Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_01-cv-01933/USCOURTS-caed-2_01-cv-01933-2/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 EASTERN DISTRICT OF CALIFORNIA

KAREN LaMANTIA,

NO. CIV. S-01-1933 LKK/GGH

Plaintiff,

v. O R D E R

HEWLETT-PACKARD COMPANY

EMPLOYEE BENEFITS

ORGANIZATION INCOME

PROTECTION PLAN,

Defendant.

 /

Plaintiff, Karen LaMantia (“plaintiff”), filed this action

against Hewlett-Packard Company Employee Benefits Organization

(“defendant”) pursuant to the Employee Retirement Income Security

Act (“ERISA”) to recover benefits provided under an employee income

protection plan. On August 18, 2005 this court granted defendant’s

motion for summary judgment and plaintiff appealed. The Ninth

Circuit remanded the case in light of its recent decision in Abatie

v. Alta Health & Life Ins. Co., 458 F.3d 955 (9th Cir. 2006) (en

banc). Pending before the court are supplemental cross-motions for

summary judgment addressing Abatie and its impact, if any, on this

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26 Undisputed unless otherwise noted. 1

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case. I decide the motions based on the papers and pleadings filed

herein and after oral argument.

I.

FACTS & PROCEDURAL HISTORY1

The basic facts of this case, as well as the procedural

history, are well known to the parties, and, for the most part,

undisputed. However, in the interest of having a clear record, the

court includes a detailed review of the necessary facts and

procedural history of the case. 

A. The Plan

Plaintiff, who held a full-time position as Account

Representative in Hewlett-Packard's Customer Support department,

was a member of the Hewlett-Packard Company Employee Benefits

Organization Income Protection Plan ("Plan"). The Plan was adopted

by Hewlett-Packard Company ("HP") to provide its employees with

income in the event of certain disabilities. HP sponsors the plan

through the Hewlett-Packard Company Employee Benefits Organization

("the Organization"). The Plan is self-funded by HP, rather than

insured through an insurance company, and is administered pursuant

to the Administrative Services Contract it has with Voluntary Plan

Administrators, Inc. ("VPA"), which acts as the claim administrator

for the Plan. 

For VPA to approve a claim for Plan benefits, a member must

establish that she is "Totally Disabled" as defined under the Plan.

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 The practice of calling the Plan Administrator’s proceeding 2

administrative, thus suggesting it is similar to federal

administrative proceedings, puts the entire process in a false

light and may be at least partially responsible for the unusual

deference paid to a private company’s financial decisions.

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Administrative Transcript (“AT”) at HP00354-00355. The 2

requirements for Total Disability vary, depending upon whether the

member seeks short or long term disability benefits. Where the

member seeks short-term disability ("STD") benefits, Total

Disability means that, "following the onset of injury or sickness,

the member is continuously unable to perform each and every duty

of his or her Usual Occupation." A member's Usual Occupation is

defined as the normal work assigned to the member by HP. AT at

HP00358. The Plan also provides that a member must be under the

care of a licensed physician and be examined at a frequency

consistent with the Member's condition. AT at HP00355. If a

member qualifies, the member is entitled to up to a maximum of 39

weeks of STD benefits. 

By contrast, after the initial 39 week period, where a member

seeks long-term disability ("LTD") benefits, Total Disability means

that, "the Member is continuously unable to perform any occupation

for which he or she is or may become qualified by reason of his or

her education, training or experience." AT at HP00355. Certain

conditions are excluded under the Plan from consideration for LTD

benefits. First, the Plan provides:

Any condition diagnosed as, or without regard to its

designation is equivalent to, (1) attention deficit

disorder (ADD), or (2) chronic fatigue syndrome,

Epstein-Barr Virus, or infectious mononucleosis shall be

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disregarded in determination of Total Disability 

. . . .

AT at HP00355. The Plan also provides:

[I]n the case of a disability resulting from a nervous

or mental disorder, the Member shall be considered

Totally Disabled only if he or she is confined to a

hospital or other licensed long-term care facility for

the treatment of such disability or has been so confined

for fourteen (14) or more consecutive days during the

preceding three (3) months.

AT at HP00356. Under the Plan, an illness is considered a nervous

or mental disorder if:

1. The illness has psychologic or behavioral

manifestations or results in impairment of mental

functioning due to any causes including, but not limited

to, social, psychological, genetic, physical, chemical

or biological; and

2. The illness has a primary diagnosis that either is

listed in the American Psychiatric Association's

Diagnostic and Statistical Manual of Mental Disorders,

Third Edition-Revised, or falls within diagnostic codes

290 through 319 in the International Classification of

Diseases, 9th Revision.

Id. 

The Plan's claims administrator, VPA, must make the

determination of Total Disability on the basis of "objective

medical evidence," which the Plan defines as "evidence establishing

facts or conditions as perceived without distortion by personal

feelings, prejudices or interpretations." AT at HP00355. It is the

member seeking benefits who is "solely responsible for submitting

the claim form and any other information or evidence on which the

Member intends the Claims Administrator to consider in order to

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render a decision on the claim." AT at HP00375.

Where a claim for benefits is denied, the Plan provides that

the member is permitted to appeal the denial by submitting a

written request for review. AT at HP00377. With respect to an

appeal of a denial of benefits, the Organization "is the named

fiduciary which has the discretionary authority to act with respect

to any appeal from a denial of benefits. The Organization's

discretionary authority includes the authority to determine

eligibility for benefits and to construe the terms of the Plan."

Id. 

