Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_03-cv-03898/USCOURTS-cand-3_03-cv-03898-0/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

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United States District Court

For the Northern District of California

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United States District Court

For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

LARRY FENBERG,

Plaintiff,

 v.

COWDEN AUTOMTIVE LONG TERM

DISABILITY PLAN,

Defendants.

 /

No. C 03-03898 SI

ORDER RE: JUDGMENT

On May 24, 2005, the Court filed its Order granting summary judgment in favor ofplaintiff. The Court

directed the parties to provide the Court with a proposed order that included the appropriate payment ofback

benefits and clarification of future benefits. Plaintiff submitted such an order on June 17, 2005, but defendant

did not agree with the analysis in the order or the award requested by plaintiff and on June 21, 2005 submitted

its own analysis. Plaintiff’s letter stated that he would file a response to defendant’s objections, but he has not

done so. Thus, to date, no judgment has been entered.

The parties agree that the Gross Monthly Benefit (“GMB”) is $3,745.35. The parties also agree that

the amount provided under the plan should be reduced by any Social Security benefits or state disability

benefits received by plaintiff. The parties agree that the state disability payments total $2,123.33 a month.

However, plaintiff asserts that he received state disability benefitsfromJune 1, 2002 until November 30, 2002.

Defendant argues thatstate disability benefits are paid forone year, and ifplaintiff’sstate disability benefits were

discontinued, it means that he was no longer disabled. Therefore, the Court will reduce plaintiff’s award by

$2,123.33 a month fortwelve months beginning on June 1, 2002, unless plaintiff 1) produces evidence that his

state disability benefits were discontinued 2) for reasons other than a change in whether he was disabled, as

defined by the state. Additionally, if defendant’s assertion that state disability benefits are paid for 12 months

is incorrect, plaintiff should notify the Court and it would then be entitled to have the reduction withdrawn.

Case 3:03-cv-03898-SI Document 71 Filed 09/12/05 Page 1 of 4
United States District Court

For the Northern District of California

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The parties disagree on the amount ofSocialSecurity Benefitsreceived. Plaintiff states that the monthly

payment is $1,314. Defendant states that the payment is $1,333. Neither party has presented any evidence

in support oftheir assertion. Therefore, unless plaintiff presents evidence to the contrary, his award should be

reduced by $1,333 a month.

The remaining issue is whether plaintiffis entitled to recover benefitsfromJune 1, 2002 until the present.

Plaintiff asks the Court to award benefits “for as long as plaintiff remains disabled under the terms of the plan

or until plaintiff reaches the age of 65 years as provided in the plan documents.” See Proposed Order at 2.

Defendant arguesthatthe policy limits benefitsto 24 months for disabilities “caused by or contributed by mental

or nervous disorders including depressive disorders.” Letter Brief at 2. See AR at 18. Additionally, after

receiving benefits for 36 months, an individual can only receive benefits if “totally disabled from any

occupation.” Id. See AR at 8.

Because plaintiff’s diagnosis by his doctor that he was disabled was based, at least in part, on his

depression, the Court finds that plaintiff is entitled to benefits for at least 24 months beginning from June 1,

2002. It is clear from the administrative record that plaintiff had physical limitations. However, plaintiff’s

doctor specifically included depression in his diagnosis. See AR at 191. Therefore, the current record does

not allow determination whether, after receiving coverage for 24 months, plaintiff’s disability was not

“contributed by mental or nervous disorders” as provided in the policy. See AR at 18. Hence, the matter

should be remanded to determine whether plaintiff was entitled to coverage under the policy after 24 months.

Accordingly, the Court orders plaintiffto prepare a formofjudgment providing forthe proper payment

of back benefits, taking into consideration this Order, and submit it to the Court by no later than September

23, 2005. Thereupon, the matter will be remanded for further consideration by the plan administrator

concerning coverage after 24 months and/or into the future.

IT IS SO ORDERED.

