Ingorvaia v. Reliastar Life Insurance
944 F. Supp. 2d 964
S.D. Cal.2013Background
- ERISA death-benefits dispute; Defendants seek abuse of discretion standard; Plaintiff argues de novo standard applies.
- Only plan documents that confer discretionary authority are controlling; burden on Defendants to prove discretion.
- Group Policy is the governing document; plan booklet and certificate references exist, with an integration clause.
- SPD is included in the plan booklet but not incorporated into the Group Policy; no explicit grant of discretion in incorporated terms.
- Court finds no clear incorporation of SPD terms to confer discretion; de novo review applies to termination of benefits.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the ERISA standard of review is abuse of discretion or de novo | Sarbraw: de novo review | ReliaStar: abuse of discretion | De novo review applies |
| Whether the SPD is incorporated to confer discretionary authority | SPD is not clearly incorporated | SPD grant of discretion is part of the Group Policy | SPD not incorporated; no discretion |
| Whether the Group Policy or plan documents authorize discretionary review | Group Policy lacks discretion clause | Group Policy evidence may confer discretion | Discretionary authority not conferred; de novo governs |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (Supreme Court 1989) (establishes de novo vs. discretionary review under ERISA)
- Thomas v. Or. Fruit Products Co., 228 F.3d 991 (9th Cir. 2000) (burden on plan to prove discretionary authority)
- Grosz-Salomon v. Paul Revere Life Ins. Co., 237 F.3d 1154 (9th Cir. 2001) (SPD terms not binding unless incorporated into plan)
- Eugene S. v. Horizon Blue Cross Blue Shield of N.J., 663 F.3d 1124 (10th Cir. 2011) (SPD can be part of the plan but must be clearly incorporated)
- Bergt v. Ret. Plan for Pilots Employed by MarkAir, Inc., 293 F.3d 1139 (9th Cir. 2002) (integration of plan documents and SPD)
- Langlois v. Metropolitan Life Insurance Company, 833 F.Supp.2d 1182 (N.D. Cal. 2011) (SPD terms used to evaluate incorporation)
- Gonzales v. Unum Life Insurance Co. of America, 861 F.Supp.2d 1099 (S.D. Cal. 2012) (governing document can confer discretion if incorporated)
- Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955 (9th Cir. 2006 (en banc)) (establishes de novo review when no discretion conferred)
- U.S. Airways, Inc. v. McCutchen, 133 S. Ct. 1537 (Supreme Court 2013) (ERISA contract interpretation guidance)
- Schwartz v. The Prudential Ins. Co. of America, 450 F.3d 697 (7th Cir. 2006) (SPD incorporation considerations)