Upon appeal of a denial of benefits, the claims administrator

must "give the claimant (or the claimant's representative) an

opportunity to review pertinent documents . . . in preparing a

request for review." Id. The Plan provides, however, that the

claimant is "solely responsible for submitting a written request

for review of the claim and any other information or evidence on

which the Member intends the Claims Administrator to consider in

order to render a decision on review." AT at HP00377. The claims

administrator may require the claimant to seek additional

information or evidence as it deems appropriate to its review. Id.

The Plan provides that, absent special circumstances, a

request for review should be "act[ed] upon" "within sixty (60) days

after the receipt thereof," and "[i]n no event shall the decision

of the Claims Administrator be rendered more than one hundred

twenty (120) days after it receives the request for review." AT

at HP00378. The Plan further provides that a claimant should

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receive written notice of a denial of the appeal and the specific

bases for denial. It also provides, however, that, absent written

notice that additional time for review is required, "within sixty

(60) days of the date his or her request for review is reached by

the Claims Administrator, the claim shall be deemed to have been

denied on review." Even where a claimant is given notice that

additional time is required for review, the Plan provides that

where the claimant "does not receive written notice of the Claims

Administrator's decision with respect to his or her claim within

one hundred twenty (120) days after the date the Claims

Administrator receives the request for review, the claim shall be

deemed to have been denied." AT at HP00379. 

Should the claimant wish to file suit regarding the denial of

benefits, the Plan provides that the claimant must first exhaust

the so-called administrative remedies set forth in the Plan. AT

at HP00379. The Plan also contains a time limitation for bringing

suit. It provides that "[N]o action at law or equity shall be

brought to recover benefits under the Plan unless the action is

commenced within four (4) years after the occurrence of the loss

for which the claim is made." Id. The Summary Plan Description

provides plan members with information concerning the exhaustion

requirement and the limitations for suit. It reads: "No legal

action may be taken until all the claim review procedures have been

completed. No legal action may be taken to gain benefits from the

Plan after four years from when the disability occurred." AT at

HP00441.

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B. Plaintiff’s Benefits Claim 

On August 19, 1996, plaintiff filed her initial claim for STD

benefits under the Plan. She described her disability as anemia,

hysterectomy, and stress. In the Physician's Certification of

Disability, her doctor explained that plaintiff's primary diagnosis

was iron deficiency and anemia, and listed "chronic immune

deficiency fatigue syndrome" as a secondary diagnosis. Plaintiff

was awarded short-term benefits.

On February 27, 1997, plaintiff filed a claim for long-term

disability benefits in which she listed a number of symptoms

including nausea, muscle and joint pain, stress, chronic

bronchitis, headaches, anxiety, depression, and panic attacks. 

The VPA denied plaintiff's claim for LTD benefits by letter

dated May 14, 1997. In the letter, Dee Goodenough, a VPA employee

with the title "Disability Benefit Specialist," addressed the

limitations on disability claims based on mental health issues and

chronic fatigue syndrome. She then asserted that the objective

medical records supported that plaintiff was being treated for

chronic fatigue syndrome, fibromyalgia, depression, and chronic

bronchitis, but did not support a limitation in function due to

these conditions. Goodenough concluded that, in her opinion, the

objective medical evidence in the file did not support any

limitation in function. She also stated that, as to the diagnosis

of fibromyalgia, the medical records contained no supporting data

that plaintiff's symptoms were the result of an organic impairment.

Goodenough noted that plaintiff had a right to request review, and

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 There is no evidence that Ms. Goodenough has any meaningful 3

training justifying her making the evaluation that defined

plaintiff’s right to LTB. This absence would seem enough in and

of itself, in a rational system, to suggest that the determination

was arbitrary and capricious

 The failure to provide counsel will all the relevant records 4

is at least suggestive that VPA had not examined all the pertinent

information. In any event it would appear that the defendant had

the duty to explain the failure and in the absence of explanation

there is a second suggestion of arbitrary decision making. 

8

informed plaintiff that she would receive a written decision within

120 days of the date of her request for review. Goodenough also

noted that if plaintiff did not receive a written decision within

120 days, "the appeal can be considered denied." AT at HP00067.3

In a letter dated June 10, 1997, plaintiff appealed the denial

of benefits, alleging that she was disabled due to fibromyalgia,

chronic fatigue syndrome, immune deficiency syndrome, pulmonary

problems, and depression. She stated that she was appealing on the

basis that her fibromyalgia, pulmonary problems, and immune

deficiency syndrome were disabling. Def's AT at HP00062-63. 

4

On July 1, 1997, copies of the Plan were sent to plaintiff's

attorney, along with most of plaintiff's medical records. VPA

informed plaintiff's counsel that any additional information

plaintiff wished to submit should be submitted within 30 days. AT

at HP00005-6, 00061. On July 24, 1997, plaintiff's attorneys

requested additional time to acquire additional medical

documentation to support her appeal. VPA agreed to extend the

appeal submission date another thirty days to September 3, 1997.

VPA sent copies of additional medical reports to plaintiff's

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Part of the problem in many ERISA cases, including this 5

one, is that the time limits imposed by the administrator in the

plan ignores the fact that many physicians are busy treating

patients and view writing reports as a distraction from their

primary duty. Of course this observation is inapplicable to

physicians who are hired by the plan to evaluate claimants and

thus, as to those examined, the physicians have no treating

obligations.

9

counsel on August 11, 1997, and gave plaintiff until September 8,

1997 to submit her information. On September 18, 1997, plaintiff's

counsel sent VPA a copy of a report from Dr. Agresti dated

September 16, 1997, and stated that an additional report would be

forthcoming. The following day, in a telephone conversation with

Lance Tomei of VPA, plaintiff's counsel stated that it might take

another month to schedule plaintiff for a medical evaluation. On

October 3, 1997, plaintiff's counsel sent a letter to Tomei

purporting to "memorializ[e] our agreement that the appeal review

. . . will not conclude until such time as Ms. LaMantia has

obtained a report from an evaluator of her choice and submitted

said report." AT at 000414. Plaintiff's counsel wrote that he

hoped to obtain the report in two months. 

