Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_19-cv-00361/USCOURTS-cand-3_19-cv-00361-0/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

---

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

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

ERIC P.,

Plaintiff,

v.

DIRECTORS GUILD OF AMERICA, et al.,

Defendants.

Case No. 19-cv-00361-WHO 

ORDER ON STANDARD OF REVIEW

Re: Dkt. No. 37

Plaintiff seeks review of the Directors Guild of America-Producer Health Plan’s decision 

denying his claim of coverage for residential mental health treatment for his daughter. The 

question at issue here is what standard of review – de novo or abuse of discretion – applies to my 

review of the Plan’s denial. Plaintiff argues de novo review is appropriate, despite the discretion 

provided to the Trustees of the Plan and through them to the Benefits Committee under the terms 

of the Plan, because: (1) because the Plan documents granted deference to so many entities 

involved in the claim-decision process, that grant is “anything but clear and unambiguous,” as 

required in the Ninth Circuit; (2) the Trust documents do not provide deferential decision-making

authority over claims to the Benefits Committee that made the final decision for the Trustees; and 

(3) the second-level appeal denial by the Plan was untimely and, therefore, is not entitled to any 

deference. Defendants (the Claims Administrator and the Plan) oppose and argue that under the 

clear provisions of the Plan documents abuse of discretion review is required. I find that the grant 

to the Benefits Committee is clear and unambiguous and that the delay in decision-making did not 

cause plaintiff substantive harm. I will utilize the abuse of discretion standard in evaluating this 

case.1

 

1 This matter is appropriate for resolution on the papers under Civil Local Rule 7-1(b). The 

November 20, 2019 hearing is VACATED.

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 1 of 11
2

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

Northern District of California

BACKGROUND

Plaintiff and his dependent daughter were covered under the defendant Directors Guild of 

America-Producer Health Plan (“Plan”). The operative provisions of the Plan are the Summary 

Plan Description (SPD, Dkt. No. 37-1) and the Trust Agreement (Trust, Dkt. No. 39-4). As 

relevant to determining the standard of review, the SPD contains the following provisions:

The Board of Trustees shall have sole, complete and absolute 

discretionary authority to, among other things, make any and all 

findings of facts, constructions, interpretations and decisions relative 

to the Health Plan, as well as to interpret any provisions of the Health 

Plan, and to determine among conflicting claimants who is entitled to 

benefits under the Health Plan. The Board of Trustees shall be the sole 

judge of the standard of proof in all such cases which means that the 

Board of Trustees shall have the right to determine the sufficiency of 

any proof you may provide to support your claim to benefits.2

Dkt. 37-1, SPD at p. 86. 

The Claim Administrator has full discretion to deny or grant a claim 

in whole or part. Such decisions shall be made in accordance with the 

governing Health Plan documents and, where appropriate, Health 

Plan provisions will be applied consistently with respect to similarly 

situated claimants in similar circumstances. The Claim Administrator 

shall have the discretion to determine which claimants are similarly 

situated in similar circumstances. 

How and when claims are processed depends on the type of claim. All 

claims under the Health Plan that are required to be submitted to the 

Health Plan office are post-service health care claims. Most other 

claims under the Health Plan will also be post-service health care 

claims.

Id.

If the decision to deny the claim was based in whole or in part on a 

medical judgment, the Claim Administrator will consult with a health 

care professional who has experience and training in the relevant field 

and who was not involved in the initial determination.

Id. at 90. 

The operation and administration of the Health Plan is the joint 

responsibility of the trustees who constitute the Board of Trustees. 

However, the Board of Trustees may designate in writing persons 

who are not trustees to carry out fiduciary or non-fiduciary duties as 

 

2 The language is consistent with the Trust (Dkt. No. 39-4 at 3) which provides:

The Plan Trustees shall have the sole complete and discretionary authority (1) create one or 

more new plans of eligibilities and/or benefits, (2) grant or deny, in whole or in part, 

particular claims for benefits filed by participants or beneficiaries, in accordance with the 

Plan Trustees’ interpretation of the Health Plan and their fact findings relative to any such 

claims for benefits . . . .” 