Dated: September 9, 2005 

 

SUSAN ILLSTON

United States District Judge

Case 3:03-cv-03898-SI Document 71 Filed 09/12/05 Page 2 of 4
United States District Court

For the Northern District of California

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United States District Court

For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

LARRY FENBERG,

Plaintiff,

 v.

COWDEN AUTOMTIVE LONG TERM

DISABILITY PLAN,

Defendants.

 /

No. C 03-03898 SI

ORDER RE: JUDGMENT

On May 24, 2005, the Court filed its Order granting summary judgment in favor ofplaintiff. The Court

directed the parties to provide the Court with a proposed order that included the appropriate payment ofback

benefits and clarification of future benefits. Plaintiff submitted such an order on June 17, 2005, but defendant

did not agree with the analysis in the order or the award requested by plaintiff and on June 21, 2005 submitted

its own analysis. Plaintiff’s letter stated that he would file a response to defendant’s objections, but he has not

done so. Thus, to date, no judgment has been entered.

The parties agree that the Gross Monthly Benefit (“GMB”) is $3,745.35. The parties also agree that

the amount provided under the plan should be reduced by any Social Security benefits or state disability

benefits received by plaintiff. The parties agree that the state disability payments total $2,123.33 a month.

However, plaintiff asserts that he received state disability benefitsfromJune 1, 2002 until November 30, 2002.

Defendant argues thatstate disability benefits are paid forone year, and ifplaintiff’sstate disability benefits were

discontinued, it means that he was no longer disabled. Therefore, the Court will reduce plaintiff’s award by

$2,123.33 a month fortwelve months beginning on June 1, 2002, unless plaintiff 1) produces evidence that his

state disability benefits were discontinued 2) for reasons other than a change in whether he was disabled, as

defined by the state. Additionally, if defendant’s assertion that state disability benefits are paid for 12 months

is incorrect, plaintiff should notify the Court and it would then be entitled to have the reduction withdrawn.

Case 3:03-cv-03898-SI Document 71 Filed 09/12/05 Page 3 of 4
United States District Court

For the Northern District of California

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2

The parties disagree on the amount ofSocialSecurity Benefitsreceived. Plaintiff states that the monthly

payment is $1,314. Defendant states that the payment is $1,333. Neither party has presented any evidence

in support oftheir assertion. Therefore, unless plaintiff presents evidence to the contrary, his award should be

reduced by $1,333 a month.

The remaining issue is whether plaintiffis entitled to recover benefitsfromJune 1, 2002 until the present.

Plaintiff asks the Court to award benefits “for as long as plaintiff remains disabled under the terms of the plan

or until plaintiff reaches the age of 65 years as provided in the plan documents.” See Proposed Order at 2.

Defendant arguesthatthe policy limits benefitsto 24 months for disabilities “caused by or contributed by mental

or nervous disorders including depressive disorders.” Letter Brief at 2. See AR at 18. Additionally, after

receiving benefits for 36 months, an individual can only receive benefits if “totally disabled from any

occupation.” Id. See AR at 8.

Because plaintiff’s diagnosis by his doctor that he was disabled was based, at least in part, on his

depression, the Court finds that plaintiff is entitled to benefits for at least 24 months beginning from June 1,

2002. It is clear from the administrative record that plaintiff had physical limitations. However, plaintiff’s

doctor specifically included depression in his diagnosis. See AR at 191. Therefore, the current record does

not allow determination whether, after receiving coverage for 24 months, plaintiff’s disability was not

“contributed by mental or nervous disorders” as provided in the policy. See AR at 18. Hence, the matter

should be remanded to determine whether plaintiff was entitled to coverage under the policy after 24 months.

Accordingly, the Court orders plaintiffto prepare a formofjudgment providing forthe proper payment

of back benefits, taking into consideration this Order, and submit it to the Court by no later than September

23, 2005. Thereupon, the matter will be remanded for further consideration by the plan administrator

concerning coverage after 24 months and/or into the future.

IT IS SO ORDERED.

Dated: September 9, 2005 

 

SUSAN ILLSTON

United States District Judge

Case 3:03-cv-03898-SI Document 71 Filed 09/12/05 Page 4 of 4