5

Whether plaintiff's counsel continued to communicate with VPA

over the next three years is in dispute. In any event, it is

undisputed that in August of 2000 VPA received a letter from

plaintiff's current counsel asking for a response to materials that

plaintiff's counsel had allegedly sent in 1999. VPA responded that

they had not received the materials and asked for copies, along

with an explanation as to why there had been a delay between

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 The reason that plaintiff’s counsel did not provide an 6

explanation may be inferred from its correspondence to VPA

suggesting that the lack of communication was the administrator’s

fault rather than plaintiff’s. Plaintiff’s counsel had been under

the belief that VPA had received the material sent in 1999.

 Once again there is no indication that Ms. Curry has any 7

expertise justifying her ability to evaluate the contents of the

file.

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October 1997 and 1999.6

It was another year before VPA sent a letter to plaintiff's

counsel stating that her appeal was denied. Claims Manager, Janet

Curry, explained: 

The medical file in question does not support Ms.

LaMantia's functional ability was limited to the point

of precluding performance of sedentary or light work

based on chronic bronchitis and fibromyalgia as of May

9, 1997. The symptoms alleged are those of depression,

chronic fatigue syndrome, and Epstein Barr virus and in

the absence of these symptoms, she could return to her

job at Hewlett-Packard Company. As the objective

medical evidence and Plan limitations in file do not

support Ms. LaMantia's total disability based on the

Plan definition as of May 9, 1997, we have no

alternative other than to reaffirm our decision to deny

benefits beyond the initial 39 weeks.

AT at HP00011.7

C. Procedural History 

The procedural history of this case is protracted and

unsatisfactory. On two occasions this court’s resolution of a

motion for summary judgment has been reversed by the Ninth Circuit

because of intervening changes in the law.

Plaintiff filed suit on October 17, 2001. On December 20,

2002, this court determined that the VPA improperly denied

plaintiff long term disability benefits resting on the then

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 Under that rule, the opinions of a claimant’s treating 8

physician was given special deference and could only be disregarded

for clear and convincing reasons based on substantial evidence in

the record. See Regula v. Delta Family-Care Disability

Survivorship Plan, 266 F.3d. 1130(9th Cir. 2001), vacated 539 U.S.

901(2003).

11

applicable “treating doctor” rule. Defendant appealed. While the 8

case was pending the Supreme Court rejected application of the rule

in ERISA cases. See Black & Decker Disability Plan v. Nord, 538

U.S. 822 (2003). On March 23, 2005, the Ninth Circuit reversed and

remanded. See Lamantia v. Voluntary Plan Administrators, Inc., 401

F.3d 1114 (9th Cir. 2005).

Although clearly all that was necessary was citation to Black

& Decker, the Circuit did not stop there but went on to opine that

the Plan at issue gave VPA “‘the discretionary power to construe

the language of the Plan and make the decision on review,’ so the

abuse of discretion standard would normally apply.” LaMantia, 401

F.3d at 1123 (citing Firestone Tire and Rubber Co. v. Bruch, 489

U.S. 101, 115 (1989)). That panel concluded: 

By exercising its discretion and allowing material to be

filed after the deemed-denial period when the claimant is

requesting the extension, the claims administrator should

not be subjected to the more scrutinizing de novo standard

of review . . . Otherwise, claims administrators would have

no incentive to allow extensions beyond the deemed-denial

period when claimants seek an extension because they would

be subject to de novo review.

Id. at 1123 -1124 (internal citations omitted). As will become

clear, the first Ninth Circuit opinion, when read in conjunction

with the second opinion discussed below, creates serious questions

as to this court’s obligations.

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In any event, this court did its duty upon the first remand,

and reviewed the parties’ summary judgment motions consistent with

the Ninth Circuit’s instructions. 

On August 18, 2005 this court ruled on the parties’ cross

motions for summary judgment and per the Circuit’s instruction,

reviewed the administrator’s decision for abuse of discretion. The

court found in favor of defendant. Given the deferential standard

of review, this court reasoned that VPA was within its discretion

to deny benefits:

[P]laintiff's physicians' statements concluded that her

condition precluded her from working, but never explained what

objective medical evidence supported those conclusions.

Similarly, defendant made a specific request to Dr. Argesti to

provide it with the specific information that was missing, and

Dr. Argesti failed to respond. Following Jordan, it was

reasonable for defendant to render Dr. Argesti's conclusory

statements less reliable. . . [D]efendant also had before it

medical evidence casting the diagnoses of the alleged

debilitating conditions into question. Finally, the terms of

the Plan made it clear that it was plaintiff's burden to

produce objective medical evidence of a Total Disability. As

in Jordan, given the method of analysis mandated, this court

cannot conclude that it was unreasonable for defendant to deny

her application for LTD benefits on the basis that she failed

to prove that she was completely unable to work at any job for

which she was or could become qualified for. 

August 18, 2005 Order at 28. Plaintiff appealed the court’s

decision granting defendant’s motion. Once again a change in the

law intervened.

The day before oral argument on plaintiff’s appeal, the Ninth

Circuit issued an opinion in Abatie v. Alta Health & Life Ins. Co.,

458 F.3d 955 (9th Cir. 2006)(en banc). In light of Abatie, the

Ninth Circuit remanded the pending case. In the remand order, the

court explained: 

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Abatie states that abuse-of-discretion review is merited, in

almost all cases, when the plan confers sufficient discretion

to the plan administrator. This court has held that the Plan

[at issue in the pending case] sufficiently vests such

discretion.