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 2 of 11
3

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

Northern District of California

long as the designation complies with federal law and all applicable 

provisions of the Trust Agreement.

The Board of Trustees may establish such committees as the Board of 

Trustees in its discretion deems proper and desirable for the 

administration of the Health Plan. . . . Such committees may also

take final action in specified areas as authorized by a duly adopted 

resolution of the Board of Trustees. When final action is authorized 

and taken as specified in Article IV of the Trust Agreement, then such 

action taken by a committee shall have the same binding effect as an 

action by the full Board of Trustees. The standing committees of the 

Board of Trustees are the Administrative Committee, the Benefits 

Committee, the Finance Committee, and the Legal and Delinquency 

Committee. . . . All such committees shall have the authority and 

responsibilities as described in Article IV, Section 9, of the Trust 

Agreement and as specified by the Board of Trustees by duly adopted 

resolution.

Id. at 106. Finally:

With respect to post-service claims, as indicated above, if a third party 

Claim Administrator denies your claim, you must appeal that claim to 

the third party Claim Administrator. If the third party Claim 

Administrator denies your appeal, and you have exhausted the Health 

Plan’s claims and appeals procedure, you may request review of a 

post-service claim by the Benefits Committee of the Board of 

Trustees.

. . . 

The entity reviewing a claim (whether it is a third party Claim 

Administrator, or the Designated Committee of the Board of Trustees) 

will have discretion to deny or grant the appeal in whole or part. 

Decisions shall be made in accordance with the governing Health Plan 

documents and, where appropriate, Health Plan provisions will be 

applied consistently with respect to similarly situated claimants in 

similar circumstances. The entity reviewing a claim (whether it is a 

third party Claim Administrator or the Designated Committee of the 

Board of Trustees) shall have discretion to determine which claimants 

are similarly situated in similar circumstances.

Reviews of denials by the Health Plan office will be heard by the 

Designated Committee at its next regularly scheduled quarterly 

meeting. However, if an appeal is received fewer than 30 days before 

the meeting, the review may be delayed until the next meeting. In 

addition, if special circumstances require further extension of time, 

the review may be delayed to the following meeting. Once the benefit 

determination is made, you will be notified within 5 days after the 

determination.

Id. at 89.

Under the Plan, defendant Blue Cross of California dba Anthem Blue Cross (Anthem) is 

the Claims Administrator and handles claims and the initial appeal process. SPD at 88-89. The 

Board of Trustees of the Plan established a Benefits Committee (comprised of Trustees) to decide 

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 3 of 11
4

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

Northern District of California

second-level appeals under the Plan. SPD at 89, 106.

Plaintiff filed a claim with Anthem in October 2017, seeking reimbursement for and 

coverage of expenses related to his daughter’s stay at a residential mental health facility. Dkt. No. 

40-2. Plaintiff’s claim was denied initially by Anthem, concluding that the treatment was “not 

medically necessary.” Dkt. No. 40-2. Plaintiff appealed that denial to Anthem (“first-level 

appeal”), and Anthem denied that appeal on January 26, 2018. Dkt. No. 40-3. 

Plaintiff then filed a second-level appeal for determination by the Benefits Committee of 

the Plan. Plaintiff requested that the matter not be heard at the Benefits Committee June 2018 

meeting, in order to allow plaintiff’s counsel to provide additional information. Dkt. No. 39-6. 

Around October 1, 2018, plaintiff submitted over 2,000 pages of documents in support of his 

appeal. The Plan’s appeals coordinator sent the information out to a third-party reviewer, the 

Medical Review Institute of America (MRI), and received a report back from MRI dated October 

18, 2018. Dkt. No. 39-8. The appeals coordinator sent plaintiff’s counsel a letter on November 5, 

2018, which was misaddressed and re-sent on November 20, 2018, advising that MRI confirmed 

the denial as not medically necessary and stating that the appeal would be reviewed by the 

Benefits Committee at the “next” meeting in February 2019. Declaration of Daga Olsen (Dkt. No. 

