 

does concede that if the § 410(d) election is valid and 

applicable to her claim, then ERISA preempts her state law 

claims. In order to determine what law applies to this motion, 

the Court must first determine if a welfare benefit plan can 

make an election pursuant to 26 U.S.C. § 410(d), and if so, 

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whether or not the CHW Plan made a valid election such that 

ERISA applies to the parties’ claims. 

a. Applicability of § 410(d) Elections to 

Welfare Benefit Plans

Defendant contends that any church plan, whether it is 

welfare, pension, or both, may elect to be governed by ERISA by

following the procedure in 26 U.S.C. § 410(d). Defendant relies 

on one case from the District of Maine, Catholic Charities of 

Me., Inc. v. City of Portland, 304 F. Supp. 2d 77 (D. Me. 2004), 

and a plain reading of the applicable statutes to support its 

position. Plaintiff responds that the Catholic Charities case 

was wrongly decided, that the case is only persuasive authority, 

and § 410(d) should be correctly read as only applying to 

pension plans. Plaintiff therefore contends that 29 U.S.C. 

§ 1003(b)(3) only authorizes a § 410(d) election for pension 

plans, even if the statute does not explicitly limit the 

election. 

Neither the Ninth Circuit nor the Supreme Court has decided 

whether or not a church welfare benefit plan can make a § 410(d) 

election. Accordingly, this is a matter of first impression 

within this Circuit. As the Plaintiff correctly points out, the 

only authority squarely on point consists of the Catholic 

Charities decision, which is not binding on this Court, and the 

statutory text. See Boyd v. Benton Cnty., 374 F.3d 773, 781 

(9th Cir. 2004) (holding that only decisions of the Supreme 

Court and Ninth Circuit constitute binding authority).

In construing the provisions of a statute, a court must 

first look to the statute itself to see whether its language has 

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a plain meaning. Satterfield v. Simon & Schuster, Inc., 569 

F.3d 946, 951 (9th Cir. 2009) (citing McDonald v. Sun Oil Co., 

548 F.3d 774, 780 (9th Cir. 2008)). If the statutory language 

is unambiguous, the inquiry ends and the court applies the 

statute as it is written. Id.

29 U.S.C. § 1003(b)(2) is located within the “General 

Provisions” subtitle of ERISA. It states, “The provisions of 

this subchapter shall not apply to any employee benefit plan if 

. . . such plan is a church plan (as defined in section 1002(33) 

of this title) with respect to which no election has been made 

under section 410(d) of Title 26 . . . .” 29 U.S.C. 

§ 1003(b)(2). That section is certainly plain – church plans 

are not governed by ERISA unless they make a § 410(d) election. 

26 U.S.C. § 410(d) is located within a part of the Internal 

Revenue Code (“IRC”) titled, “Pension, Profit-Sharing, Stock 

Bonus Plans, Etc.” That section provides, “If the church . . .

makes an election under this subsection [pursuant to 

regulation], then the provisions of this title relating to 

participation, vesting, funding, etc. . . . shall apply to such 

church plan as if such provisions did not contain an exclusion 

for church plans.” There are two possible points of ambiguity 

in § 410(d). First, it is located within a section of the IRC 

that seems to apply only to deferred compensation plans. 

Second, it contains an enumeration concluded by a necessarily 

ambiguous “etc.” It is these potential ambiguities that 

Plaintiff relies on to argue that Congress only wished to allow 

pension plans to make a § 410(d) election. 

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This Court is not persuaded by Plaintiff’s argument. 

First, the IRC defines exactly what a church plan is for its 

purposes. A church plan is one whose “principal purpose or 

function . . . is the administration or funding of a plan or 

program for the provision of retirement benefit or welfare 

benefits, or both . . . .” 26 U.S.C. § 414(e)(3)(a) (emphasis 

added). Section 410(d) is only ambiguous when analyzed without 

the definitions also provided in the IRC. The relevant 

regulations adopted by the Treasury Department support this 

interpretation. 26 C.F.R. § 1.410(d)-1 states that any church 

plan can make a § 410(d) election. The regulation refers to the 

definition in 26 U.S.C. § 414(e), which includes welfare benefit 

plans. Second, the operative statutory section for the present 

motion is 26 U.S.C. § 1003(b)(2), which contains no ambiguity. 