LaMantia v. Hewett-Packard Company, No. 05-17744, 2006 WL 2634697

(9th Cir. Sept. 14, 2006)(citing to LaMantia v. Voluntary Plan

Adm'rs, Inc., 401 F.3d 1114, 1123 (9th Cir.2005)). Nevertheless in

remanding the case, the court determined that “[b]ecause Abatie

creates such a significant shift in the analysis and because of the

district court’s ability to conduct fact finding beyond the

administrative record, the district court should apply Abatie in

the first instance.” LaMantia, No. 05-17744, 2006 WL 2634697 (9th

Cir. Sept. 14, 2006).

It is difficult for this court to understand its duty in light

of the Circuit’s acknowledgment on the one hand that the plan

vested discretion in the administrator, and the Circuit’s assertion

that this court has the power to conduct “fact finding beyond the

administrative record,” on the other. It may be that the Circuit,

in suggesting that this court “apply Abatie in this first

instance,” was directing this court to examine whether under Abatie

a less deferential review was appropriate.

As best it can, this court now reviews the parties’ cross

motions consistent with the Ninth Circuit’s instructions.

II.

STANDARDS

Summary judgment is appropriate when it is demonstrated that

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there exists no genuine issue as to any material fact, and that the

moving party is entitled to judgment as a matter of law. Fed. R.

Civ. P. 56(c); See also Adickes v. S.H. Kress & Co., 398 U.S. 144,

157 (1970); Secor Limited v. Cetus Corp., 51 F.3d 848, 853 (9th

Cir. 1995).

Under summary judgment practice, the moving party

[A]lways bears the initial responsibility of

informing the district court of the basis for

its motion, and identifying those portions of

"the pleadings, depositions, answers to

interrogatories, and admissions on file,

together with the affidavits, if any," which

it believes demonstrate the absence of a

genuine issue of material fact.

Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). "[W]here the

nonmoving party will bear the burden of proof at trial on a

dispositive issue, a summary judgment motion may properly be made

in reliance solely on the 'pleadings, depositions, answers to

interrogatories, and admissions on file.'" Id. Indeed, summary

judgment should be entered, after adequate time for discovery and

upon motion, against a party who fails to make a showing sufficient

to establish the existence of an element essential to that party's

case, and on which that party will bear the burden of proof at

trial. See id. at 322. "[A] complete failure of proof concerning

an essential element of the nonmoving party's case necessarily

renders all other facts immaterial." Id. In such a circumstance,

summary judgment should be granted, "so long as whatever is before

the district court demonstrates that the standard for entry of

summary judgment, as set forth in Rule 56(c), is satisfied." Id.

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at 323.

If the moving party meets its initial responsibility, the

burden then shifts to the opposing party to establish that a

genuine issue as to any material fact actually does exist.

Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574,

586 (1986); See also First Nat'l Bank of Ariz. v. Cities Serv. Co.,

391 U.S. 253, 288-89 (1968); Secor Limited, 51 F.3d at 853. 

In attempting to establish the existence of this factual

dispute, the opposing party may not rely upon the denials of its

pleadings, but is required to tender evidence of specific facts in

the form of affidavits, and/or admissible discovery material, in

support of its contention that the dispute exists. Fed. R. Civ. P.

56(e); Matsushita, 475 U.S. at 586 n.11; See also First Nat'l Bank,

391 U.S. at 289; Rand v. Rowland, 154 F.3d 952, 954 (9th Cir.

1998). The opposing party must demonstrate that the fact in

contention is material, i.e., a fact that might affect the outcome

of the suit under the governing law, Anderson v. Liberty Lobby,

Inc., 477 U.S. 242, 248 (1986); Owens v. Local No. 169, Assoc. of

Western Pulp and Paper Workers, 971 F.2d 347, 355 (9th Cir. 1992)

(quoting T.W. Elec. Serv., Inc. v. Pacific Elec. Contractors Ass'n,

809 F.2d 626, 630 (9th Cir. 1987), and that the dispute is genuine,

i.e., the evidence is such that a reasonable jury could return a

verdict for the nonmoving party, Anderson, 477 U.S. 248-49; see

also Cline v. Industrial Maintenance Engineering & Contracting Co.,

200 F.3d 1223, 1228 (9th Cir. 1999).

In the endeavor to establish the existence of a factual

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dispute, the opposing party need not establish a material issue of

fact conclusively in its favor. It is sufficient that "the claimed

factual dispute be shown to require a jury or judge to resolve the

parties' differing versions of the truth at trial." First Nat'l

Bank, 391 U.S. at 290; See also T.W. Elec. Serv., 809 F.2d at 631.

Thus, the "purpose of summary judgment is to 'pierce the pleadings

and to assess the proof in order to see whether there is a genuine

need for trial.'" Matsushita, 475 U.S. at 587 (quoting Fed. R.

Civ. P. 56(e) advisory committee's note on 1963 amendments); see

also International Union of Bricklayers & Allied Craftsman Local

Union No. 20 v. Martin Jaska, Inc., 752 F.2d 1401, 1405 (9th Cir.

1985).

In resolving the summary judgment motion, the court examines

the pleadings, depositions, answers to interrogatories, and

admissions on file, together with the affidavits, if any. Rule

56(c); See also In re Citric Acid Litigation, 191 F.3d 1090, 1093

(9th Cir. 1999). The evidence of the opposing party is to be

believed, see Anderson, 477 U.S. at 255, and all reasonable

inferences that may be drawn from the facts placed before the court

must be drawn in favor of the opposing party, see Matsushita, 475

U.S. at 587 (citing United States v. Diebold, Inc., 369 U.S. 654,

655 (1962) (per curiam)); See also Headwaters Forest Defense v.

