Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Yox v. Providence Health Plan

United States District Court, D. Oregon

July 11, 2014

KELLY J. YOX, an individual, Plaintiff,
v.
PROVIDENCE HEALTH PLAN, an Oregon non-profit corporation, Defendant.

John C. Shaw, Megan E. Glor, Megan E. Glor Attorneys at Law, Portland, OR, Attorneys for Plaintiff.

Arden J. Olson, Aaron T. Bals, Harrang Long Gary Rudnick, PC, Eugene, OR, Attorneys for Defendant.

OPINION & ORDER

MARCO A. HERNNDEZ, District Judge.

Plaintiff Kelly J. Yox brought this ERISA action against Defendant Providence Health Plan to challenge the denial of her medical claim for dental treatment. Defendant moved for partial summary judgment on whether a prior review was an arbitration, and thus Plaintiff was barred from seeking judicial review. I denied Defendant's motion for partial summary judgment. The parties then cross-moved for summary judgment. I granted Plaintiff's motion and denied Defendant's motion because I found Defendant's denial of the medical claim was an abuse of discretion.

Plaintiff now moves for attorney's fees and costs [78] in the amounts of $124, 045 in fees and $414.76 in costs. For the reasons explained below, I grant the motion in part and deny the motion in part. Plaintiff is awarded $78, 440 in attorney's fees and $414.76 in costs.

DISCUSSION

I. Motion for Attorney's Fees

A. Entitlement to Attorney's Fees

In an ERISA action to recover unpaid disability benefits, "the court in its discretion may allow a reasonable attorney's fee and costs of action to either party." 29 U.S.C. § 1132(g)(1). According to the Ninth Circuit, "[t]his section should be read broadly to mean that a plan participant or beneficiary, if he prevails in his suit under § 1132 to enforce his rights under his plan, should ordinarily recover an attorney's fee unless special circumstances would render such an award unjust." Smith v. CMTA-IAM Pension Trust , 746 F.2d 587, 589 (9th Cir. 1984) (internal quotations omitted).

In determining whether to award fees and costs, the Court should consider the following five factors, often referred to as the "Hummell factors":

(1) the degree of the opposing parties' culpability or bad faith;
(2) the ability of the opposing parties to satisfy an award of fees;
(3) whether an award of fees against the opposing parties would deter others from acting in similar circumstances;

(4) whether the parties requesting fees sought to benefit all participants and beneficiaries of an ERISA plan or to resolve a significant legal question regarding ERISA; and

(5) the relative merits of the parties' positions.

Hummell v. S.E. Rykoff & Co. , 634 F.2d 446, 453 (9th Cir. 1980). A court need not discuss the Hummell factors if a plaintiff "prevailed completely on the sole issue in question, received the entire relief sought, and resolved a significant legal question[.]" Nelson v. EG & G Energy Measurements Group , 37 F.3d 1384, 1392 (9th Cir. Cal. 1994). However, if "after determining a litigant has achieved some degree of success on the merits, district courts must still consider the Hummell factors before exercising their discretion to award fees under § 1132(g)(1)." Simonia v. Glendale Nissan/Infiniti Disability Plan , 608 F.3d 1118, 1121 (9th Cir. 2010). Because Plaintiff achieved some degree of success, as opposed to completely prevailing on her claim or resolving a significant legal question, the Hummell factors apply.

With respect to the first factor, a finding of bad faith is not necessary to support an attorney's fee award. McElwaine v. U.S. West, Inc. , 176 F.3d 1167, 1173 (9th Cir. 1999). However, a defendant is "culpable" if it did not fulfill a legal duty owed to plaintiff. See Oster v. Std. Ins. Co. , 768 F.Supp.2d 1026, 1033 n3 (N.D. Cal. 2011). Here, there is no evidence that Defendant intentionally, in bad faith, withheld benefits. But Defendant is culpable because it failed to adequately explain the denial of Plaintiff's medical claim. Defendant concedes that it has the ability to satisfy an award of attorney's fees. Def.'s Resp. 4. Although Plaintiff's claim did not seek to benefit other participants, an award of fees may deter other insurers from denying a medical without adequate explanation of the denial. Finally, ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.