Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_08-cv-00284/USCOURTS-caed-1_08-cv-00284-2/pdf.json

Nature of Suit Code: 110
Nature of Suit: Insurance
Cause of Action: 28:1132 E.R.I.S.A.

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Defendants are the Wilbur-Ellis Company Salaried Employees Ltd. Plan of New York (“Plan”) and Life 1

Insurance Company of North America (“LINA”). The Plan and LINA will be referred to collectively as “defendants.”

“ERISA” is the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001, et seq.

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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

JAMES FRANK, CASE NO. CV F 08-0284 LJO GSA

Plaintiff, ORDER ON PLAINTIFF’S MOTION TO

STRIKE PORTIONS OF DEFENDANTS’

vs. ANSWER AND TO DEEM ALLEGATIONS

ADMITTED

WILBUR-ELLIS COMPANY SALARIED (Doc. 25.)

EMPLOYEES LTD PLAN; LIFE 

INSURANCE COMPANY OF NORTH

AMERICA,

Defendants.

 /

INTRODUCTION

Plaintiff James Frank (“Mr. Frank”) seeks to strike several paragraphs of and an affirmative

defense in defendants’ answer to his amended complaint pursing ERISA claims that defendants 1 2

wrongfully terminated Mr. Frank’s disability benefits and life policy premium waiver. As an alternative,

Mr. Frank seeks to have allegations of his amended complaint deemed admitted. Defendants challenge

Mr. Frank’s requested relief as an improper attempt to remove an unfavorable medical form from the

administrative record. This Court considered Mr. Frank’s F.R.Civ.P. 12(f) motion to strike and

alternative motion to deem allegations admitted on the record and VACATES the September 30, 2008

hearing, pursuant to Local Rule 78-230(h). For the reasons discussed below, this Court ORDERS

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Defendants note that to recover LTD benefits, a claimant must establish that due to sickness or injury,

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he/she is “unable to perform all the material duties of any occupation for which he or she may reasonably become qualified

based on education, training or experience.” Defendants assert that Mr. Frank is not disabled if he is able to perform a job

for which he is qualified or for which he can become reasonably qualified by training, education or experience.

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defendants to file an amended answer to satisfy F.R.Civ.P. 8(b) and F.R.Civ.P. 11(b) requirements and

strikes the affirmative defense as Mr. Frank requests.

BACKGROUND

Mr. Frank’s Disability And Benefits Termination

Staring in 1981, Mr. Frank worked as an agricultural equipment salesman at Wilbur-Ellis

Company (“Wilbur-Ellis”). Through his employment, Mr. Frank participated in the Plan, which

provides disability and life insurance for Wilbur-Ellis employees and their families through LINA

policies. LINA is the Plan’s claims administrator. 

In April 2000, Mr. Frank became disabled due to right knee osteoarthritis. LINA determined that

Mr. Frank was disabled under the Plan. In May 2000, Mr. Frank started to receive long-term disability

(“LTD”) benefits. In August 2006, LINA determined, based on “the medical evidence in the 3

administrative record,” that Mr. Frank was no longer disabled under the Plan and terminated his LTD

benefits and life policy premium waiver. LINA based its termination decision in part on a June 26, 2006

Physical Abilities Assessment (“PAA”) signed by Malcolm E. Ghazal, M.D. (“Dr. Ghazal”). The PAA

indicates that Mr. Frank is capable to work an eight-hour day with “positional changes and meal breaks.”

Mr. Frank’s Amended Complaint And Defendant’s Answer

Mr. Frank’s July 23, 2008 amended complaint alleges that defendants wrongly found him

disabled and pursues ERISA claimsthat defendantswronglydiscontinued hisLTDbenefits and wrongly

dishonored his waiver of life policy premiums based on his continued disability. The amended

complaint alleges Mr. Frank’s damages of lost LTD benefits and higher life policy premiums.

Defendants filed an August 11, 2008 answer to Mr. Frank’s amended complaint, and Mr. Frank

takes issue with the responses of defendants’ answer to many of the amended complaint’s allegations,

and those responses will be discussed below. Mr. Frank notes he would propound requests for

admission to address defendants’ responses but defendants contest discovery in this ERISA action in that

this Court is limited to de novo review of defendants’ denial of Mr. Franks benefits. As such, Mr. Frank

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claims he must seek to strike defendants’ responses or deem his allegations admitted.