County of Humboldt, 211 F.3d 1121, 1132 (9th Cir. 2000).

Nevertheless, inferences are not drawn out of the air, and it is

the opposing party's obligation to produce a factual predicate from

which the inference may be drawn. See Richards v. Nielsen Freight

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 This apparent limitation on the scope of examination for 9

conflict seems extremely crabbed. Obviously, plans are not

eleemosynary organizations. They are paid for acting as an

administrator, and must have in mind that too liberal a granting

of long term disability benefits may cause its employer to seek

administration elsewhere. How to account for this reality has not

17

Lines, 602 F. Supp. 1224, 1244-45 (E.D. Cal. 1985), aff'd, 810 F.2d

898, 902 (9th Cir. 1987).

Finally, to demonstrate a genuine issue, the opposing party

"must do more than simply show that there is some metaphysical

doubt as to the material facts. . . . Where the record taken as a

whole could not lead a rational trier of fact to find for the

nonmoving party, there is no 'genuine issue for trial.'"

Matsushita, 475 U.S. at 587 (citation omitted).

III.

ANALYSIS

A. The Significance of Abatie

The Abatie ruling is significant in several ways. First, the

decision clarifies that abuse of discretion review is required

whenever “an ERISA plan grants discretion to the plan

administrator, but a review informed by the nature, extent, and

effect on the decision-making process of any conflict of interest

that may appear in the record.” Abatie, 458 F.3d at 967. This

standard applies to the kind of inherent or structural conflict of

interest that exists when an insurer acts as both the plan

administrator and funding source for benefits, without any

additional requirement that the claimant come forth with "smoking

gun" evidence of the administrator's motives. Id. at 967-69. 

9

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been addressed in the cases. Because of that, nothing in the

instant record reflects whether HP has in the past changed

administrators, if so what reasons were given, the fees paid VPA

and other facts which might bare on the issue. Of course it is not

for the court to determine what facts the parties believe are

relevant. 

18

The Abatie decision also addresses what standard of review

district courts should apply when administrators fail to follow

procedural requirements of ERISA. Id. at 971. Citing to its own

decision in Gatti v. Reliance Standard Life Ins. Co., 415 F.3d 978,

985 (9th Cir 2005), the court clarified that when “an administrator

engages in wholesale and flagrant violations of the procedural

requirements of ERISA, and thus acts in utter disregard of the

underlying purpose of the plan as well, we review de novo the

administrator's decision to deny benefits.” Id. at 981. As an

example of a flagrant violation, the court described the

administrator’s actions in Blau v. Del Monte Corp., 748 F. 2d 3d

1349 (9th Cir. 1984). There, the administrator kept the policy

details secret from the employees, offered the employees no claims

procedure, and did not provide the employees in writing the

relevant plan information; “in other words, the administrator

‘failed to comply with virtually every applicable mandate of

ERISA.’” Abatie, 458 F.3d at 971 (quoting Blau, 748 F. 2d at 1353).

Finally, the Abatie decision also clarifies what standard of

review to apply when there is evidence of procedural irregularities

that cannot be characterized as flagrant or wholesale violations of

ERISA. Id. at 972. The Abatie decision instructs that procedural

errors are relevant to a court’s analysis: 

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A procedural irregularity, like a conflict of interest, is a

matter to be weighed in deciding whether an administrator's

decision was an abuse of discretion . . . When an

administrator can show that it has engaged in an ‘ongoing,

good faith exchange of information between the administrator

and the claimant,’ the court should give the administrator's

decision broad deference notwithstanding a minor irregularity.

. . A more serious procedural irregularity may weigh more

heavily.

Id. at 972. (internal citations omitted). Importantly, the Abatie

decision also provides that: 

Even when procedural irregularities are smaller . . .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. The court turns next to the question of what standard

of review to apply in the instant case.

B. The Appropriate Standard of Review in Light of Abatie

At the outset, it is important to note that the Abatie

decision, while significant, has a limited scope. Abatie addresses

the proper standard of review in light of either conflicts of

interest or procedural errors. The Abatie decision does not,

however, alter how courts determine if procedural errors exist in

any given case.

It is also important to acknowledge that the Ninth Circuit in

its first LaMantia opinion determined that there was no conflict of

interest. While the most recent remand order requires that Abatie

be applied in the first instance, it does noting to suggest that

the Circuit’s first opinion relative to a conflict is subject to

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 Although at one point plaintiff claimed there was a 10

conflict of interest, in its August 18, 2006 order, this court

specifically found that there was no conflict of interest. See

August 18, 2006 order at 18. The Ninth Circuit, in its recent

remand order, also found that the plan at issue in this case

confers sufficient discretion to the plan administrator. In short,

under present standards, and the present record, there is no

structural conflict of interest present in this case. For this

reason, Abatie’s holding with respect to the standard of review

when the administrator labors under a conflict of interest is not

relevant. 

20

further review. The court thus assumes that it is bound by the

first LaMantia opinion and, where, as here, the Ninth Circuit has

already found that VPA was not acting under a conflict of interest,

there is no occasion to revisit this finding in light of Abatie.10

Plaintiff argues that there were flagrant procedural

violations of ERISA and therefore, the court should review de novo

VPA’s decision to deny plaintiff’s long-term disability benefits.

Reviewing the record, however, the court cannot conclude that the

administrator engaged in “wholesale and flagrant violations of the

procedural requirements of ERISA,” which would justify de novo

review. See Abatie at 971. The court briefly addresses

plaintiff’s arguments.

Plaintiff first maintains that VPA’s final denial of her LTD

claim was inconsistent with its initial denial. Citing to Lang v.

