Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_09-cv-02177/USCOURTS-cand-3_09-cv-02177-5/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 28:1132 E.R.I.S.A.

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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

MARYLYN BEAVER,

Plaintiff,

 v.

BANK OF THE WEST 

WELFARE BENEFITS PLAN, and

BANCWEST CORPORATION

WELFARE BENEFIT PLAN,

Defendants. /

METROPOLITAN LIFE 

INSURANCE COMPANY,

Real Party in Interest. /

No. C 09-02177 WHA

ORDER DENYING

DEFENDANTS’ MOTION 

FOR REMAND, STAYING

PROCEEDINGS FOR LONG

TERM BENEFITS CLAIMS, 

AND VACATING HEARING

Defendants move to “remand” plaintiff’s claims for long-term disability benefits to the

administrator because plaintiff has not exhausted her administrative remedies. The threshold

question is whether plaintiff has exhausted her administrative remedies.

The Ninth Circuit has stated that “[f]ederal courts have the authority to enforce the

exhaustion requirement in suits under ERISA, and that as a matter of sound policy they should

usually do so. Accordingly, we have consistently held that before bringing suit under § 502 [of

ERISA, 29 U.S.C. 1132], an ERISA plaintiff claiming a denial of benefits ‘must avail himself or

herself of a plan’s own internal review procedures before bringing suit in federal court.’” Vaught

v. Scottsdale Healthcare Corp. Health Plan, 546 F.3d 620, 626 (9th Cir. 2008) (citation omitted). 

“[D]espite the usual applicability of the exhaustion requirement, there are occasions when a court

Case 3:09-cv-02177-WHA Document 45 Filed 02/19/10 Page 1 of 3
United States District Court

For the Northern District of California

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is obliged to exercise its jurisdiction and is guilty of an abuse of discretion if it does not, the most

familiar examples perhaps being when resort to the administrative route is futile or the remedy

inadequate.” Ibid.

Defendants argue that plaintiff only applied for short-term disability benefits and never

applied for LTD benefits, and therefore, plaintiff has not exhausted her administrative remedies

regarding the LTD benefits. Plaintiff counters by arguing that applying for STD benefits is

applying for LTD benefits. Plaintiff argues that the STD and LTD benefits are provided by a

single-group policy and that the same phone call suffices to make both claims. Plaintiff’s

arguments are unpersuasive. Plaintiff in his complaint states “[a]lthough the original claim was

made during the short term period, the claim was considered and processed as both a short and

potential long term claim” (Second Am. Compl. ¶ 5) (emphasis added). Additionally, Metlife

made it quite clear that she had only applied and appealed for STD disability in their letters to

plaintiff after reviewing her STD claim. See (ADMIN 116S ,171S, 287S) (“claim for Short Term

Disability benefits”) (emphasis added). Nothing in these letters refers to or mentions plaintiff’s

LTD benefits. Finally, defendants state in their motion that they approached plaintiff’s counsel

and suggested that plaintiff submit an LTD application which counsel refused (Br. 8). It is

perplexing that counsel would refuse such an invitation. Clearly plaintiff has not availed herself

to the plan’s own administrative procedures or exhausted her administrative remedies for LTD

benefits.

Plaintiff argues that she was not required to exhaust her administrative remedies because

availing herself to the administrative process would have been futile. Plaintiff’s strongest

argument for futility is the possible misrepresentation to plaintiff that STD benefits need to be

exhausted as a prerequisite to LTD benefits. Plaintiff, as proof, quotes a transcript of a

conversation with a Metlife representative, the transcript stated: 

“cms advised if claim in appeals is overturned will max in July and

will be eligible for ltd. if appeals determines medical does not

support than ee will not be eligible for any further benefits . . .”

(ADMIN 209S-10S). Defendants argues that this conversation is taken out of context and that

Metlife was referring to her not being able to gain further STD benefits not LTD benefits. 

Case 3:09-cv-02177-WHA Document 45 Filed 02/19/10 Page 2 of 3
United States District Court

For the Northern District of California

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Defendants point out, as proof, that plaintiff was assigned to a STD claims specialist not a LTD

claims specialist (ADMIN 116S, 409S-10S). Defendants also assert that plaintiff has been

confused about the application for STD and LTD benefits, and that there are two separate

procedures which require independent applications. Defendants show that there are two different

policy names, specifically, “The BancWest Corporation Welfare Benefit Plan” and “Bank of the

West Welfare Benefit Plan.” See (ADMIN 59, 111S). Defendants also show that these each have

different procedures and requirements for disability. See (ADMIN 20-24, 80S-86S). Nothing in

the LTD plan asserted that plaintiff was required to exhaust her STD benefits. Amidst all these

facts, plaintiff’s argument that defendants represented to plaintiff that she was required to exhaust

her STD benefits before qualifying for LTD benefits is unpersuasive. 

Plaintiff also has an array of other futility arguments that are difficult to understand. The

essence of these arguments seem to be the following: (1) that there is no difference between the

LTD and STD definition; (2) that defendants never differentiate between STD and LTD; and (3)

that defendants should have bridged plaintiff’s STD benefits to LTD benefits. The first two

arguments are refuted by facts of the case. As explained above, STD and LTD benefits have

different procedures and requirements for qualification, and defendants did differentiate between

LTD and STD benefits in their letters to plaintiff. Plaintiff’s third argument, if true, would not

make applying for LTD benefits futile. Futility is not established.

Therefore, plaintiff is ordered to promptly exhaust her LTD administrative remedies and

to do so within 90 days, and defendants are ordered to promptly process all submissions by her so

that this deadline can be met. Until then, proceedings regarding LTD claims are STAYED.

Defendants’ motion for remand is DENIED. The hearing on Thursday, February 25, 2010, is

VACATED.

IT IS SO ORDERED.

Dated: February 19, 2010. WILLIAM ALSUP

UNITED STATES DISTRICT JUDGE

Case 3:09-cv-02177-WHA Document 45 Filed 02/19/10 Page 3 of 3