United States District Court, D. Nevada
ORDER GRANTING DEFENDANT'S MOTION FOR JUDGMENT
AND DENYING PLAINTIFF'S MOTION FOR JUDGMENT (ECF NOS. 59,
P. GORDON UNITED STATES DISTRICT JUDGE.
Linda Sliwa brings a claim for wrongful denial of ERISA
benefits arising out of the denial of her claim for long-term
disability (LTD) benefits by defendant Lincoln National Life
Insurance Company. Lincoln is the claims administrator for a
disability benefits plan offered through Sliwa's former
employer, Allied Home Mortgage Capital
Corporation. Sliwa claims that although the LTD
policy's pre-existing condition exclusion applies to her
situation, Lincoln was forbidden to enforce it against her
because she never received a copy of the policy.
argues the policy was delivered to Sliwa or, at a minimum,
she was on notice of the pre-existing condition provision
based on a summary of benefits she received and telephone
conversations she had with Lincoln representatives. Both
parties move for judgment on the paper record. I conclude
that Lincoln did not abuse its discretion in determining that
Sliwa received a copy of the policy. I therefore grant
Lincoln's motion for judgment.
STANDARD OF REVIEW
parties bring competing motions for judgment under Federal
Rule of Civil Procedure 52, which is the appropriate
procedure for an ERISA case. Kearney v. Standard Ins.
Co., 175 F.3d 1084, 1094-95 (9th Cir. 1999) (en banc).
The trial court in such cases states its findings of fact and
conclusions of law. Burke v. Pitney Bowes Inc. Long Term
Disability Plan, 640 F.Supp.2d 1160, 1170 (N.D. Cal.
FINDINGS OF FACT
began working as an underwriter for Allied Home Mortgage
Capital Corporation in November 2009. ECF No. 55-1 at 2.
Lincoln issued short-term disability (STD) and LTD policies
provided under Allied's employee benefit plan. Sliwa
enrolled in both plans, effective February 1, 2010.
Id. The LTD plan had a pre-existing condition
exclusion stating that it:
will not cover any Total or Partial Disability (1) Which is
caused or contributed to by, or results from a Pre-Existing
Condition; and (2) Which begins in the first 24 months after
the Insured Employee's Effective Date; unless such
Insured Employee received no Treatment of the condition for
12 consecutive months after the Insured Employee's
ECF No. 55-26 at 67.
claimed disability leave on February 14, 2011, just over 12
months after her initial enrollment date on the two
disability policies. ECF No. 55-1 at 2. Lincoln paid her STD
claim covering the period February 21, 2011 through May 23,
2011. ECF No. 55-2 at 60. Lincoln subsequently converted
Sliwa's STD claim into an LTD claim for consideration of
payment of LTD benefits. Lincoln denied the claim on April 2,
2012, finding it precluded by the LTD preexisting condition
provision. Id. at 5-8.
appealed, arguing that the exclusion should not be enforced
because she never received a copy of the plan. ECF No. 55-1
at 89-91. She also contended a Lincoln representative had led
her to believe that so long as she qualified for STD
coverage, a later LTD claim would not be subject to
additional review for a pre-existing condition exclusion.
Id. at 97. Lincoln denied the appeal, citing the
policy exclusion. Id. at 76. Sliwa appealed again
and Lincoln again denied, exhausting Sliwa's
administrative remedies. Id. at 56-58.
then brought this suit, which I remanded in January 2015 for
Lincoln to make an administrative determination on a fully
developed factual record. See ECF No. 42. In April
2015, Lincoln completed its review of Sliwa's claim and
again denied benefits. ECF No. 56-2 at 23-25. With respect to
plan delivery, Lincoln wrote:
[D]ocumentation obtain[ed] during our review . . . indicates
that certificates were provided to the group for
distribution. Our documentation further indicates that a
named certificate was generated for Ms. Sliwa on her
effective date of 02/01/2010. Ms. Pizana has provided a
declaration that a copy of the approval letter and plan
documents are kept in employee files as their proof of
During our oversight review we did consult with Ms. Pizana to
confirm the accuracy of her previous declaration. She
confirmed that her statement was accurate and that Ms.
Sliwa's certificate would have been mailed to her ...