LTD Plan of Spinsor Applied Remote Tech. Inc., 125 F.3d 794 (9th

Cir. 1977), plaintiff avers that review should be de novo when a

plan administrator gives one reason for the initial denial and then

changes reasons in the final denial. See Pl.’s Mot. for Summ. J.

at 10. 

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 See footnote 3. 11

 See footnote 7. 12

21

The record does not support plaintiff’s contention. VPA’s

initial denial of plaintiff’s LTD benefits noted that plaintiff was

“being treated for Chronic Fatigue Syndrome, Fibromyalgia,

depression and chronic bronchitis.” AT at HP 00066. Dee

Goodenough, the Disability Benefit Specialist, determined, 11

however, that although plaintiff did “have some of the classic

tender points to support this diagnosis [Fibromyalgia] there is no

supporting data to indicate your subjective symptoms are a result

of an organic impairment.” Id. Accordingly, Ms. Goodenough

determined that: 

Due to the lack of objective findings to support an

organic basis for a limitation in function which would

preclude you from performing your occupation at

Hewlett-Packard or any other sedentary occupations

outside of Hewlett-Packard Company, we have no

alternative than to deny your claim as you do not satisfy

the definition of Total Disability as defined above.

AT at HP00066. VPA's final denial of plaintiff's claims was no

different. The Claims Manager, Janet Curry, evaluated evidence 12

submitted by plaintiff and concluded that despite Dr. Agresti’s

diagnosis of Fibromyalgia, he “provided no evidence of Ms.

LaMantia’s functional level and fails to support [that] her

symptoms are related to other than depression, chronic fatigue

syndrome and Esptein barr virus.” AT at HP 00015. Ms. Curry also

reviewed the report of an independent medical examiner, Dr. Wood.

Dr. Wood “did not believe that [plaintiff] has fibromyalgia as a

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 Plan § 2(q)(i), defines Total disability to specifically 13

provide that a member suffering from a mental illness meets the

22

clinical entity...[and] the diagnosis of fibromyalgia is

unwarranted.” Id. Accordingly, Ms. Curry concluded: 

The medical file in question does not support Ms.

LaMantia's functional ability was limited to the point of

precluding performance of sedentary or light work based

on chronic bronchitis and fibromyalgia as of May 9, 1997.

The symptoms alleged are those of depression, chronic

fatigue syndrome, and Epstein Barr virus and in the

absence of these symptoms, she could return to her job at

Hewlett-Packard Company. As the objective medical

evidence and Plan limitations in file do not support Ms.

LaMantia's total disability based on the Plan definition

as of May 9, 1997, we have no alternative other than to

reaffirm our decision to deny benefits beyond the initial

39 weeks.

AT at HP00011. Without passing judgment on whether VPA’s reasons

for the denials were an abuse of discretion, the court finds that

the reasoning for both denials was essentially the same: the

medical evidence did not support a finding that plaintiff suffered

from any limitation in function that might render her totally

disabled as that term is defined in the Plan. 

While plaintiff is correct that the denial of plaintiff’s

appeal mentioned an additional alleged symptom, the Epstein Barr

virus, these disabilities were discussed as being alleged symptoms

that were part of the record. There was no discussion of whether

plaintiff was in fact disabled due to these conditions. See AT at

HP00011. In this regard it is important to note that the

definition of "total disability" under the Plan specifically

excludes these conditions, therefore, any statement regarding them

cannot serve as a basis for granting the LTD claim. 

13

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definition of "Total Disability" "only if he or she is confined to

a hospital or other licensed long term care facility for the

treatment of such disability or has been so confined for fourteen

(14) or more consecutive days during the preceding three (3)

months." Curry Decl. Ex. A, HP 00356. Because Plaintiff was never

confined to a "hospital or other long term care facility" for the

treatment of her depression, that depression is a condition

expressly excluded from the definition of "Total Disability." Id.

 The remand order states that “the district court should 14

apply Abatie in the first instance.” Clearly this language might

suggest that the court should disregard its prior rulings premised

on a narrower scope of review and essentially start from scratch.

However, in the context of the rest of language of the remand

order, it seems reasonable to conclude that the Circuit is

suggesting that if, upon analysis, Abatie changes the standard of

review, the district court is in the best position to conduct fact

finding beyond the record. 

23

The conclusion of both findings were essentially the same:

there was insufficient evidence that plaintiff suffered from

Fibromyalgia. There was no significant variance between the

initial denial and the final denial. Therefore, this alleged error

does not constitute a “wholesale and flagrant violation[] of the

procedural requirements of ERISA.” Abatie at 971.

Plaintiff also makes several arguments that were previously

presented to this court. Richardson v. United States, 841 F.2d 993

(9th Cir.1988). It is well established that “[u]nder the ‘law of

the case’ doctrine, a court is ordinarily precluded from

reexamining an issue previously decided by the same court, or a

higher court, in the same case.” Id. at 996. The court now turns 14

to plaintiff’s other contentions. 

First, plaintiff maintains that the VPA did not issue a timely

decision. See Pl.’s Mot. for Summ. J. at 11. Both this court and

the Ninth Circuit have already rejected this argument. In the

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first remand order, the Ninth Circuit concluded that it was

plaintiff who was responsible for the delay: 

[B]y allowing more medical information to be filed past

the deemed-denial period when the claimant makes such a

request, and by subsequently rendering a decision on the

merits, VPA exercised its discretion. By exercising its

discretion and allowing material to be filed after the

deemed-denial period when the claimant is requesting the

extension, the claims administrator should not be

subjected to the more scrutinizing de novo standard of

review.

