Justia U.S. 9th Circuit Court of Appeals Opinion Summaries

Plaintiff appealed the district court's dismissal of her claim challenging the termination of her long-term disability benefits under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1132. Plaintiff challenged the district court's grant of summary judgment in favor of Unum on it's counterclaim for restitution of overpaid benefits. The court held that the district court abused its discretion by dismissing the claim for denial of benefits for failure to exhaust administrative remedies. The exhaustion requirement should have been excused because plaintiff acted reasonably in light of Unum's ambiguous communications and failure to engage in a meaningful dialogue. Accordingly, the court vacated the judgment in favor of Unum on plaintiff's claim for denial of benefits. View "Bilyeu v. Morgan Stanley Long Term Disability Plan, et al." on Justia Law

Defendant appealed the district court's grant of partial summary judgment in favor of CGI in its action seeking "appropriate equitable relief" under section 502(a)(3) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq. CGI appealed the district court's grant of partial summary judgment in favor of defendant's counsel and codefendant, dismissing the codefendant from the action. CGI also appealed the district court's grant of proportional fees and costs to the codefendant, deducted from CGI's recovery from defendant. The court affirmed the district court's grant of summary judgment in favor of the codefendant, dismissing it from the action. However, because the court saw no indication that in fashioning "appropriate equitable relief" for CGI, the district court did more than interpret the plain terms of the reimbursement provision, and no indication that the district court considered traditional equitable principles in assigning responsibility to CGI for attorneys' fees and costs, the court vacated the judgment in favor of CGI, vacated the judgment that the codefendant deducted fees and costs from CGI's entitlement, and remanded to the district court for further proceedings. View "CGI Technologies and Solutions v. Rose, et al." on Justia Law

Sierra filed a motion under FRCP 60 in the district court that had issued default judgments against defendant, an officer of a French corporation that bought assets from an insolvent California insurance company pursuant to a rehabilitation plan, asking that court to correct judgments to add an explanation sufficient to permit its enforcement in France. The district court granted the motion and entered two corrected judgments. Defendant appealed. The court affirmed because the operative, substantive terms of the corrected judgments were identical to the terms of the original judgments. Therefore, the amendments only clarified the original intent of the judgments, and the district court did not abuse its discretion in making those changes under Rule 60(a). The court also held that, by failing to challenge the original judgments, defendant waived his arguments as to setoff, release, and the nature and amount of his liability. Finally, the court concluded that the district court did not abuse its discretion by refusing to stay entry of the amended or corrected judgments. View "Garamendi v. Hennin" on Justia Law

Plaintiff, insured under two-long term disability plans, sued the Plans when Unum decided to deduct his Social Security Disability Insurance (SSDI) benefit as deductible income under each plan, resulting in what he termed a "double offset." Because the court held that Unum's decision was not an abuse of discretion, that the plain language of the Plans permitted the deduction of the SSDI benefit from each plan, and that plaintiff was not entitled to equitable estoppel, the court affirmed the district court's grant of summary judgment in favor of the Plans. View "Renfro v. The Funky Door Long Term Disability Plan, et al." on Justia Law

Plaintiff brought suit against Deerbrook for breach of the implied covenant of good faith and fair dealing. Plaintiff was injured in an accident caused by Deerbrook's insured and after plaintiff received a judgment against the insured, the insured assigned his bad faith claim to plaintiff. Plaintiff argued that Deerbrook breached the implied covenant of good faith and fair dealing owed to its insured when Deerbrook did not attempt to reach a settlement of plaintiff's claims after the insured's liability in excess of the policy limit became reasonably clear. Plaintiff subsequently appealed the district court's rejection of his request to instruct the jury that it could consider Deerbrook's failure to effectuate a settlement in determining whether Deerbrook breached the implied covenant. The court concluded that plaintiff's proposed jury instruction was consistent with the law but that there was no evidentiary basis for the instruction. Accordingly, the court affirmed the judgment.

