Chapin v. Prudential Ins. Co. of Am.

CHRISTOPHER RICHARD CHAPIN, Plaintiff, v. THE PRUDENTIAL INSURANCE COMPANY OF AMERICA,MICROSOFT CORPORATION, and theMICROSOFT CORPORATION WELFARE PLAN, Defendants.

No. 2:19-cv-01256-RAJ

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF WASHINGTON AT SEATTLE

March 22, 2021

HONORABLE RICHARD A. JONES

ORDER

I. INTRODUCTION

This matter comes before the Court on two motions. Defendant The Prudential Insurance Company of America ("Prudential") filed a motion for summary judgment on Plaintiff Christopher Richard Chapin's ("Plaintiff") ERISA claims for long-term disability ("LTD") benefits and equitable relief. Dkt. # 44. On the same day, Plaintiff filed a motion for judgment on the Administrative Record ("AR") under Fed. R. Civ. P. 52 on those same claims against Prudential. Dkt. # 49.

Having thoroughly reviewed the parties' submissions, the administrative record, and applicable law, the Court DENIES Prudential's cross-motion for summary judgment and GRANTS Plaintiff's motion for judgment on the administrative record. The Court first addresses Prudential's motion for summary judgment. Dkt. # 44.

II. SUMMARY JUDGMENT

Summary judgment is appropriate if there is no genuine dispute as to any material fact and the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(a). The moving party bears the initial burden of demonstrating the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). Where the moving party will have the burden of proof at trial, it must affirmatively demonstrate that no reasonable trier of fact could find other than for the moving party. Soremekun v. Thrifty Payless, Inc., 509 F.3d 978, 984 (9th Cir. 2007). On an issue where the nonmoving party will bear the burden of proof at trial, the moving party can prevail merely by pointing out to the district court that there is an absence of evidence to support the non-moving party's case. Celotex Corp., 477 U.S. at 325. If the moving party meets the initial burden, the opposing party must set forth specific facts showing that there is a genuine issue of fact for trial to defeat the motion. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1986). The court must view the evidence in the light most favorable to the nonmoving party and draw all reasonable inferences in that party's favor. Reeves v. Sanderson Plumbing Prods., 530 U.S. 133, 150-51 (2000).

In its pending motion, Prudential moves for summary judgment on Plaintiff's ERISA claims for LTD benefits pursuant to ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B) and equitable relief pursuant to § 1132(a)(3). Dkt. # 44 at 7; Dkt. # 1 at 22-24. Under § 1132(a)(1)(B), a beneficiary may bring a civil action to "recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan." Under 29 U.S.C. § 1132(a)(3), a beneficiary may bring a civil action "to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain otherappropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan."

As Plaintiff correctly observes, the dispositive question before the Court for Plaintiff's first claim is whether the evidence in the administrative record shows that Chapin has a disability under the terms of the Plan. Dkt. # 52 at 2. Whether Plaintiff is disabled is a genuine issue of material fact that requires a review of the evidence. See Gordon v. Metro. Life Ins. Co., 747 F. App'x 594, 595 (9th Cir. 2019) (holding that "because the parties have produced conflicting medical opinions regarding [the plaintiff's] disability, those opinions create a genuine dispute of material fact"). The medical opinions provided by both parties here create a genuine dispute of material fact. See AR at 55-56, 97-100, 112, 118-122. Because the Court cannot decide whether Plaintiff is disabled as a matter of law without considering the evidence, Prudential is not entitled to summary judgment on this claim. See 477 U.S. at 323. The Court therefore DENIES Prudential's motion for summary judgment as to Plaintiff's claim for benefits under ERISA 29 U.S.C. § 1132(a)(1)(B).

With respect to Plaintiff's second claim, Prudential argues that it is entitled to summary judgment because the claim is "impermissibly duplicative" of Plaintiff's first claim for benefits. Dkt. # 44 at 24. The Court disagrees. This Court has noted that although a plaintiff is barred from seeking duplicative relief in an ERISA action, a plaintiff is not barred from seeking different remedies under § 1132(a)(3) and § 1132(a)(1)(B). See Hancock v. Aetna Life Ins. Co., 251 F. Supp. 3d 1363, 1369, 1371-72 (W.D. Wash. 2017) ("[Plaintiff] is not precluded from bringing a Section 1132(a)(3) claim simply because she also brings a Section 1132(a)(1)(B) claim . . . ."); see also Zisk v. Gannett Co. Income Prot. Plan, 73 F. Supp. 3d 1115, 1118 (N.D. Cal. 2014) ("Courts of this district have found that (a)(3) claims remain viable even when an (a)(1)(B) claim is asserted, particularly where the relief sought in connection with each claim is distinct.").