LaMantia, 401 F.3d at 1123. This Court took note of the Ninth

Circuit's decision and found that VPA did not issue an untimely

final decision:

Plaintiff first asserts that a less deferential standard

should apply because defendant acted in bad faith when it

failed to render a timely decision of her appeal of the

denial of long-term disability benefits. The Ninth

Circuit has already addressed this issue and foreclosed

this argument. The panel determined that the delays in

making a final determination on plaintiff's appeal were

not a result of defendant's bad faith because it was

plaintiff "who sought an extension of time which caused

the deadline to file documents to occur beyond the

deemed-denial date." LaMantia at 1123.

August 18, 2005 Order, at 15-16. Plaintiff presents no compelling

reason as to why the court should upset its prior ruling on the

matter. Similarly, plaintiff presents no legal authority for why

the court should view the timing of the VPA’s decision as evidence

of a “flagrant” procedural error. 

Second, plaintiff avers that VPA “went doctor shopping.” Pl.’s

Mot. for Summ. J. at 12. Again, the court already addressed this

very argument in its August 18, 2005 order:

Plaintiff next argues that defendant acted in bad faith

because the VPA arranged for her to be evaluated by more

than one doctor. According to plaintiff, this

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demonstrates that the VPA "acted more as an advocate for

denial, than a fair and impartial third party looking to

make the right decision." This argument is unsupported

by any legal authority and is less than convincing.

Nothing in the record supports a finding that the

independent medical examinations were impermissible.

August 18, 2005 Order, at 16. The Abatie decision offers no

additional guidance or insight into how to analyze the issue of

whether VPA was “doctor shopping.” Even if the court were to have

second thoughts on its prior order, the law of the case doctrine

prevents this court from revisiting its prior ruling. Because

Abatie does not alter how the court should analyze this particular

issue, there is no basis for the court to revisit its prior ruling.

Third, plaintiff argues that VPA wrongfully evaluated her

eligibility for long-term disability benefits as of May 1997, at

the end of the Plan’s 39 week short-term disability period, instead

of August 1997, at the end of the 52 week period. See Pl.’s Mot.

for Summ. J. at 14. In its August 18, 2005 order, the court

rejected this identical argument: 

In any event, plaintiff was in no way prejudiced by

defendant's evaluation of her application at the end of

the 39 week period rather than after 52 weeks. there is

no indication that any new documents were available at

the end of the 52 week period that were not available at

the end of the 39 week period. Therefore, any procedural

error committed by defendant was harmless, since waiting

an additional 13 weeks to assess plaintiff's status would

have been inconsequential.

More importantly, VPA's initial assessment has no bearing

on the larger issue now before the court, that is,

whether or not VPA's ultimate denial of benefits was an

abuse of discretion. The final determination of her

long-term application was not made until August of 2001,

which included a review of plaintiff's medical reports

from September 1997 to 1999. Accordingly, the medical

reports reviewed by VPA were not limited to those dated

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before May 1997, as claimed by plaintiff.

August 18, 2005 Order, at 20. Plaintiff fails to present any

reason as to why, in light of Abatie, this alleged error should be

construed as a flagrant error warranting de novo review. There is

simply no reason for the court to revisit its prior finding that

any procedural error was harmless. 

Plaintiff also asserts that VPA failed to include two letters

in the administrative record. The letters at issue were written by

Dr. Agresti and Dr. Herman in June of 1997. Without deciding

whether or not this omission constitutes a flagrant procedural

error, the court notes that it did in fact review these two letters

in its August 18 order. See August 18, 2005 Order at 22. Having

reviewed these two letters, along with the rest of the record, this

court still concluded that VPA did not abuse its discretion in

denying benefits. See August 18, 2005 order at 28. 

Plaintiff’s final two arguments are that VPA failed to

adequately investigate the claim and that VPA failed to credit

plaintiff’s reliable evidence when it determined that she was not

editable for LTD benefits. See Pl.’s Mot. for Summ. J. at 15 & 17.

Both of these arguments are, in fact, disagreements with VPA’s

decisions on the merits, not VPA’s procedures. Any procedural

irregularity plaintiff cites within these arguments is minor. 

For these reasons, the court finds that there were no

“wholesale and flagrant violations of the procedural requirements

of ERISA” which would require de novo review. Abatie, at 971-972

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(explaining that “when a plan administrator's actions fall so far

outside the strictures of ERISA that it cannot be said that the

administrator exercised the discretion that ERISA and the ERISA

plan grant, no deference is warranted.”) Under Abatie, abuse of

discretion remains the proper standard of review. 

Plaintiff also appears to argue that, at the very least, the

above cited violations should be considered procedural

irregularities, if not flagrant errors. Abatie explains:

A procedural irregularity, like a conflict of interest,

is a matter to be weighed in deciding whether an

administrator's decision was an abuse of discretion . .

. When an administrator can show that it has engaged in

an ‘ongoing, good faith exchange of information between

the administrator and the claimant,’ the court should

give the administrator's decision broad deference

notwithstanding a minor irregularity. . . A more serious

procedural irregularity may weigh more heavily.

Abatie, at 972 (internal citations omitted). In the case at bar,

the Ninth Circuit, in its first remand order in 2005, specifically

addressed the issue of “good faith.” In the remand order, the

Ninth Circuit discussed at some length its own decision in Jebian

v. Hewlett-Packard Co. Employee Benefits Org. Income Prot. Plan,

349 F.3d 1098, 1103 (9th Cir. 2003). In Jebian, the court

addressed when a court applies de novo review and explained that an

exception which would warrant deference is when the plan

administrator “is engaged in a good faith attempt to comply with

its deadlines.” Id. The Ninth Circuit concluded that the Jebian

“good faith” exception applied to the circumstance in the case at

bar. The Circuit explained that there was: 

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good faith communication between the claims administrator

and the claimant. There were letters and telephone

conversations between VPA and LaMantia's counsel

beginning several weeks before the deemed-denial date

that led to extensions of time, all of which were at the

request of LaMantia to enable her to file additional

medical information. 

