Radevska v. Noble Americas Energy Solutions, LLC
3:15-cv-00271
S.D. Cal.Apr 10, 2017Background
- Plaintiff Tamara Radevská was on FMLA leave when Sempra Energy Solutions was acquired; she received and signed a Confirmation of Employment and returned two days after the acquisition closed.
- Defendants (Noble Americas entities) terminated Plaintiff’s participation/benefits under the Noble Health Plan, deeming her ineligible.
- Defendants had informed Plaintiff the Noble Health Plan was governed by ERISA and required administrative exhaustion prior to suit.
- The only plan-related documents the parties have identified to the Court are the 2010 and 2011 Summary Plan Descriptions (SPDs); neither party has produced the formal Plan document(s) or clarified plan terms beyond the SPDs.
- The parties have not defined the administrative record or explained what, if any, extrinsic evidence is necessary; the Court says review requires identifying the full administrative record and relevant Plan terms.
- The Court tentatively concluded Plaintiff is a “participant” with a colorable claim to benefits and that Defendants’ eligibility determination is subject to ERISA review, but will order supplemental briefing to resolve (1) the true Plan documents/terms and (2) the scope of the administrative record.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Radevská is a “participant” under ERISA | She has a colorable claim to benefits (employee at time of acquisition; confirmation letter; on FMLA) | Defendants implicitly argue she was ineligible and thus not a participant | Court tentatively: Plaintiff is a participant with a colorable claim (Firestone standard) |
| Whether termination of benefits is reviewable under ERISA and which standard applies | ERISA governs Noble Plan; administrative exhaustion required and review appropriate | Defendants contend their eligibility determination controls and may preclude ERISA review | Court tentatively: Termination is reviewable under ERISA; must select appropriate standard of review (de novo vs. abuse of discretion) |
| Whether SPDs suffice as Plan terms for § 1132(a)(1)(B) review | Implicitly relies on SPD language cited in briefing | SPD alone cannot substitute for formal Plan documents; Defendants have not produced Plan terms | Court: SPDs are insufficient; parties must produce the actual Plan documents/certificate defining Plan terms |
| Scope of review: what constitutes the administrative record and whether extrinsic evidence is allowed | Plaintiff asserts procedural irregularities and may need to add evidence beyond record | Defendants have not delineated administrative record or justified adding extrinsic evidence | Court: Parties must identify and lodge the administrative record; if de novo review or procedural irregularities justify it, court may consider additional evidence (Abatie/Opeta guidance) |
Key Cases Cited
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (establishes ERISA participant standard and review frameworks)
- Miller v. Rite Aid Corp., 504 F.3d 1102 (applies Firestone participant tests in Ninth Circuit)
- CIGNA Corp. v. Amara, 563 U.S. 421 (SPD statements do not constitute plan terms for § 502(a)(1)(B) relief)
- Prichard v. Metro. Life Ins. Co., 783 F.3d 1166 (SPD cannot supplant governing plan documents)
- Becker v. Williams, 777 F.3d 1035 (reiterates limits of SPD as plan terms)
- Tremain v. Bell Indus., Inc., 196 F.3d 970 (district court review standards for benefit terminations)
- Bergt v. Ret. Plan for Pilots Employed by MarkAir, Inc., 293 F.3d 1139 (abuse of discretion review of eligibility determinations)
- Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955 (when the district court may consider evidence beyond the administrative record and how procedural irregularities affect review)
- Opeta v. Nw. Airlines Pension Plan for Contract Employees, 484 F.3d 1211 (limits on admitting extrinsic evidence; exceptional circumstances for beyond-record evidence)