DISCUSSION

Motion To Strike Standards

F.R.Civ.P. 12(f) empowers a court to strike from a pleading “any redundant, immaterial,

impertinent, or scandalous matter.” Motions to strike may be granted if “it is clear that the matter to be

stricken could have no possible bearing on the subject matter of the litigation.” LeDuc v. Kentucky

Central Life Ins. Co., 814 F.Supp. 820, 830 (N.D. Cal. 1992); Colaprico v. Sun Microsystems, Inc., 758

F.Supp. 1335, 1339 (N.D. Cal. 1991). “[T]he function of a [F.R.Civ.P.] 12(f) motion to strike is to avoid

the expenditure of time and money that must arise from litigating spurious issues by dispensing with

those issues prior to trial.” Fantasy, Inc. v. Fogerty, 984 F.2d 1524, 1527 (9 Cir. 1993), rev’d on other th

grounds, Fogerty v. Fantasy, Inc., 510 U.S. 517, 114 S.Ct. 1023 (1994); Sidney-Vinstein v. A.H. Robins

Co., 697 F.2d 880, 885 (9 Cir. 1983). The grounds for a motion to strike must appear on the face of th

the pleading under attack or from matter which the court may judicially notice. Securities Exchange

Comm. v. Sands, 902 F.Supp. 1149, 1165 (C.D. Cal. 1995). 

An “immaterial” matter has no essential or important relationship to the claim for relief or

defenses pleaded. Fantasy, Inc., 984 F.2d at 1527; Gilbert v. Eli Lilly & Co., Inc., 56 F.R.D. 116, 120,

n. 5 (D. P.R. 1972); Fleischer v. A.A.P., Inc., 180 F.Supp. 717 (D. Pa. 1958). An “impertinent”

allegation is neither responsive nor relevant to the issues involved in the action and which could not be

put in issue or given in evidence between the parties. Gilbert, 56 F.R.D. at 120, n. 6; Burke v. Mesta

Mach. Co., 5 F.R.D. 134 (D. Pa. 1946). An “impertinent” matter consists of statements that do not

pertain and are unnecessary to the issues in question. Fantasy, Inc., 984 F.2d at 1527. Matters may be

stricken to reduce trial complication or if challenged allegations are so unrelated to plaintiff’s claims to

be unworthy of consideration as a defense and their presence in the pleading will prejudice the party

seeking to strike matters. Fantasy, Inc., 984 F.2d at 1527.

An affirmative defense may be stricken if there are no questions offact, questions of law are clear

and not in dispute, and the defense could succeed under no circumstances. See Sands, 902 F.Supp. at

1165. 

With these standards in mind, this Court turns to Mr. Frank’s criticisms of defendants’ answer.

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Physical Abilities Assessment

Mr. Frank claims that the PAA in defendants’ administrative record does not pertain to him. Mr.

Frank takes issue with defendants’ responses to allegations that the PAA is not the form which

defendants sent to his treating physician. More specifically, the amended complaint alleges that:

1. The PAA “was not prepared on the form that Defendants had sent to Dr. Ghazal”

(paragraph 26) ;

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2. Mr. Frank’s “name was typed on the PAA form that Defendants sent to Dr. Ghazal”

(paragraph 27);

3. The PAA “upon which Defendants relied to deny Plaintiff disability benefits does not

bear Plaintiff’s name or any patient’s name” (paragraph 28);

4. Mr. Frank’s “date of birth was typed on the PAA form that Defendants sent to Dr.

Ghazal” (paragraph 29);

5. The PAA “upon which Defendants relied to deny Plaintiff disability benefits does not

bear Plaintiff’s date of birth or any patient’s date of birth (paragraph 30);

6. “The PAA form that Defendants sent to Dr. Ghazal bore a date that is different from the

date” on the PAA (paragraph 31);

7. The PAA “did not pertain to Plaintiff” (paragraph 32); and

8. The PAA “did not describe Plaintiff’s physical abilities” (paragraph 33). 

Defendants’ answer responded to paragraphs 26-33 that defendants admit that the “PAA form

signed by Dr. Ghazal is part of the claims file and administrative record and that it speaks for itself.

Defendants deny that Plaintiff is eligible for further LTD benefits.” 

Mr. Frank challenges defendants’ responses that the PAA “speaks for itself.” Mr. Frank notes

that defendants’ permissible responses to his allegations are an admission, denial or statement of lack

of information or belief to permit defendants to admit or deny an allegation. Mr. Frank contends that

defendants must respond properly to the allegations because defendants seek to include the PAA in the

administrative record and to determine the case based on the administrative record without further

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discovery. Mr. Frank concludes that in the absence of denials to his amended complaint’s paragraphs

26-33, their allegations are deemed admitted or “Defendants must file an amended answer, subject to

the good faith representation requirements of F.R.C.P. 11, denying these allegations.” 

