Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_07-cv-05957/USCOURTS-cand-3_07-cv-05957-2/pdf.json

Nature of Suit Code: 110
Nature of Suit: Insurance
Cause of Action: 28:1441 Petition for Removal- Insurance Contract

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United States District Court

For the Northern District of California

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UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

ROBERT E. BLAKE,

Plaintiff,

 v.

UNUM PROVIDENT CORPORATION; UNUM

CORPORATION; UNUM LIFE INSURANCE

COMPANY OF AMERICA, MATTHEW F.

CARROLL, M.D., LYNETTE D. RIVERS,

PH.D., MARK W. BONDI, PH.D.,

COMMISSIONER OF THE CALIFORNIA

DEPARTMENT OF INSURANCE, and DOES

1-50 inclusive,

Defendants. 

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Case No. 07-5957 SC

ORDER DENYING

PLAINTIFF'S MOTION TO

REMAND AND DENYING

DEFENDANT BONDI'S

MOTION TO DISMISS THE

FIFTH AND SIXTH

CAUSES OF ACTION

I. INTRODUCTION

This matter comes before the Court on the Motion to Remand by

plaintiff Robert Blake ("Plaintiff" or "Blake") and the Motion to

Dismiss the Fifth and Sixth Causes of Action by the defendant Mark

Bondi ("Defendant Bondi"). Docket Nos. 18, 14. The Unum

Defendants filed an Opposition to the Motion to Remand, Docket No.

21, Plaintiff filed an Opposition to the Motion to Dismiss, Docket

No. 20, and Defendant Bondi filed a Reply in support of the Motion

to Dismiss. Docket No. 28. For the following reasons, the Court

DENIES Plaintiff's Motion to Remand and DENIES Defendant Bondi's

Motion to Dismiss the Fifth and Sixth Causes of Action. 

Case 3:07-cv-05957-SC Document 45 Filed 04/11/08 Page 1 of 7
United States District Court

For the Northern District of California

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1

 The Declaration of Chris Renner was submitted in support of

Plaintiff's Motion to Remand to State Court. Renner is the

Benefits Director for MedAmerica. MedAmerica is the business arm

of California Emergency Physicians.

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II. BACKGROUND

Plaintiff was a partner/physician with California Emergency

Physicians, an organization comprised, in part, of emergency room

physicians. Renner Decl., Docket No. 19, ¶¶ 3, 4.1 The present

action arises out of Defendants' denial of disability benefits to

Plaintiff. Notice of Removal, Docket No. 1, Compl. ¶ 32. 

Plaintiff alleges that, as a result of his work as an emergency

room doctor, he now suffers post-traumatic stress disorder and is

unable to perform his job as an emergency room physician. Id.

Plaintiff filed the present action in the Superior Court of San

Francisco, stating the following causes of action: (1) breach of

contract against the Unum Defendants; (2) intentional/fraudulent

and negligent misrepresentation against the Unum Defendants; (3)

breach of the covenant of good faith and fair dealing, insurance

bad faith, against the Unum Defendants; (4) intentional infliction

of emotional distress against all Defendants; (5) inducing breach

of contract against Defendants Carroll, Rivers, and Bondi; (6)

interference with prospective economic advantage against

Defendants Carroll, Rivers, and Bondi; (7) writ of mandamus

against the Defendant Commissioner of the California Department of

Insurance. Defendants removed the action to this Court and

Defendant Bondi filed a motion to dismiss two of the claims

against him. Docket Nos. 1, 14. Plaintiff then filed a motion to

remand to state court. Docket No. 18.

Case 3:07-cv-05957-SC Document 45 Filed 04/11/08 Page 2 of 7
United States District Court

For the Northern District of California

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III. MOTION TO REMAND

The threshold issue for the Court is whether Plaintiff's long

term disability insurance policy is governed by the Employee

Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§

1001-1461. If it is, removal to federal court is proper; if not,

the case will be remanded to state court. "The existence of an

ERISA plan is a question of fact, to be answered in light of all

the surrounding facts and circumstances from the point of view of

a reasonable person." Kanne v. Conn. Gen. Life Ins., 867 F.2d

489, 492 (9th Cir. 1988). "[A] plan whose sole beneficiaries are

the company's owners cannot qualify as a plan under ERISA." 

Kennedy v. Allied Mut. Ins. Co., 952 F.2d 262, 264 (9th Cir.

1991). Conversely, "[i]f the plan covers one or more employees

other than the business owner[,]" the plan is governed by ERISA. 

Yates, M.D., P.C. Profit Sharing Plan v. Hendon, 541 U.S. 1, 6

(2004) ("Yates").

The parties agree that Unum provided a long term disability

benefit plan to MedAmerica. The parties disagree on the issue of

whether there was only one plan issued to MedAmerica, which

contained policies for physician partners, physician employees,

and employees, or whether there were three separate plans. If

three separate plans were issued, then Plaintiff's plan, which

only covered physician partners, would not be covered by ERISA. 

See Kennedy, 952 F.2d at 264. If only one plan was issued, and

this plan contained sub-policies for physicians, physician

employees, and employees, then the entire plan, including

Plaintiff's policy, would be governed by ERISA and the Court would

Case 3:07-cv-05957-SC Document 45 Filed 04/11/08 Page 3 of 7
United States District Court

For the Northern District of California

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2

 The Declaration of David Chidester was submitted in support

of Defendants' Opposition to Remand. Docket No. 25. Chidester is

a Senior Disability Benefits Specialist for Unum Group.