That section simply states that any church employee benefit plan 

that chooses to make a § 410(d) election is thereafter governed 

by ERISA. Since ERISA clearly applies to pension and welfare 

benefit plans, there is no principled basis for excluding 

welfare plans from § 1003(b)(2). The Court is required to 

presume that Congress meant what it said in § 1003(b)(2), and it 

is improper to seek out ambiguities in order to change the plain 

meaning of a statute. Satterfield, 569 F.3d at 951. 

Plaintiff’s remaining arguments are equally unpersuasive. 

Plaintiff argues that Congress only made the exception for 

pension plans because it wanted them to be able to opt-in to 

oversight by the Secretary of the Treasury and be eligible for 

federal pension insurance. Plaintiff contends that no such 

exception is necessary for welfare plans because the states 

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generally regulate the insurance companies that provide employee 

welfare benefits. Plaintiff’s argument ignores the whole point 

of ERISA, which was to provide a comprehensive federal scheme to 

regulate employee benefit plans, including welfare benefit 

plans. If Plaintiff’s position were correct, then Congress 

would have only included pension plans in ERISA generally, and 

no provisions at all related to welfare benefit plans. 

For the foregoing reasons, it is the finding of this Court 

that ERISA applies to church welfare benefit plans that make a 

valid election pursuant to 26 U.S.C. § 410(d). 

b. Validity of the CHW Plans § 410(d) Election

Having determined that a church welfare benefit plan can 

make an election under § 410(d) to opt in to ERISA’s regulatory 

scheme, the next issue is whether or not the CHW Plan made such 

an election. Defendant argues that the CHW Plan made a § 410(d) 

election by attaching an “ERISA Election” to its 5500 Form for 

plan year 2006. Defendant argues that the election is 

irrevocable under 26 U.S.C. § 410(d), and it is therefore still 

in effect. Plaintiff responds, citing 26 C.F.R. § 1.410(d)-

1(c)(2), that the election is properly made by attaching it to a 

form required under 26 U.S.C. § 6058, but the CHW Plan made the 

election improperly through attachment to a Form 5500. 

Plaintiff alternatively argues that even if an election was 

made, it was deficient because the CHW Plan, by its terms, is

subject to change and the plan is therefore revocable in 

violation of § 410(d). 

Plaintiff’s position relies on the lack of an attachment to 

a Form 6058, but it is impossible for the CHW Plan to file a 

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Form 6058 because such a form does not exist. The proper form 

filed pursuant to the requirements in 26 U.S.C. § 6058 is 

Internal Revenue Service Form 5500. 26 C.F.R. § 301.6058–1(a). 

The unrebutted evidence before the Court is that the CHW Plan 

made a § 410(d) election through attachment to its 2006 plan 

year Form 5500 filing. Zelenak Decl. ¶ 4, Ex. A. Plaintiff’s 

argument related to the CHW Plan’s ability to change at any time 

is also unavailing. Plaintiff takes the position that once an 

election is made under § 410(d), plan terms are irrevocable and 

unable to change. Plaintiff cites no authority for this 

position, and the clear language of § 410(d) indicates that only 

the election itself is irrevocable. The section does not 

mention and therefore does not apply to a plan’s terms. 

Based on the unrebutted evidence before the Court, there is 

no genuine dispute as to whether or not the CHW Plan made a 

§ 410(d) election. The election attached to the 2006 Form 5500 

satisfies 26 U.S.C. § 410(d) and the CHW Plan is therefore 

governed by ERISA. 

c. Applicability of § 410(d) Election to 

Plaintiff’s Claims

Finally, Plaintiff argues that the § 410(d) election does 

not apply to her claim because it arose before the election was 

made. It is undisputed that Plaintiff became disabled on June 

19, 2007, and that the § 410(d) election was executed on October 

15, 2007. The parties agree that under the terms of the plan, 

Plaintiff was not entitled to benefits until a 180 exclusion 

period expired on December 16, 2007. Defendant does not argue

that a § 410(d) election applies retroactively, but argues that 

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the election applies because Plaintiff was not due any payments 

until after the election took effect. Defendant takes the 

position that in order for any rights to accrue under the CHW 

Plan, Plaintiff had to be receiving benefit payments. Plaintiff 

takes the position that the claim arose, at the latest, when 

Plaintiff became disabled on June 19, 2007. Plaintiff argues 

that it would be unfair to allow Defendant to change the law 

applicable to her claim during the elimination period by filing 

an election.

Plaintiff relies on Geter v. St. Joseph Healthcare Sys., 

Inc., 575 F. Supp. 2d 1244 (D.N.M. 2008), to support her 

position. Geter dealt with a § 410(d) election that was made 

after the claimant was receiving benefits. Id. at 1249. The 

court rejected the plan’s argument that the § 410(d) election 

applied, even though the plan was permitted to retroactively 

file tax forms for years prior to the claimant’s disability. 

