Ricardo Bircher v. Metropolitan Life Insurance Company

[7] 8 UNITED STATES DISTRICT COURT 9 CENTRAL DISTRICT OF CALIFORNIA [10] 11 RICARDO BIRCHER, Trustee of the No. CV 19-04864 PA (SKx) Bircher Living Trust 12 FINDINGS OF FACT AND CONCLUSIONS Plaintiff, OF LAW [13] v. [14] METROPOLITAN LIFE INSURANCE 15 COMPANY, 16 Defendant. [18] 19 Following the filing of the parties’ Opening and Responsive Trial Briefs, the submission of 20 their respective Proposed Findings of Fact and Conclusions of Law, and their objections, the Court 21 conducted a telephonic bench trial on April 9, 2020. 22 Having considered the materials submitted by the parties, including the Administrative 23 Record, and after reviewing the evidence, the Court makes the following findings of fact and 24 conclusions of law pursuant to Federal Rule of Civil Procedure 52(a). Any finding of fact that 25 constitutes a conclusion of law is hereby adopted as a conclusion of law, and any conclusion of law 26 that constitutes a finding of fact is hereby adopted as a finding of fact. [27] 2 1. This is an action brought by Ricardo Bircher, Trustee of the Bircher Living Trust (the 3 “Trust”) against Metropolitan Life Insurance Company (“MetLife”) for recovery of life insurance 4 benefits under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), 29 5 U.S.C. § 1001 , et seq. The Court has jurisdiction over this matter pursuant to 29 U.S.C. §§ 1132 (a), 6 (e), (f), and (g), as well as 28 U.S.C. § 1331 . 7 2. Ricardo Bircher’s mother, Lupe Bircher (“Decedent”) was a participant in an ERISA8 governed employee welfare benefit plan (the “Plan”) sponsored by her employer, AT&T. AT&T is 9 not named as a defendant in this action. (PLAN_000001 - 000190.) 10 3. MetLife issued the group certificate of life insurance that funds the benefits of the 11 Plan. (AR_000048 - 49.) 12 4. The Plan provided both basic life insurance and supplemental life insurance 13 (“Supplemental Life Insurance”) for eligible employees. 14 5. The Plan specified the eligibility requirements for Supplemental Life Insurance 15 coverage for eligible employees, stating in relevant part in the Summary Plan Description as 16 follows: 17 Your Eligibility for Supplemental Life Insurance coverage ends on the 18 last day of the month during which you reach age 65 or retire, 19 whichever is later. (PLAN_000010.) 20 If you retire on or after the last day of the month in which You reach 21 age 65, You are not eligible for Supplemental Life Insurance upon 22 retirement. (PLAN_000068.) 23 Supplemental Life: Coverage ends on the last day of the month upon 24 Termination of Employment, except for Eligible Former Employees 25 of AT&T West who, with Termination of Employment before the 26 dates listed below may continue supplemental life insurance beyond 27 age 65. 2 Pacific Bell - TIU - Jan. 1, 2002 3 Pacific Bell Directory - IBEW Local 1269 - Jan. 1, 4 2004 5 Pacific Bell Directory - IBEW Local 2139 - Jan. 1, 6 2004 7 (PLAN_000121.) 8 6. Decedent began working for AT&T Corporation on February 5, 1964. 9 (AR_000012.) 10 7. Decedent retired from her employment with AT&T Corporation on June 11, 1988, at 11 the age of 65. (AR_000012.) 12 8. Prior to her retirement, Decedent submitted an enrollment form (“Insurance Payment 13 Continuation Form”), in which Decedent selected her desire to enroll in Supplemental Life 14 Insurance coverage in the amount of $24,000 with a monthly premium payment of $22.80. 15 (AR_000032; AR_000046, AR_000242-43.) 16 9. Decedent passed away on December 18, 2016 at age 93. (AR_000007.) 17 10. On March 14, 2017, Diane Bircher, daughter of Decedent and then trustee of the 18 Trust, requested the appropriate claim form and other requirements for MetLife to pay out on 19 Decedent’s Supplemental Life Insurance policy. (AR_000007.) 20 11. On May 1, 2017, MetLife paid to the Trust $12,000 in basic life insurance benefits 21 plus $4.50 in interest. (AR_000198.) MetLife did not pay any Supplemental Life Insurance 22 benefits. 