Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_15-cv-00271/USCOURTS-casd-3_15-cv-00271-3/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.: Civil Enforcement of Employee Benefits

---

1

3:15-cv-00271-GPC-RBB

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

TAMARA RADEVSKA, an individual,

Plaintiff,

v.

NOBLE AMERICAS ENERGY 

SOLUTIONS, LLC., a California limited 

liability company; NOBLE AMERICAS 

CORP., a Delaware corporation; NOBLE 

AMERICAS’ CIGNA HEALTHCARE 

OPEN ACCESS PLUS PLAN, an ERISA 

medical benefits plan,

Defendants.

Case No.: 3:15-cv-00271-GPC-RBB

ORDER REQUESTING 

SUPPLEMENTAL BRIEFING IN RE 

PLAN DOCUMENTS AND 

ADMINISTRATIVE RECORD

The Court, as stated at the motion hearing, has tentatively concluded that Plaintiff 

was a “participant” for purposes of pursuing a claim under 29 U.S.C. § 1132(a)(1)(B) and 

(a)(3), as interpreted by the Supreme Court in Firestone Tire & Rubber Co. v. Bruch, 489 

U.S. 101 (1989). The ERISA statute defines “participant” as “any employee or former 

employee of an employer . . . who is or may become eligible to receive a benefit of any 

type from an employee benefit plan which covers employees of such employer.” 29 

U.S.C. § 1002(7).

Case 3:15-cv-00271-GPC-RBB Document 118 Filed 04/10/17 PageID.<pageID> Page 1 of 5
2

3:15-cv-00271-GPC-RBB

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

The Supreme Court has interpreted [29 U.S.C. § 1002(7)] to mean that a party is a 

‘participant’ if he is an employee in, or reasonably expected to be in, currently 

covered employment, or if he is a former employee who has a reasonable 

expectation of returning to covered employment, or a ‘colorable claim’ to vested 

benefits.

Miller v. Rite Aid Corp., 504 F.3d 1102, 1106 (9th Cir. 2007) (quoting Firestone Tire & 

Rubber Co. v. Bruch, 489 U.S. 101, 117 (1989)). Here, Plaintiff has a “colorable claim”

for benefits. At minimum, the inference can be drawn that Plaintiff was an employee at 

the time of acquisition—she received and signed a “Confirmation of Employment Letter”

from Defendants, (Winters Decl. Ex. 4, Dkt. No. 99-10), and was on FMLA leave until 

November 3, 2010, two days after the acquisition of Sempra Energy Solutions closed, 

(Defs.’ SSUF ¶ 4; Pl.’s SSUF ¶¶ 7, 10.)

In addition, the Court has tentatively concluded that, contrary to Defendants’

position, Defendants’ termination of Plaintiff’s benefits, based upon Defendants’

determination that she was ineligible, is subject to review under ERISA, and that an 

ERISA standard of review must be selected. See, e.g., Tremain v. Bell Indus., Inc., 196 

F.3d 970, 973 (9th Cir. 1999) (directing district court to review de novo the termination 

of plaintiff’s benefits); Bergt v. Ret. Plan for Pilots Employed by MarkAir, Inc., 293 F.3d 

1139, 1142 (9th Cir. 2002) (subjecting plan administrator’s determination that plaintiff 

was not eligible to participate in the plan to abuse of discretion review); Gonda v. 

Permanente Med. Grp., Inc., 300 F.R.D. 609, 613 (N.D. Cal. 2014) (subjecting plan 

administrator’s termination of plaintiff’s benefits to de novo review). To conclude 

otherwise would effectively insulate Plaintiff’s claim from ERISA review, despite 

Defendants’ representation to Plaintiff that ERISA governed the Noble Health Plan, and 

that she accordingly needed to administratively exhaust her claims before seeking judicial 

relief. (See Rubin Decl., Ex. P, Dkt. No. 90-12 at 27.) Defendants’ position essentially 

amounts to an argument that Defendants’ own factual determination that Plaintiff was 

ineligible to participate in the Noble Health Plan applies with equal force to the legal 

question of whether she was a plan “participant” within meaning of the ERISA statute. 

Case 3:15-cv-00271-GPC-RBB Document 118 Filed 04/10/17 PageID.<pageID> Page 2 of 5
3

3:15-cv-00271-GPC-RBB

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

This position fails to take into account the Supreme Court’s interpretation of “participant”

in Firestone.

Having tentatively determined the above, the Court has identified two threshold 

problems impeding the Court’s selection and application of the appropriate standard of 

review. 