39-1) ¶ 3, Dkt. No. 39-2. The appeal was discussed at the February 19, 2019 Benefits Committee 

meeting and was denied. Dkt. No. 39-11. Plaintiff filed this case on January 22, 2019. 

LEGAL STANDARD

Under Section 502 of the Employee Retirement Income Security Act (“ERISA”), a 

beneficiary or plan participant may sue in federal court “to recover benefits due to him under the 

terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future

benefits under the terms of the plan.” 29 U.S.C. § 1132(a)(1)(B). A claim of denial of benefits in 

an ERISA case “is to be reviewed under a de novo standard unless the benefit plan gives the 

[plan’s] administrator or fiduciary discretionary authority to determine eligibility for benefits or 

to construe the terms of the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 115 

(1989).

When the plan grants the plan administrator discretion to determine eligibility for benefits 

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 4 of 11
5

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

Northern District of California

or to construe the terms of the plan, then a court may only review the administrator’s decision 

regarding benefits for an abuse of discretion. Id. A court “can set aside the administrator’s 

discretionary determination only when it is arbitrary and capricious.” Jordan v. Northrop 

Grumman Corp. Welfare Benefit Plan, 370 F.3d 869, 875 (9th Cir. 2004). In such a situation, “a 

motion for summary judgment is merely the conduit to bring the legal question before the district 

court and the usual tests of summary judgment, such as whether a genuine dispute of material fact 

exists, do not apply.” Harlick v. Blue Shield of Cal., 686 F.3d 699, 706 (9th Cir. 2012).

If the plan does not grant the administrator discretion to determine benefits, then review of 

the administrator’s decision is conducted under the de novo standard. Firestone Tire & Rubber 

Co., 489 U.S. at 115. Under the de novo standard, “[t]he court simply proceeds to evaluate 

whether the plan administrator correctly or incorrectly denied benefits.” Abatie v. Alta Health & 

Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006). The normal summary judgment standard applies 

under de novo review. Tremain v. Bell Indus., Inc., 196 F.3d 970, 978 (9th Cir. 1999). 

DISCUSSION

I. CLEAR AND UNAMBIGUOUS DELEGATION – SPD AND TRUST DOCUMENT

The question presented is whether terms in the Plan documents – the SPD and Trust 

document – conferred on the Benefits Committee “discretionary authority to determine eligibility 

for benefits or to construe the terms of the plan.” Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 

101, 115 (1989). If so, the standard for reviewing the denial of the claim at issue will be abuse of 

discretion. The grant of discretionary authority must be clear and unambiguous. Abatie v. Alta 

Health & Life Ins. Co., 458 F.3d 955, 963 (9th Cir. 2006). I conclude that the deferential abuse of 

discretion standard applies to my review of the Plan’s denial of plaintiff’s appeal.3

As noted above, both the Trust document and the SPD confer on the Benefits Committee 

 

3 The parties spend significant time addressing whether discretion was properly vested in Anthem 

to decide the initial claim and the first-round appeal. However, the only decision under review by 

me is the Plan’s decision. Therefore, whether discretion was given to Anthem is not really at 

issue, except to the very limited extent that it supports my ultimate conclusion that the Plan 

documents vested discretion in the Benefits Committee to finally decide claim appeals. 

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 5 of 11
6

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

Northern District of California

the authority to take “final action” which has “the same binding effect as action by the full Board,” 

including hearing and determining claims appeals. Trust at 56-57; SPD 106. While plaintiff also 

notes that Section 1 (General Powers), subsection S of the Trust gives the Trustees the “sole and 

complete and discretionary authority” to resolve claims, that the power is “sole” does not 

undermine the other provisions that allow the Trustees to delegate that very responsibility to the 

Benefits Committee, made up of a subset of the Trustees. Compare Trust at ECF pg. 54 with

Trust at pgs. 54, 56-57; see also SPD 89, 106.