LaMantia v. Voluntary Plan Administrators, Inc., 401 F.3d 1114,

1123 (9th Cir. 2005). For this reason the Ninth Circuit concluded

that the Jebian exception warranted deferential review in the

pending case.

Nothing in Abatie suggests that this court should reexamine

the Ninth Circuit’s conclusion that there was “good faith”

communication as defined by the Jebian case. Moreover, this court

noted in its August 18, 2005 order: 

The Ninth Circuit has already addressed this issue and

foreclosed this argument. The panel determined that the

delays in making a final determination on plaintiff’s

appeal were not a result of defendant’s bad faith because

it was plaintiff ‘who sought an extension of time which

caused the deadline to file documents to occur beyond the

deemed-denial date.’

 August 18, 2005 order, quoting LaMantia v. Voluntary Plan

Administrators, Inc., 401 F.3d 1114, 1123 (9th Cir. 2005). In

short, on previous occasions, the Ninth Circuit concluded that

defendant did not act in bad faith which would justify de novo

review. In light of these findings and per Abatie’s instruction,

this court “should give the administrator's decision broad

deference notwithstanding a minor irregularity.” Abatie at 972.

Accordingly, the court reviews the denial of plaintiff’s claim for

abuse of discretion, while also taking into account any minor

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irregularities.

C. Abuse of Discretion Standard 

In assessing whether a claim administrator abused its

discretion, the court considers whether the claim denial was

unreasonable. Clark v. Washington Teamsters Welfare Trust, 8 F.3d

1429, 1432 (9th Cir. 1993). ERISA plan administrators abuse their

discretion when they "construe provisions of the plan in a way that

conflicts with the plain language of the plan." Eley v. Boeing Co.,

945 F .2d 276, 278 (9th Cir.1991). An abuse of discretion will

also be found if the administrator relies on clearly erroneous

findings of fact in making benefit determinations, Taft v.

Equitable Life Assur. Soc., 9 F.3d 1469, 1473 (9th Cir. 1993), or

the decision is unsupported by substantial evidence. Johnson v.

District 2 Marin Eng'rs. Beneficial Ass'n., 857 F.2d 514, 516 (9th

Cir. 1988).

D. Denial of Plaintiff’s Claim

Having determined that in light of Abatie, abuse of discretion

is the proper standard of review in this case, the court finds no

reason to reconsider its August 18, 2005 order. In its August 18

order, the court concluded that VPA did not abuse its discretion in

denying plaintiff LTD benefits. Citing Jordan v. Northrop Grumman

Corp. Welfare Benefit Plan, 370 F.3d 869 (9th Cir. 2004), the court

explained: 

As in Jordan, plaintiff's physicians' statements

concluded that her condition precluded her from working,

but never explained what objective medical evidence

supported those conclusions. Similarly, defendant made

a specific request to Dr. Agresti to provide it with the

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specific information that was missing, and Dr. Agresti

failed to respond. Following Jordan, it was reasonable

for defendant to render Dr. Agresti's conclusory

statements less reliable. Finally, defendant also had

before it medical evidence casting the diagnoses of the

alleged debilitating conditions into question . . . The

terms of the Plan made it clear that it was plaintiff's

burden to produce objective medical evidence of a Total

Disability. As in Jordan, given the method of analysis

mandated, this court cannot conclude that it was

unreasonable for defendant to deny her application for

LTD benefits on the basis that she failed to prove that

she was completely unable to work at any job for which

she was or could become qualified for.

August 18, 2005 Order at 28. Applying Abatie, and weighing any

minor procedural irregularities and the merits of VPA’s decision,

the court is again unable to conclude that VPA abused its

discretion or was arbitrary and capricious in denying plaintiff’s

claim for long-term disability benefits. 

Finally, the court addressees plaintiff’s claim that the court

consider additional evidence outside of the administrative record.

See Pl.’s Mot. for Summ. J. at 19. Plaintiff requests that the

court review an August 23, 2002 report by Dr. Agresti and a follow

up report dated June 22, 2005. Abatie instructs that, 

Even when procedural irregularities are smaller . . .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. The court must determine, therefore, if under Abatie

it is appropriate to review these records.

Defendant properly points out that both of these reports postdate VPA’s final denial of plaintiff’s LTD claim (which was issued

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 It seems plain that this result does not accord with simple 15

justice. If the court were able to look at the two excluded

reports it seems clear that the plaintiff is entitled to long term

benefits. If this court has misread the effect of the new law I

urge the Court of Appeals to award plaintiff the benefits and not

return the case to this court for yet another decision and appeal.

31

on August 24, 2001) and therefore, they could not have been part of

the administrative record. Plaintiff, however, argues that since

the reports pertain to her condition at the time of the denial, it

is not relevant that they are dated after the final denial date.

This argument, while initially compelling, is problematic when

drawn out to its logical conclusion. Clearly, a case cannot remain

open and unresolved. A line must be drawn somewhere. Abatie

provides that courts may “recreate what the administrative record

would have been had the procedure been correct.” Abatie, at 973.

As this court reads Abatie, only those records which could have

been part of the administrative record may be reviewed. Therefore,

a court may not consider records which were created after the date

of the decision to deny benefits. 

The two reports at issue here were both written after August

24, 2001, the date VPA issued its decision denying plaintiff’s

claim. Accordingly, these two reports could not have been part of

the administrative record and may not be reviewed by the court.

V.

CONCLUSION 

1. Plaintiff’s Motion for Summary Judgment is DENIED.

2. Defendant’s Motion for Summary judgment is GRANTED. 

IT IS SO ORDERED. 

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DATED: February 12, 2007.

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