3

 The Declaration of Sarita Johnston was submitted in support

of Defendants' Opposition to Remand. Docket No. 24. Johnston is

the Director of Service and Administration for Unum Group.

4

 This version of the policy is attached to the Complaint and

to Plaintiff's Declaration. Docket No. 27.

5 Plaintiff objects to Exhibit C as hearsay and as an opinion

without foundation. Exhibit C is a copy of a letter from Unum to

MedAmerica, dated April 20, 1999. Chidester, in his declaration,

attests that the letter is a "true and correct copy." Id. ¶ 9. 

Plaintiff's objections are overruled.

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have jurisdiction over Plaintiff's action. See Yates, 541 U.S. at

6.

Based on the evidence submitted by the parties, it is

apparent that Unum issued only one plan to MedAmerica. See

Chidester Decl. ¶ 1, Ex. A;2 Johnston Decl. ¶ 1, Ex. A.3 The

copies of the insurance plan attached to these declarations are

identical and both state that the eligible groups for insurance

coverage under the long term disability plan are "employees,"

"physician employees," and "partners." Chidester Decl. Ex. A;

Johnston Decl. Ex. A. Although Plaintiff has attached a version

of the plan that only includes "physician partners" under the

heading of "Eligible Group(s)," this appears only to refer to the

sub-policy that covered Plaintiff, and does not demonstrate that

there were instead three separate plans issued.4 This conclusion

is further supported by additional evidence submitted by

Defendants. See Chidester Decl. Exs. C, D.5 

The Renner Declaration does little to overcome this

Case 3:07-cv-05957-SC Document 45 Filed 04/11/08 Page 4 of 7
United States District Court

For the Northern District of California

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6

 Although Renner did not attach a copy of the policy to

which he makes continued reference in his Declaration, the Court

assumes, for the sake of argument, that Renner is referring to the

policy attached to Plaintiff's Complaint and Declaration.

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conclusion.6 Renner states: "It is my understanding that when we

[MedAmerica] obtained Unum Policy No. 543289-031 that [sic] it was

for physician partners only." Id. ¶ 2. In light of the evidence

submitted by Defendants, this statement is entirely consistent

with the Court's conclusion that the umbrella insurance plan

contained three sub-policies directed towards physician partners,

physician employees, and employees, respectively. Plaintiff has

not submitted any evidence to contradict this conclusion.

For these reasons, the Court finds that the plan that

governed Plaintiff's insurance policy also applied to employees

and therefore is governed by ERISA. Yates, 541 U.S. at 6. The

Court therefore has jurisdiction and Plaintiff's Motion to Remand

to State Court is DENIED.

IV. MOTION TO DISMISS

A. Legal Standard

A Federal Rule of Civil Procedure 12(b)(6) motion to dismiss

tests the sufficiency of the complaint. Dismissal pursuant to

Rule 12(b)(6) is appropriate if the plaintiff is unable to

articulate "enough facts to state a claim to relief that is

plausible on its face." Bell Atl. Corp. v. Twombly, 127 S. Ct.

1955, 1974 (2007). For purposes of such a motion, the complaint

is construed in the light most favorable to the plaintiff and all

properly pleaded factual allegations are taken as true. Jenkins

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United States District Court

For the Northern District of California

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v. McKeithen, 395 U.S. 411, 421 (1969); Everest & Jennings, Inc.

v. Am. Motorists Ins. Co., 23 F.3d 226, 228 (9th Cir. 1994). All

reasonable inferences are to be drawn in favor of the plaintiff. 

Id. Unreasonable inferences or conclusory legal allegations cast

in the form of factual allegations, however, are insufficient to

defeat a motion to dismiss. W. Mining Council v. Watt, 643 F.2d

618, 624 (9th Cir. 1981).

B. Analysis

Defendant Bondi has moved to dismiss the fifth and sixth

causes of action as they apply to Bondi. Dr. Bondi apparently

examined Plaintiff at the behest of Unum and determined that

Plaintiff was not disabled. Plaintiff's fifth cause of action

alleges that Bondi and other Defendants induced the Unum

Defendants to breach their disability insurance contract with

Plaintiff. Plaintiff's sixth cause of action alleges that Bondi

and other Defendants intentionally interfered with Plaintiff's

prospective economic advantage.

Defendant Bondi's argument in favor of dismissal of these two

claims is that Plaintiff has presented other claims against the

Unum Defendants that are inconsistent with the allegations against

Bondi. As Federal Rule of Civil Procedure 8(d)(3) states,

however, "[a] party may state as many separate claims or defenses

as it has, regardless of consistency" (emphasis added). Thus, "a

pleading should not be construed as an admission against another

alternative or inconsistent pleading in the same case." McCalden

v. Cal. Library Ass'n, 955 F.2d 1214, 1219 (9th Cir. 1990)

(internal quotation marks omitted). For these reasons, Defendant

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United States District Court

For the Northern District of California

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Bondi's Motion to Dismiss is DENIED.

V. CONCLUSION

For the reasons stated herein, Plaintiff's Motion to Remand

to State Court is DENIED and Defendant Bondi's Motion to Dismiss

the Fifth and Sixth Causes of Action is DENIED.

IT IS SO ORDERED.

Dated: April 11, 2008

 

UNITED STATES DISTRICT JUDGE

Case 3:07-cv-05957-SC Document 45 Filed 04/11/08 Page 7 of 7