Plaintiff’s reliance on Shane v. Albertson’s Inc., 504 F.3d 1166 (9th Cir. 2007) is 

misplaced. In that case, while the Plan granted the Trustees the authority “[t]o determine all 

questions relating to” benefits, because the final decision maker was the “medical review 

committee” (MRC) and not the Trustees themselves, the question became “whether the MRC 

properly received and was vested with the Trustees’ discretionary authority to review [plaintiff’s]

LTD claim. If the MRC was not properly vested with such discretion, its decision to terminate 

[plaintiff’s] LTD benefits would not be subject to the deferential standard of review of abuse of 

discretion.” Id. at 1170. In determining that question, the Ninth Circuit instructed, “the focus 

should have been on whether the Disability Plan contemplated the possibility of a transfer of 

discretionary authority to a third-party and whether there was evidence establishing delegation to 

the MRC.” Id. at 1171. Because the “delegation clause” of the plan at issue did not expressly 

contemplate a transfer of that authority to the MRC (but instead contemplated delegation only to

the “Contract Administrator and Employees of the Employer”), there was no clear and 

unmistakable delegation of authority to the MRC and the review was appropriately de novo. Id. at 

1172.

Here, as noted, the Plan documents themselves expressly contemplate the transfer of the 

full discretionary decision-making authority of the Trustees over claims to the Benefits 

Committee, and any decision by the Benefits Committee is final and binding as if the Trustees 

made it themselves. SPD 89 (“the Designated Committee of the Board of Trustees[] will have 

discretion to deny or grant the appeal in whole or part.”); see also id. at 106 (allowing Board of 

Trustees to establish Benefits Committee and authorizing the Committee to “take final action in 

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 6 of 11
7

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

Northern District of California

specified areas” that “shall have the same binding effect as an action by the full Board of 

Trustees.”). The facts are starkly different than in Shane. See also Madden v. ITT Long Term 

Disability Plan for Salaried Employees, 914 F.2d 1279, 1284 (9th Cir. 1990) (sufficient delegation 

where plan documents allowed Board of Directors to appoint a specific “Long–Term Disability 

(‘LTD’) Administration Committee” to determine eligibility for benefits and construe terms of 

plan).

In Reply, plaintiff points to language from the Trust document confirming that the Trustees 

have “sole” authority over claims. Trust, Section 1.S. That provision simply confirms that the 

Plan Trustees have “the sole complete and discretionary authority” to “grant or deny, in whole or 

in part, particular claims for benefits . . . in accordance with the Plan Trustees’ interpretation of 

the Health Plan. . . .” Dkt. No. 39-4 at 3. It concludes, the “granting or denial of benefits” and 

“decisions of the Plan Trustees (who shall have complete and discretionary authority to make each 

of the foregoing) under this Section shall be final and binding on all personas whomsoever.” Id. 

That language confirms the Trustees’ discretion, which according to both the Trust and SPD 

documents was vested in the Benefits Committee. There is nothing inconsistent, unclear, or 

ambiguous about the powers of the Trustees, the creation and duties of the Benefits Committee, or 

the discretion granted to the Benefits Committee to make final claim decisions on behalf of the 

Board of Trustees.

II. TIMELINESS OF DECISION

Plaintiff also argues that his appeal should have been decided at the November 7, 2018 

Benefits Committee meeting, and that by waiting until the February 2019 meeting, the Plan 

violated its own internal timeframe that required it to review the decision at the Benefits 

Committee’s November 2018 meeting.4 Plaintiff also argues that the failure to proceed on 

November 7, 2018 violated ERISA’s regulations, which also require the appeal to be determined 

 

4 Plan at 89 (“Reviews of denials by the Health Plan office will be heard by the Designated 

Committee at its next regularly scheduled quarterly meeting. However, if an appeal is received 

fewer than 30 days before the meeting, the review may be delayed until the next meeting. In 

addition, if special circumstances require further extension of time, the review may be delayed to 

the following meeting.”).