23 12. On May 31, 2017, Diane Bircher disputed MetLife’s decision, claiming Decedent 24 had Supplemental Life Insurance benefits that MetLife was required to pay. (AR_000029-35.) In 25 her letter, Diane Bircher included Decedent’s Insurance Payment Continuation Form, which 26 indicated Decedent elected Supplemental Life Insurance effective July 1, 1988 (AR_000031.) 27 13. On July 14, 2017, MetLife denied Diane Bircher’s claim for Supplemental Life 2 Supplemental Life Insurance coverage cancels at age 65 if retired or 3 on the last day of the month in which they retire if the employee is 4 already age 65. The decedent reached age 65 in 1987 and her 5 retirement date was June 11, 1988. So the supplemental life benefit 6 would have terminated on June 30, 1988. 7 (AR_000049.) 8 14. On August 23, 2017, Diane Bircher submitted an appeal request. (AR_000059.) In 9 her appeal request, Diane Bircher stated that per the Plan, “supplemental life coverage may continue 10 beyond age 65, for eligible former employees of AT&T West Core Contract, with termination 11 before July 1, 2001.” (Id.) 12 15. On September 6, 2017, Met Life acknowledge receipt of the appeal request, and 13 notified Diane Bircher that “[d]ue to special circumstances, it [was] necessary for [MetLife] to 14 further evaluate this claim; therefore, completion [was] delayed for a short period of time.” 15 (AR_000061.) Again on October 11, 2017 MetLife informed Diane Bircher that they were 16 continuing to review her appeal. (AR_000080.) 17 16. While MetLife was reviewing Diane Bircher’s appeal, she passed away. 18 (AR_000094.) At this time, Troy York, successor trustee, and Ricardo Bircher, beneficiary, took 19 over pursuing the claim. 20 17. On November 17, 2017, MetLife wrote a letter to Troy York and Ricardo Bircher 21 stating Decedent did not qualify for Supplemental Life Insurance coverage. MetLife stated: 22 Supplemental Life: Coverage ends on the last day of the month upon 23 Termination of Employment, except for Eligible Former Employees 24 of AT&T West who, with termination of Employment before the 25 dates below, may continue Supplemental Life beyond age 65. AT&T 26 West Core Contract - July 1, 2001. According to our records, the 27 decedent’s Certificate of Death lists the date of birth as . . . 1922. Ms. 2 retired or on the last day of the month in which they retire if the 3 employee is already age 65. The Supplemental Life Insurance 4 terminated on June 30, 1988, which was the last day of the month in 5 which she retired. 6 (AR_000096.) 7 18. On January 8, 2018, Troy York and Ricardo Bircher filed another appeal of 8 MetLife’s denial of their Supplemental Life Insurance claim. (AR_000101.) In their letter, Troy 9 York and Ricardo Bircher stated: 10 Your letter dated Nov. 17, 2019 stated that Lupe Bircher an eligible 11 former bargained employee was not an employee of AT&T West, 12 which is correct, she was an employee of AT&T Inc. For your 13 information: AT&T West is one of five core contracts which covers 14 landline employees in California and Nevada. It is a bargaining unit, 15 See: Summary Plan Description Page 63 (AT&T West Core Contract 16 - CWA District 9.) Plan states on page 31 of the summary plan 17 description: For employees in bargaining unit of AT&T West Core 18 Contract with termination of employment before July 1, 2001, and 19 your employment ends on or after age 65, supplemental life coverage 20 may continue beyond age 65 which applies to Lupe Bircher. 21 (AR_000126.) 22 19. In response, MetLife discussed the issue with the account management team for 23 AT&T, which confirmed that only one employee population, Pacific Telesis Group (“PTG”) was 24 permitted to continue Supplemental Life Insurance coverage for retirees after the age of 65. 25 (AR_0000107-108.) 26 20. MetLife also found that Decedent did not pay premiums on any Supplemental Life 27 Insurance after she retired. (AR_0000113.) 