Id. at 1251. The Geter court reasoned that the plain language 

of the applicable statute, 29 U.S.C. § 1003, does not allow 

retroactive ERISA preemption. Id. at 1250. Further, the court 

pointed out that permitting such preemption would be anomalous 

because the plan would benefit from ERISA’s preemption provision 

for years that it was not compelled to comply with any of 

ERISA’s mandatory reporting, disclosure, and fiduciary 

requirements. Id. 

This Court agrees with the Geter court’s holding. The 

plain text of 29 U.S.C. § 1003(b)(2) states that a church plan 

is exempt from ERISA until it makes a § 410(d) election. There 

is no reference to retroactive ERISA coverage, and no basis for 

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inferring it. Disability claims arising before the election are 

therefore not governed by ERISA, and claims arising after the 

election are. The remaining issue for purposes of the present 

summary judgment motion is therefore whether or not Plaintiff’s 

claim began when she became disabled or when she began to 

receive benefit payments at the end of the 180 day elimination 

period. 

Plaintiff relies heavily on the terms of the CHW Plan 

itself to support its position. Plaintiff points out that the 

CHW Plan defines “disability” to include the elimination period. 

Admin. 23. Plaintiff also points out that once a person is 

disabled, their benefits under the CHW Plan remain unchanged 

even if the insurance policy ends or is amended. Admin. 36, 41. 

Based on the language of the Plan, Plaintiff essentially argues 

there is a claim that accrues when the insured becomes disabled 

and a separate plan benefit that begins to accrue at the end of 

the elimination period. While benefits require a valid claim, a 

valid claim does not necessarily lead to benefit payments 

because the 180 day elimination period may not be satisfied. 

Other terms of the CHW Plan support Plaintiff’s position. For 

instance, an initial claim is generally supposed to be filed 

within 90 days of a loss, not when a person becomes eligible to 

receive benefits. Admin. 47. Legal suits related to the CHW 

Plan are able to be filed as soon as 60 days of when the proof 

of a claim is filed, not when benefits begin to accrue. Admin. 

48. 

Defendant’s position is “that the Election took effect 

before [P]laintiff ever had a claim, because she had no claim 

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unless she was ‘disabled’ under the Plan for at least 180 days. 

. . .” Reply, at 16. That position, however, is not based on 

any legal authority and it contradicts the terms of the CHW 

Plan. The CHW Plan clearly describes a situation where a claim 

accrues at the point of disability, and further provides that 

benefits begin to pay at the end of the 180 day elimination 

period. Disability under the CHW Plan includes the 180 day 

elimination period. Admin. 23 (“Disabled or Disability means 

that, due to Sickness or as a direct result of accidental injury 

. . . You are unable to earn during the Elimination Period and 

the next 24 months of Sickness or accidental injury . . . .”) 

Based on the CHW Plan’s definition of disability, it is clear 

that disability occurs when the covered person is unable to 

earn, not at the end of the elimination period. The contention 

that a § 410(d) election applies to a claim for which the 

underlying disability has already started is inconsistent with 

the terms of the plan that guarantee coverage once a person 

becomes disabled, even if the policy expires or changes. The 

only operative date that the terms of the CHW Plan contemplate 

for purposes of claim accrual is the date of onset of 

disability. 

Due to the lack of applicable legal authority and evidence 

supporting Defendant’s position that the § 410(d) election 

should apply to Plaintiff’s claim, judgment on this issue in 

Defendant’s favor is denied. The remainder of Defendant’s 

motion assumes that ERISA is binding on Plaintiff’s claim. 

Since the Court has found otherwise, and Defendant has not 

produced authority, evidence, or argument showing that it is 

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entitled to judgment on Plaintiff’s state law claims on their 

merits, the remainder of the motion is also denied.

PAGE LIMIT SANCTIONS

Defendant’s Reply Brief (Doc. #23) is twelve pages long in 

violation of this Court’s Order Re Page Limits (Doc. #5-2). 

Accordingly, Counsel for Defendant is ordered to pay a $100 

sanction ($50 per page) to the Court within ten days of the date 

of this Order. 

ORDER

For the foregoing reasons Defendant’s Motion for Summary 

Judgment is DENIED. Defendant is to pay a $100 sanction within

ten days.

IT IS SO ORDERED.

Dated: March 27, 2013

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