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 7 of 11
8

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

Northern District of California

at the next quarterly meeting, unless the claimant is notified of special circumstances warranting a 

further delay prior to the commencement of the extension.5 

Plaintiff points out that the Plan did not notify him of any “special circumstances” and did 

not provide effective notice until after commencement of the extension because no correspondence 

was sent to him until November 5, 2018, and that correspondence was misaddressed. Given these 

facts, plaintiff argues that I should consider the appeal “deemed denied” and apply a de novo

standard of review. 

The Ninth Circuit in Jebian v. Hewlett-Packard Co. Employee Benefits Org. Income 

Protec. Plan, 349 F.3d 1098 (9th Cir. 2003) addressed the situation where a claimant’s appeal had 

not been determined within the time frames required by the plan and ERISA. The plan language 

at issue provided that if the administrator had not decided the appeal within a time certain, the 

appeal was “deemed denied.” Given that language, the court held that “where, according to plan 

and regulatory language, a claim is ‘deemed ... denied’ on review after the expiration of a given 

time period, there is no opportunity for the exercise of discretion and the denial is usually to be 

reviewed de novo. While deference may be due to a plan administrator that is engaged in a good 

faith attempt to comply with its deadlines when they lapse, this is not such a case.” Id. at 1103. 

Plaintiff argues the same result should follow here in light of the Benefit Committee’s failure to 

timely consider his appeal. 

However, the import of Jebian was clarified by the Ninth Circuit in Gatti v. Reliance 

Stand. Life Ins. Co., 415 F.3d 9785 (9th Cir. 2005) and does not require de novo review under the 

facts of this case. In Gatti, the Ninth Circuit limited the impact of Jebian and held that 

“procedural violations of ERISA do not alter the standard of review unless those violations are so 

flagrant as to alter the substantive relationship between the employer and employee, thereby 

 

5

29 C.F.R. § 2560.503-1(i)(2)(iii)(B) (“If special circumstances (such as the need to hold a 

hearing, if the plan’s procedures provide for a hearing) require a further extension of time for 

processing, a benefit determination shall be rendered not later than the third meeting of the 

committee or board following the plan's receipt of the request for review. If such an extension of 

time for review is required because of special circumstances, the plan administrator shall notify 

the claimant in writing of the extension, describing the special circumstances and the date as of 

which the benefit determination will be made, prior to the commencement of the extension.”).

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 8 of 11
9

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

Northern District of California

causing the beneficiary substantive harm.” Id. at 985.6 That result was required because it would 

be inconsistent with the statutory structure and Ninth Circuit case law “to alter the standard of 

review on the basis of technical violations of ERISA's requirements.” Id. (discussing and relying 

on Blau v. Del Monte Corp., 748 F.2d 1348 (9th Cir.1984)); see also P. Shores Hosp. v. United 

Behavioral Health, 764 F.3d 1030, 1040 (9th Cir. 2014) (“most procedural errors are not 

sufficiently severe to transform the abuse-of-discretion standard into a de novo standard.”).

Here, as defendants point out, the only alleged violations of the Plan terms or ERISA’s 

requirements are the hearing of the appeal in February 2019 (as opposed to November 2018) and, 

relatedly, the Plan’s failure to identify the special circumstances requiring the continuance and 

effectively notify plaintiff of the continuance prior to the November 7, 2018 Benefits Committee 

meeting. While there may have been a technical violation of ERISA procedural requirements, 

plaintiff does not identify how he was harmed from the lack of prior notice of the extension (due 

to the misaddressing of the November 5, 2018 letter) or the failure to identify special 

circumstances in writing. That failure means plaintiff’s request for de novo review is not 

warranted.

The mere fact that there was delay does not mean the Plan was not acting in good faith. 