2 appeal request. (AR_000107-108.) MetLife stated: 3 In your letter of appeal dated January 8, 2018, you asked us to 4 reconsider our decision to deny your claim. You assert that the 5 decedent was a member of the AT&T West employee population. 6 Persons in that population were permitted to continue their 7 Supplemental Life Insurance beyond age 65. You cite the terms of the 8 AT&T West Core Contract and the Summary Plan Description for 9 that employee population. As described above and in the initial denial 10 letter, Lupe Bircher was not a member of the AT&T West employee 11 population; she was a part of AT&T Inc. Members of the AT&T Inc. 12 employee population were not permitted to continue their 13 supplemental life insurance benefits after age 65, if retired. We 14 discussed the question of Supplemental Life Insurance with the 15 account management team for AT&T. They have confirmed for us 16 that only one employee population, Pacific Telesis Group (PTG), 17 permitted the continuation of Supplemental Life Insurance coverage 18 for retirees beyond the age of 65. The decedent was neither a PTG 19 retiree nor a retiree of AT&T West. 20 (Id.) 21 22. On April 20, 2018, Ricardo Bircher and Troy York submitted another appeal to 22 MetLife. (AR_000159.). In their appeal request, Ricardo Bircher and Troy York stated: 23 As stated in our appeal letter dated January 8, 2018, AT&T West is 24 one of five core contracts which covers landline employees in 25 California and Nevada. It is an employee bargaining unit. . . . Plan 26 states on page 31 of the Summary Plan Description; for employees in 27 bargaining unit of AT&T West Core Contract with termination of 2 which applies to Lupe Bircher. We are providing proof that Lupe 3 Bircher was a member of bargaining unit AT&T West Core Contract 4 in CWA District Nine’s jurisdiction of California & Nevada. 5 (Id.) 6 23. On May 1, 2018, MetLife responded stating “[w]e are in receipt of your additional 7 appeal statement dated April 20, 2018. This is to advise you that we are in the process of reviewing 8 the additional information that you provided in order to reach a decision.” (AR_000164.) 9 24. As part of its investigation, MetLife reached out to AT&T’s administrator. AT&T’s 10 administrator advised MetLife that the legacy company Decedent was part of was AT&T 11 Corporation and not AT&T West. (AR_0000170-171, 176.) AT&T’s administrator further 12 explained that while Decedent had a union classification of AT&T West Core, the AT&T West 13 Core contracts were under different legacy companies, and that only employees of the AT&T West 14 legacy company could continue supplemental coverage after age 65. (Id.) 15 25. On May 25, 2018, Anne Suprinski, Senior Client Services Consultant for MetLife 16 National Accounts, stated: 17 Attached is the response I received from Alight. They have confirmed 18 that Ms. Bircher was a retiree of AT&T Corp. with a union 19 classification of AT&T CWA. I think the main thing to take away 20 here is that the legacy company is AT&T Corp. and not AT&T West. 21 As noted below, the ability to continue Supp Life past age 65 was for 22 retirees of AT&T West and not AT&T Corp. 23 (AR_000170.) 24 26. On May 29, 2018, MetLife explained to Ricardo Bircher and Troy York that it was 25 upholding its initial determination and that no further appeals would be considered. (AR_000205.) 26 27. On May 29, 2019, in order for Ricardo Bircher to oversee the filing of this action, 27 Troy York appointed Ricardo Bircher as the trustee of the Trust. (Dkt. No. 32, Bircher Decl. Ex. 1.) 1] Il. Conclusions of Law 2 1. Ricardo Bircher has standing to bring this lawsuit. See Power v. Ashton, 45 Cal. 3 || App. 3d 783, 787 (1975). 4 2. The Plan at issue in this lawsuit is an employee welfare benefit plan governed by 5 || ERISA, which provides the exclusive remedy for Ricardo Bircher’s claims. See 29 U.S.C. § 6 | 1132(a)(1)(B). 