Plaintiffs, employees at a defense plant in Arizona, collectively bargained for the right to receive employer-provided healthcare coverage after they retired. At issue was whether those employees, now retirees, were contractually entitled to receive premium-free healthcare coverage until age 65, or whether the contracts on which the retirees relied as providing that entitlement allowed their prior employer to start charging them for their insurance. The court held that Raytheon expressly agreed to provide 100% company-paid healthcare coverage for eligible retirees; that Raytheon's obligation survived the expectation of the collective bargaining agreements (CBAs); and that Raytheon's agreed-upon obligation could not be unilaterally abrogated by Raytheon, regardless of the rights Raytheon reserved for itself in Plan documents, because the CBAs did not incorporate the Plans' reservation-of-rights provisions with respect to employer contribution issues, as opposed to issues relating to the provision of monetary or in kind benefits for particular medical services. The court further held that the district court did not err in rejecting plaintiffs' claim for punitive and extra-contractual damages.

This case arose when R&R sued the Insurance Company of Pennsylvania, a subsidiary of AIG, for breach of contract, unfair competition, and tortious bad faith denial of an insurance claim to recover damages from a wildfire. In Case No. 10-55115, R&R appealed from the district court's grant of judgment as a matter of law on its bad faith tort claim. In Case No. 10-55888, R&R appealed from the district court's grant of costs in favor of AIG. The court reversed the district court's grant of judgment in AIG's favor on R&R's bad faith tort claim after addressing the disclosure requirements of Rules 26(a) and 26(e), as well as exclusion of the invoices at issue under Rule 37(c)(1). Therefore, the court remanded for further proceedings. The court's reversal of the district court's judgment on R&R's claims necessitated reversal of the district court's award of costs as well.

In this case, an insurance agency had a contract with an insurance company that allowed the agency to commingle collected insurance premiums with its other funds in its general operating account. The government contended that the premiums collected by the agency were the property of the insurance company and held "in trust" by the agency; it alleged that when the funds were not remitted but used for other purposes, they were embezzled by the agency's treasurer, defendant. Defendant was charged with ten counts of embezzlement of insurance premiums in violation of 18 U.S.C. 1033(b)(1) and one count of conspiracy to commit embezzlement. The court held that under long-standing Arizona law, the contract between the agency and the company, which permitted agency commingling, required monthly agency payments whether premiums were collected or not, and created a right of interest on late payments, created a creditor-debtor relationship, not a trust. The agency had contractual and fiduciary duties to the company, but was not a trustee. Because the funds in question were not held "in trust" by the agency as a matter of law, an essential element of embezzlement was lacking. Therefore, the court reversed the denial of defendant's motion for judgment of acquittal.

Appellant filed a declaratory judgment action seeking a declaration that AHCCCS had no right to recover from her father's annuity at all or, alternatively, had no right to recover for any costs incurred for the care of her mother received after her father's death. Appellant subsequently appealed the district court's judgment granting summary judgment to AHCCCS. The court held that the 2006 amendment to 42 U.S.C. 1396p(c)(1)(F)(i) created a right in the State to recover as a remainder beneficiary against a community spouses' annuity for an institutionalized spouse's medical costs. The court further held that the State's recovery was not limited to the amount it paid for the institutionalized spouse's medical costs as of the date of the community spouse's death. Accordingly, the court affirmed the judgment, concluding that AHCCCS could be reimbursed as the primary remainder beneficiary from the father's annuity for the cost of the medical assistance it paid on the mother's behalf after the father's death.

Plaintiff, the personal representative of the Estate of Gaye S. Glaser, appealed the district court's affirmance of the Medicare Appeals Council's (MAC) ruling that Kaiser was not required to pay for Glaser's liver surgery. Plaintiff contended that by refusing to cover the procedure, Kaiser failed to comply with 42 C.F.R. 422.112(a)(3), which required Medicare Advantage plans to make their services available, accessible, and adequate, and 42 C.F.R. 422.112(a)(9) and 422.113(b)(iii), which required the plans to cover "urgently needed services." The court held that substantial evidence supported the MAC's decision and affirmed the judgment.