First, the only documents indicative of the terms of the Noble Health Plan are the 

2010 and 2011 Summary Plan Descriptions (“SPDs”). (See, e.g., Dkt. No. 90 at 7 

(referring to the eligibility conditions “outlined in the summary plan description of the 

Noble Health Plan”); Dkt. No. 90-2, Defs.’ SSUF ¶ 16 (referencing “certain conditions 

outlined in the SPD for the Noble Heath Plan”).) Neither party has identified for the 

Court the relevant terms of the Noble Health Plan, beyond language from the SPDs. The 

Supreme Court has expressly held that “the summary documents, important as they are, 

provide communication with beneficiaries about the plan, but . . . their statements do not 

themselves constitute the terms of the plan for purposes of § 502(a)(1)(B).” CIGNA 

Corp. v. Amara, 563 U.S. 421, 438 (2011) (emphasis added); see also Prichard v. Metro. 

Life Ins. Co., 783 F.3d 1166, 1171 (9th Cir. 2015) (holding that “the district court clearly 

erred in finding that the SPD, and not the insurance certificate, constitutes the Plan 

document” (internal quotation marks omitted)); accord Becker v. Williams, 777 F.3d 

1035, 1040 n.3 (9th Cir. 2015) (“The Supreme Court has specifically excluded the 

statutorily mandated summary plan description, listed in § 1024(b)(4), as a source of the 

plan's governing terms.”). The Court notes the presence of language in the SPDs 

indicating that formal Plan documents exist. (See, e.g., Rubin Decl., Ex. M, Dkt. No. 90-

11 at 53 (referring to “the Certificate” and the “provider's network participation 

documents”).)1 The very language of 29 U.S.C. § 1132(a)(1)(B) implicates “the terms of 

the plan.” 29 U.S.C. § 1132(a)(1)(B); accord Opeta v. Nw. Airlines Pension Plan for 

 

1 All citations to the record are based upon the pagination generated by the CM/ECF system.

Case 3:15-cv-00271-GPC-RBB Document 118 Filed 04/10/17 PageID.<pageID> Page 3 of 5
4

3:15-cv-00271-GPC-RBB

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Contract Employees, 484 F.3d 1211, 1219 (9th Cir. 2007) (“De novo review requires the 

district court to evaluate whether [the plan administrator] correctly denied [the plan 

participant] benefits under the terms of the Plan.”). The Parties need to identify the Plan 

documents and apprise the Court of the relevant terms of the Plan in order for the Court 

to proceed in its determination. 

Second, neither party has specifically identified for the Court which documents 

comprise the administrative record in this case. Applying either de novo or abuse of 

discretion review, the Court must review the administrative record to make its 

determination. “[I]n general, a district court may review only the administrative record 

when considering whether the plan administrator abused its discretion,” but “when de 

novo review applies, the court is not limited to the administrative record and may take 

additional evidence.” Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955, 970–73 (9th 

Cir. 2006). 

Moreover, 

when an administrator has engaged in a procedural irregularity that has affected the 

administrative review . . . [e]ven where procedural irregularities are smaller, 

though, and abuse of discretion review applies, the court may take additional 

evidence when the irregularities have prevented full development of the 

administrative record. In that way the court may, in essence, recreate what the 

administrative record would have been had the procedure been correct.

Id. at 973. Thus, even if the Court accepts Plaintiff’s position that procedural 

irregularities occurred, Plaintiff still needs to clarify where the administrative record 

begins and ends, and what additional evidence is necessary to “recreate what the 

administrative record would have been.” Id. Further, Plaintiff needs to identify which 

“exceptional circumstances” establish that “introduction of evidence beyond the 

administrative record” is necessary. See Opeta, 484 F.3d at 1217 (reiterating the Ninth 

Circuit’s prior holding “that extrinsic evidence could be considered only under certain 

limited circumstances” and citing with approval the Fourth Circuit’s rule “that the district 

court should exercise its discretion to consider evidence outside of the administrative 

Case 3:15-cv-00271-GPC-RBB Document 118 Filed 04/10/17 PageID.<pageID> Page 4 of 5
5

3:15-cv-00271-GPC-RBB

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

record only when circumstances clearly establish that additional evidence is necessary to 

conduct an adequate de novo review of the benefit decision” (internal citation and 

quotation marks omitted)).

The Parties are ordered to provide supplemental briefing of no more than ten pages 

on the two discrete problems outlined in this Order. They are further ordered to identify 

the contents of the administrative record (and if extrinsic evidence is proffered, to clearly 

explain why it is necessary) and lodge the administrative record with the Court 

accordingly. The Parties are to comply with this Order on or by Tuesday, April 18, 2017.

IT IS SO ORDERED.

Dated: April 10, 2017

Case 3:15-cv-00271-GPC-RBB Document 118 Filed 04/10/17 PageID.<pageID> Page 5 of 5