7 3, The standard of review is de novo. See Abatie v. Alta Health & Life Ins. Co., 458 8 || F.3d 955, 963 (9th Cir. 2006). When the standard of review is de novo, “[t]he court simply 9 || proceeds to evaluate whether the plan administrator correctly or incorrectly denied benefits, without 10 || reference to whether the administrator operated under a conflict of interest.” Id. On de novo 11 |) review, the court is to “evaluate the persuasiveness of conflicting testimony and decide which is 12 |) more likely true.” Kearney v. Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir.1999) (en banc). 13 |] Further, the Court should make that determination based on the evidence in the Administrative 14 |) Record. /d. at 1090-91. 15 4, In a de novo review, “the burden of proof is placed on the claimant” to establish 16 || entitlement to plan benefits. Muniz v. Amec Const. Mgmt., Inc., 623 F.3d 1290, 1294 (9th Cir. 17 || 2010). 18 5. ERISA requires that “[e]very employee benefit plan shall be established and 19 || maintained pursuant to a written instrument.” 29 U.S.C.A. § 1102 . ERISA fiduciaries must act “in 20 || accordance with the documents and instruments governing the plan,” (US Airways, Inc. v. 21 |} McCutchen, 569 U.S. 88, 101 , 133 S. Ct. 1537, 1548 (2013)), and must enforce the terms of the 22 || Plan as written (Heimeshoff v. Hartford Life & Accident Ins. Co., 134 S. Ct. 604, 611-12 (2013)). 23 6. “[O]nce a plan is established, the administrator’s duty is to see that the plan is 24 || ‘maintained pursuant to [that] written instrument.” 29 U.S.C. §1102 (a)(1). 25 7. Pursuant to the terms of the Plan, eligibility for Supplemental Life Insurance for most 26 || AT&T employees ends on the last day of the month during which the employee reaches age 65 or 27 || retires, whichever is later. (PLAN 000010.) [28] 2 Insurance coverage after retirement and age 65. Pursuant to the Plan, only employees of AT&T 3 West were eligible to continue coverage after the last day of the month during which they retired or 4 reached age 65. (See, e.g., AR_000123.) 5 9. Decedent was an employee of AT&T Corporation. 6 10. Decedent was not an employee of AT&T West. (AR_000084, 000165-66, 000171, 7 000176, 000245.) 8 11. Upon her retirement, Decedent was a member of the Communications Workers of 9 American in the bargaining unit for the AT&T West Core Contract in CWA District Nine’s 10 jurisdiction of California & Nevada.” (AR_000130.) 11 12. Decedent’s union membership does not determine whether Decedent was eligible to 12 enroll in Supplemental Life Insurance benefits after age 65 or after her retirement. Decedent’s 13 union membership would only matter if Decedent was an employee of AT&T West, which she was 14 not. 15 13. Decedent’s submission of an Insurance Payment Continuation Form only 16 demonstrates that Decedent wanted to select Supplemental Life Insurance coverage after her 17 retirement. It does not demonstrate that Decedent was eligible for coverage, or that she was ever 18 enrolled in Supplemental Life Insurance after her retirement. (AR_000046, 242, 243). 19 14. There is no evidence in the record to show that Decedent ever paid premiums for 20 Supplemental Life Insurance coverage after she retired. 21 15. Applying the terms of the Plan, Decedent’s eligibility for Supplemental Life 22 Insurance ended on June 30, 1988. 23 16. MetLife correctly determined that only basic life insurance benefits under the Plan 24 were payable after Decedent’s death, and MetLife paid those benefits in full. 25 17. Because MetLife paid the entire basic life insurance benefits due under the terms of 26 the Plan, the Trust is not entitled to any additional life insurance benefits as a result of Decedent’s 27 death. 1 | 1. Analysis 2 Ricardo Bircher argues that pursuant to the Administrative Record, the Trust is entitled to 3 || Supplemental Life Insurance benefits Decedent had when she retired. In addition, Ricardo Bircher 4 ll argues MetLife failed to conduct a full and fair review of his claim, and did not timely respond to 5 || his appeals. MetLife argues Ricardo Bircher does not have standing to bring this claim, and that, 6 || assuming Ricardo Bircher does have standing, Decedent did not have Supplemental Life Insurance 7 || at the time of her death. 