Defendants respond that their responses are appropriate in that they “are not required to admit

or deny the actual content of a document that is part of the administrative record” and the PAA’s content

“is the best proof and evidence of the nature and import of the document.” Defendants continue that the

amended complaint contains “unnecessary advocacy, matters of opinion, and matters which are neither

claims nor allegations.” Defendants claim that they are required to address only “the averments upon

which Plaintiff relied to allegedly state a claim.”

F.R.Civ.P. 8(b)(1) requires a defendant responding to a complaint to:

(A) state in short and plain terms its defenses to each claim asserted against it;

and

(B) admit or deny the allegations asserted against it by an opposing party.

“A denial must fairly respond to the substance of the allegation.” F.R.Civ.P. 8(b)(2). If a defendant

“lacks knowledge or information sufficient to form a belief about the truth of an allegation,” the

defendant “must so state, and the statement has the effect of a denial.” F.R.Civ.P. 8(b)(5). 

Courts have explained the need to comply with F.R.Civ.P. 8(b):

Rule 8(b) is quite specific in defining the only circumstances under which a

pleader can do something other than either admit or deny an allegation:

. . .

That carefully-framed requirement has gained added significance now that Rule

11 has put added teeth into the need for a lawyer's prior verification of what is said in any

pleading he or she signs or files. Rule 8(b) teaches (1) the critical factor for a party

seeking the benefit of a deemed denial is his or her belief, rather than out-and-out

knowledge, as to whether or not an allegation is true and (2) information may be enough

to support such a belief that the allegation is true.

Gilbert v. Johnston, 127 F.R.D. 145, 146 (N.D. Ill. 1989).

Courts do not tolerate the “speaks for itself response”:

Another unacceptable device, used by lawyers who would prefer not to admit

something that is alleged about a document in a complaint (or who may perhaps be too

lazy to craft an appropriate response to such an allegation), is to say instead that the

document “speaks for itself.” This Court has been attempting to listen to such written

materials for years (in the forlorn hope that one will indeed give voice) – but until some

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such writing does break its silence, this Court will continue to require pleaders to employ

one of the three alternatives that are permitted by Rule 8(b) in response to all allegations

about the contents of documents (or statutes or regulations).

State Farm Mut. Auto. Ins. Co. v. Riley, 199 F.R.D. 276, 279 (N.D. Ill. 2001).

“An allegation – other than one relating to the amount of damages – is admitted if a responsive

pleading is required and the allegation is not denied.” F.R.Civ.P. 8(b)(6). “Averments in a pleading to

which a responsive pleading is required, other than those as to the amount of damage, are admitted when

not denied in the responsive pleading.” King Vision Pay Per View, Ltd. v. J.C. Dimitri’s Restaurant,

Inc., 180 F.R.D. 332, 334 (N.D. Ill. 1998).

The amended complaint’s paragraphs 26-33 make specific factual allegations as to the PAA upon

which defendants rely to terminate Mr. Frank’s LTD benefits. The gist of the paragraph 26-33

allegations is that Dr. Ghazal completed a PAA that did not pertain to Mr. Frank and defendants relied

on such PAA to deny Mr. Frank’s LTD benefits. These allegations do not ask defendants to admit or

deny the PAA’s substantive contents. With their responses, defendants attempt to duck specific factual

allegations, “not unnecessary advocacy” or “matters of opinion.” Defendants’ responses disregard

F.R.Civ.P. 8(b) requirements and will not be tolerated by this Court. To respond to a complaint’s

allegation, F.R.Civ.P. 8(b) requires: (1) an admission; (2) a denial; or (3) a statement of absence of

knowledge or sufficient information. Although this Court is empowered and is tempted to deem the

responses to paragraphs 26-33 as admissions, this Court GRANTS defendants leave to amend their

responses to paragraphs 26-33 to conform with F.R.Civ.P. 8(b) and F.R.Civ.P. 11(b). If the amended

responses fail to deny paragraphs 26-33, paragraphs 26-33 will be deemed admitted. 

Moreover, contrary to defendants’ suggestion, the import of Mr. Frank’s alternative motions is

not to strike the PAA from the administrative record. The PAA and the remainder of the administrative

record will be available for this Court’s de novo review. Based on evidence at trial, this Court will be

in a position to evaluate the PAA and accord it appropriate weight.

Satisfaction Of Appeal Requirements

The amended complaint’s paragraph 23 alleges that Mr. Frank “has fully satisfied all appeal

requirements under the Plan, and his appeal has been denied.” Defendants’ answer denied “all

allegations in said Paragraph in their entirety.” The parties’ Joint Scheduling Report (“report”), signed

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The parties filed the report May 2, 2008, three months prior to defendants’ answer to the amended 5

complaint.