On September 12, 2018, the Plan provided plaintiff information about the claim and the appeals 

process and notified plaintiff’s counsel that the next quarterly Benefits Committee meeting was 

scheduled for November 7, 2018. Dkt. No. 37-1 at ECF 147. Plaintiff then filed his “final appeal” 

along with over 2000 pages of supporting documents on October 1, 2018. Dkt. No. 37-1 at ECF 

153. The Plan promptly sent those documents out for review to third-party MRI. Even though the 

Plan had the MRI report in mid-October (in advance of the November 7, 2018 meeting), the record 

shows that there were additional steps that needed to be taken. That included reviewing the MRI 

report, summarizing all of the records for the Benefits Committee and, presumably, getting the 

input from the Chief Medical Advisor. Dkt. No. 39-10; see also 37-1 at ECF 150. The 

 

6 The panel noted that the purpose of the “deemed denial” holding in Jebian meant only that 

plaintiff “could have brought her lawsuit after the time limits [for the appeal] expired,” so that she 

could move her claim forward despite the plan’s failure to act on her appeal within their set 

timeframe. Gatti, 415 F.3d at 984.

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 9 of 11
10

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

Northern District of California

continuation of the matter to the February 2019 meeting was supported by special circumstances.

In addition, the Plan attempted to notify plaintiff’s counsel that the matter would be heard in 

February 2019 on November 5, 2018, which was prior to the previously noted November 7, 2018

meeting (although that letter was apparently misaddressed letter and so was faxed to plaintiff’s 

counsel on November 20, 2018). 

Finally, it is significant that in the Plan’s November 5, 2018 letter plaintiff’s counsel was 

notified of the result of MRI’s report and given a copy of the report. The Plan informed plaintiff’s 

counsel that “any additional information,” including a response to the MRI report, was due 30 

days before the February 2019 meeting. The Plan gave plaintiff more process, namely the 

opportunity to respond to the MRI report before having the appeal finally determined.

Assuming that the Plan did not comply with its own notice and ERISA’s timing 

requirements, that violation was only technical and does not constitute a violation “so flagrant as 

to alter the substantive relationship between the employer and employee, thereby causing the 

beneficiary substantive harm.” Gatti, 415 F.3d at 985. There is no evidence that the Plan took 

egregious steps or otherwise acted in bad faith, or that plaintiff suffered any harm that would merit 

stripping the Plan’s February 2019 determination of an abuse of discretion review. See, e.g.,

Gorbacheva v. Abbott Laboratories Extended Disability Plan, 309 F. Supp. 3d 756, 767 (N.D. 

Cal. 2018) (“Here, regardless of the parties' respective computations of the timeliness of the Plan 

Administrator’s decision, Plaintiff has not identified any substantive harm resulting from 

Defendant’s purportedly untimely decision that would justify deviating from the abuse of 

discretion standard of review.”); Otto v. Employee Ret. Income Plan - Hourly W., 2015 WL 

12516690, at *16 (C.D. Cal. Mar. 13, 2015), aff'd sub nom. Otto v. Employee Ret. Income Plan, 

667 Fed. Appx. 660 (9th Cir. 2016) (unpublished) (“Defendant’s unexplained five-month delay in 

responding was a procedural violation, but it was not so egregious as to warrant the application of 

de novo review.”); Barnes v. AT & T Pension Ben. Plan--Nonbargaines Program, C-08-4058 

EMC, 2012 WL 1657054, at *11 (N.D. Cal. May 10, 2012), aff'd sub nom. Barnes v. AT & T 

Pension Ben. Plan--Nonbargained Program, 622 Fed. Appx. 669 (9th Cir. 2015) (unpublished) 

(“Defendant Plan was late in deciding the initial claim by about 90 days and the appeal by about 

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 10 of 11
11

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

Northern District of California

40 days. It is hard to see how this kind of delay caused Mr. Barnes any substantive harm.”).

CONCLUSION

For the foregoing reasons, the abuse of discretion standard will apply to my review of the 

Plan’s denial of the claim.

IT IS SO ORDERED.

Dated: November 19, 2019

William H. Orrick

United States District Judge

Case 3:19-cv-00361-WHO Document 47 Filed 11/19/19 Page 11 of 11