8 The Court concludes: (1) Ricardo Bircher does have standing to bring this claim, (2) whether 9 || MetLife conducted a full and fair review of Ricardo Bircher’s claim is irrelevant to the Court’s de 10 || novo review, and (3) Ricardo Bircher has not satisfied his burden of showing that the Trust is 11 || entitled to benefits in excess of those MetLife has already paid. Specifically, the Court finds that 12 || Decedent did not have Supplemental Life Insurance at the time of her death, and that MetLife has 13 |] paid the entire basic life insurance benefits due under the Plan. 14 A. Ricardo Bircher’s Standing 15 MetLife argues that Ricardo Bircher does not have standing to bring this lawsuit because he 16 || is not the trustee of the Trust and is simply a beneficiary of the Trust. Under California law, where a 17 || claim is prosecuted on behalf of a trust, “the trustee is the real party in interest because he is the one 18 || in whom title to cause is vested.” Power v. Ashton, 45 Cal. App. 3d 783, 787 (1975). A trust 19 |) beneficiary cannot sue in the name of the trust. See Estate of Bowls, 169 Cal. App. 4 " 684, 691 20 || (2008). 21 Here, Diane Bircher was the trustee of the Trust until her death in October of 2017. Upon 22 || Diane Bircher’s death, Troy York became the successor trustee of the Trust. On May 29, 2019, 23 || Troy York appointed Ricardo Bircher trustee of the Trust. (Dkt. No. 32, Bircher Decl., Ex. □□□□ [24] u MetLife argues the Court cannot consider Ricardo Bircher’s declaration and the attached 25 | Exhibit showing he is the trustee of the Trust because “a court may not consider additional evidence %6 outside the Administrative Record that was not presented to the claim administrator at the time it made its decision.” (See Dkt. No. 40, Defendant Metropolitan Life Insurance Company’s 97 || Objections to Evidence Submitted by Plaintiff in Support of Responsive Trial Brief). However, it is well established that “consideration of new evidence is permitted . . . in conjunction with de novo 28 || review of denial of benefits.” Abatie, 458 F.3d at 969 (“Today, we continue to recognize that, in general, a district court may review only the administrative record when considering whether the 1 || Ricardo Bircher then filed this lawsuit on June 4, 2019. Because Ricardo Bircher was trustee of the 2 || Trust at the time this lawsuit was filed, and remains the trustee of the Trust, he has standing to bring 3 || this lawsuit. 4 B. MetLife’s Review of Ricardo Bircher’s Claim 5 Ricardo Bircher argues MetLife did not conduct a full and fair review of his claim, and that 6 || MetLife did not respond to his appeal within the required time. Under ERISA, “plan administrators 7 || must follow certain practices when processing and deciding plan participants’ claims.” Abatic, 458 8 || F.3d at 971. For example, “administrators must adhere to various procedures for giving notice, 9 || reporting, and claims processing.” Id. (citing 29 U.S.C. § 1021 (a) (disclosure to all plan 10 || participants); id. § 1021(b) (reporting requirements); id., § 1133 (claims procedures). 11 In some situations procedural irregularities may be so substantial as to alter the standard of 12 |) review from abuse of discretion to a de novo review. Id. Here, the Court is already conducting a de 13 || novo review. Therefore, any alleged procedural irregularities are irrelevant. See Muniz v. Amec. 14 || Constr. Mgmt., Inc., 623 F.3d 1290, 1295-1296 (9th Cir. 2010) (When a court is conducting a de 15 || novo review, the court “does not give deference to the claim administrator’s decision, but rather 16 || determines in the first instance if the claimant has adequately established that he or she is [entitled 17 |) to benefits] under the terms of the plan.”); Harber v. Reliance Standard Life Insurance Co., 14-cv18 || 0566, 2016 WL 4154917 , at *8 (C.D. Cal. Aug. 4, 2016) (“Harber also cites to procedural 19 || irregularities in the appeal. ... These irregularities, however, are not relevant on de novo review. . . 