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by defense counsel, notes: “Defendants admit Plaintiff has fully exhausted his administrative remedies

under the Plan.” 

Mr. Frank characterizes as a “judicial admission” defendants’ acknowledgment in the report that

Mr. Frank exhausted his administrative remedies under the Plan. Mr. Frank contends that defendants’

denial to paragraph 23 of the amended complaint is contrary to defendants’ prior judicial admission and 5

must be stricken to render the allegation deemed admitted. 

A “party is bound by what it states in its pleadings.” Soo Line Railroad Co. v. St. Louis

Southwestern Railway Co., 125 F.3d 481, 483 (7 Cir. 1997). “Judicial admissions are formal th

concessions in the pleadings, or stipulations by a party or its counsel, that are binding upon the party

making them.” Keller v. United States, 58 F.3d 1194, 1198, n. 8 (7 Cir. 1995). th

In their opposition papers, defendants admit that Mr. Frank exhausted his administrative

remedies and that his appeal was denied after he satisfied appeal requirements. As such, this Court

GRANTS defendants’ request and leave to amend their response to paragraph 23 to admit that Mr. Frank

exhausted administrative remedies. 

Reliance On PAA

The amended complaint’s paragraph 25 alleges: “Defendants’ determination that Plaintiff was

not disabled was based upon a 6/26/06 Physical Ability Assessment [“PAA”] form.” In their answer to

respond to paragraph 25, defendants “admit that the 6/26/06 PAA and LINA’s correspondence to

Plaintiff are part of the claims file and administrative record that those documentsspeak for themselves.

Defendants deny that Plaintiff is eligible for further LTD benefits.” 

The report notes:

Defendant LINA based its decision to terminate Plaintiff’s LTD benefits, as well

as to deny his appeals of that decision, on the evidence in the administrative record

considered in total. This included, but is not limited to, on [sic] the following:

1. Dr. Malcolm E. Ghazal’s June 26, 2006, Physical Abilities Assessment

form which indicated that Plaintiff was capable of working an 8-hour workday with

restrictions including “positional changes and meal breaks.”

Mr. Frank characterizes as a “judicial admission” defendants’ acknowledgment that they relied

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on the PAA. Mr. Frank contends that since defendants’ response to paragraph 25 is neither a denial nor

an admission and is contrary to the statements in the report, the response should be stricken and

paragraph 25 deemed admitted.

Similar to defendants’ responses to paragraphs 26-33, defendants response to paragraph 25

disregards F.R.Civ.P. 8(b) requirements and will not be tolerated by this Court. Although this Court is

empowered and is tempted to deem the response as an admission, this Court GRANTS defendants leave

to amend their response to paragraph 25 to conform with F.R.Civ.P. 8(b) and F.R.Civ.P. 11(b). If the

amended response fails to deny paragraph 25, paragraph 25 will be deemed admitted.

De Novo Review

Defendants’ answer to the amended complaint asserts a (third) affirmative defense of decision

not arbitrary or capricious:

Under the terms of the Plan, LINA is vested with discretionary authority to

determine eligibility for benefits and to interpret the terms and provisions of the

insurance policy. The claim decision is properly reviewed by the court under an arbitrary

and capricious standard of review. The decision to deny Plaintiff’s claim for continued

long term disability benefits and continued life insurance benefits was not arbitrary and

capricious.

The report notes: “Defendants admit that the standard of review in this matter is de novo.” The

report further notes: “As discussed above, this matter is governed by de novo review . . .” 

Mr. Frank characterizes as a “judicial admission” and “legally correct,” the statements that “this

matter is subject to the de novo standard of review.” As such, Mr. Frank concludes that the (third)

affirmative defense of decision not arbitrary or capricious should be stricken. Defendants concede that

the standard of review is de novo and agree to strike (third) affirmative defense of decision not arbitrary

or capricious. 

CONCLUSION AND ORDER

For the reasons discussed above, this Court ORDERS defendants, no later than October 7, 2008,

to file an amended answer to conform to this order and to:

1. Satisfy F.R.Civ.P. 8(b) and F.R.Civ.P. 11(b) to respond to paragraphs 25-33 of Mr.

Frank’s amended complaint. If defendants fail to deny paragraphs 25-33, paragraphs 25-

33 will be deemed admitted; and

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2. Admit paragraph 23 of Mr. Frank’s amended complaint that Mr. Frank exhausted his

administrative remedies and that his appeal was denied after he satisfied appeal

requirements.

This Court STRIKES defendants’ (third) affirmative defense of decision not arbitrary or capricious. 

IT IS SO ORDERED.

Dated: September 24, 2008 /s/ Lawrence J. O'Neill 

66h44d UNITED STATES DISTRICT JUDGE

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