Here, Plaintiff distinguishes the equitable relief he is seeking under § 1132(a)(3) to declaratory and injunctive relief compelling Prudential "to correct their claims-handling policies" to ensure that he will not be deprived of a full and fair review of claims within the required timelines. Dkt. # 1 at 24-25. Because these remedies are not available under § 1132(a)(1)(B), which provides only for recovery of benefits due under the terms of a plan, enforcement of rights under the terms of the plan, or clarity on rights to future benefits, the remedies sought in Plaintiff's two claims are not duplicative. The Court therefore denies Prudential's motion for summary judgment on Plaintiff's second claim against Prudential seeking declaratory and injunctive relief pursuant to 29 U.S.C. § 1132(a)(3).

III. JUDGMENT ON THE ADMINISTRATIVE RECORD

On November 25, 2019, Plaintiff submitted the administrative record under seal. Dkt. # 26. On February 19, 2020, Plaintiff and Defendants Microsoft and Microsoft Corporation Welfare Plan settled Plaintiff's STD claims and moved the Court to dismiss these claims with prejudice. Dkt. # 34. The Court granted the motion. Dkt. # 35. On May 8, 2020, Plaintiff filed the pending motion for judgment on the administrative record pursuant to Rule 52. Dkt. # 49. The Court now issues the following findings of fact and conclusions of law with respect to Plaintiff's two remaining ERISA claims seeking LTD benefits and injunctive relief.

A. FINDINGS OF FACT

1. Plaintiff has been employed as a software engineer by Microsoft from 2011 to the present. Dkt. # 1 ¶ 12.

2. Prudential is an insurer that administers claims for short term disability ("STD") benefits under Microsoft's STD Payroll Policy and administers and insures LTD benefit claims on behalf of Microsoft and the Microsoft Employee Welfare Plan (the "Plan"). Id. ¶ 8.

3. Prudential issued the LTD Insurance Policy, which is governed by ERISA, toPlaintiff in connection with the Plan. Id. ¶¶ 14-15.

4. Prudential defines "disability" as related to its LTD Insurance Policy accordingly:

You are disabled when Prudential determines that, due to your sickness or injury:

• You are unable to perform the material and substantial duties of your regular occupation, or you have a 20% or more loss in your monthly earnings; and

• You are under the regular care of a doctor; and

After 24 months of payments, you are disabled when Prudential determines that due to the same sickness or injury:

• you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience; and

• you are under the regular care of a doctor.

AR 180 (emphasis in original).

5. The term "regular occupation" is defined as "the occupation you are routinely performing when your disability begins. Prudential will look at your occupation as it is normally performed instead of how the work tasks are performed for a specific employer or at a specific location." Id.

6. Under the plan, "[d]isabilities which, as determined by Prudential, are due in whole or part to mental illness have a limited pay period." AR 932.

Mental illness means a psychiatric or psychological condition regardless of cause. Mental illness includes but is not limited to schizophrenia, depression, manic depressive or bipolar illness, anxiety, somatization, substance related disorders and/or adjustment disorders or other conditions. These conditions are usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment as standardly accepted in the practice of medicine.

7. As a Microsoft software engineer, Plaintiff worked on a team that powered "one of the largest scale services in the Office" with "35-40 million business seats on the service." Id. at 749. In his role, he was focused on "experimentation, live site analysis, automation design and implementation to monitor and validate e2e functionality, availability, capacity, freshness and performance of [the] large database." Id. His job description called for "[e]xceptional test aptitude, customerfocus and expertise in formal and informal testing techniques as well as quality measurement." Id.

8. On March 19, 2018, Plaintiff went to his primary care physician, Dr. Wallace Hodges. Id. at 29. Plaintiff reported anxiety and insomnia to Dr. Hodges related to "a supervisor who 'bullies'" him." Id. Plaintiff said he "worries constantly about work . . . can't turn his brain off at night and is consequently only getting about 4 hours sleep/night." Id. In his physical examination of Plaintiff, Dr. Hodges noted that he was "alert, attentive, intact memory, judgment, concentration," and "[n]ormal

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