20 || . These would be more relevant if the Court were conducting an abuse of discretion analysis. 21 || However, as the Court is conducting a de novo review, the focus is on the adequacy of Plaintiff’ □ 22 || evidence to support his disability.”). Therefore, the Court rejects Ricardo Bircher’s procedural 23 || irregularities arguments. —— 25 || plan administrator abused its discretion, but may admit additional evidence on de novo review.”). See also, Jebian v. Hewlett-Packard Co. Employee Benefits Org. Income Prot. Plan, 349 F.3d 1098 , 26 |} 1110 (9th Cir. 2003) (“While under an abuse of discretion standard our review is limited to the record before the plan administrator, this limitation does not apply to de novo review.”). Because 27 || the Court is conducting a de novo review, it can consider Ricardo Bircher’s declaration and exhibit 28 outside of the Administrative Record. 2 Finally, Ricardo Bircher argues that Decedent had Supplemental Life Insurance benefits at 3 the time of her death, and that therefore the Trust is entitled to these benefits. Ricardo Bircher 4 argues that, while the general rule under the Plan is that eligibility for Supplemental Life Insurance 5 coverage ends on the last day of the month during which you reach age 65 or retire, whichever 6 comes later, Decedent was part of a small group of employees that was eligible to continue 7 Supplemental Life Insurance benefits after they retired or reached age 65. 8 Based on the Court’s de novo review of the Administrative Record, Decedent was not 9 eligible to continue Supplemental Life Insurance coverage after she retired or reached age 65. 10 Pursuant to the Plan, only eligible former employees of AT&T West could continue Supplemental 11 Life Insurance beyond age 65. Eligible former employees of AT&T West included employees of 12 AT&T West who were part of one of five listed bargaining groups, and retired before a certain date. 13 Ricardo Bircher argues that, because Decedent was part of the AT&T West Core Contract 14 bargaining group, which is one of the bargaining groups listed, she was eligible to continue 15 Supplemental Life Insurance coverage after retirement. However, Ricardo Bircher’s reasoning 16 misses the first step in the analysis - whether Decedent was an employee of AT&T West. 17 According to the Plan, only employees who were both (1) an employee of AT&T West, and (2) part 18 of one of the five listed bargaining groups, were eligible to continue Supplemental Life Insurance 19 benefits. According to the Administrative Record, Decedent was not an employee of AT&T West, 20 she was an employee of AT&T Corporation. Thus, whether Decedent was a member of the AT&T 21 West Core Contract bargaining group is irrelevant, because Decedent was not an employee of 22 AT&T West. 23 Because Decedent was not an employee of AT&T West, her Supplemental Life Insurance 24 coverage ended on the last day of the month in which she retired, or in which she turned 65 - 25 whichever came first. Decedent was born in 1922. Decedent retired from AT&T Corporation on 26 June 11, 1988, at the age of 65. Thus, Decedent’s eligibility for Supplemental Life Insurance 27 coverage ended on June 30, 1988. In addition, the Court finds there is no evidence in the 2 Insurance after she retired. 3 Conclusion 4 For all of the foregoing reasons, the Court concludes that Ricardo Bircher has not sustained 5 his burden of establishing that the Trust is entitled Supplemental Life Insurance benefits. 6 Accordingly, the Trust is not entitled to benefits in excess of those already paid by MetLife. The 7 Court will enter a judgment consistent with this Order. 8 DATED: May 16, 2020 [9] 10 ___________________________________ Percy Anderson [11] UNITED STATES DISTRICT JUDGE