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Mull v. Motion Picture Industry Health Plan

United States Court of Appeals, Ninth Circuit

August 1, 2017

Danielle Mull, appointed Guardian Ad Litem for C. Mull; C. Mull, as Plaintiff and Danielle Mull is Appointed Guardian Ad Litem for C. Mull, Plaintiffs-Appellees,
v.
Motion Picture Industry Health Plan, Defendant-Appellant, Lenai Mull; Norman Mull, Plaintiffs-Counter-Defendants-Appellees, Board of Directors of Motion Picture Industry Health Plan, Defendant-Counter-Claimant-Appellant.

          Argued and Submitted June 7, 2017 Pasadena, California

         Appeal from the United States District Court No. 2:12-cv-06693-VBF-MAN for the Central District of California Valerie Baker Fairbank, District Judge, Presiding

          Kathryn Jane Halford (argued) and Elizabeth Rosenfeld, Wohlner Kaplon Cutler Halford & Rosenfeld, Encino, California, for Defendants-Appellants.

          Donald Mitchell de Camara (argued), Law Office of Donald M. de Camara, Carlsbad, California; Drew M. Widders and Daniel E. Wilcoxen, Wilcoxen Callahan LLP, Sacramento, California; for Plaintiffs-Appellees.

          Before: Susan P. Graber and Mary H. Murguia, Circuit Judges, and Susan R. Bolton, [*] District Judge.

         SUMMARY[**]

         Employee Retirement Income Security Act

         The panel vacated the district court's grant of summary judgment in favor of the plaintiffs in an ERISA action.

         The district court enjoined an ERISA plan and its board of directors from enforcing Summary Plan Description provisions regarding reimbursement of benefits previously paid upon a plan participant's receipt of a third-party recovery. The district court ruled that these reimbursement/recoupment provisions were not enforceable under ERISA because they were found only in the Summary Plan Description and not in any document that constituted the ERISA plan.

         The panel concluded that a Motion Picture Industry Plan Agreement and Declaration of Trust, along with the Summary Plan Description, together comprised the ERISA plan because only the Summary Plan Description provided the basis on which payments were made to and from the plan. The panel distinguished CIGNA Corp. v. Amara, 563 U.S. 421 (2011), which held that summary documents do not constitute the terms of an ERISA plan when there exist both a governing plan document and a summary plan description. The panel vacated the district court's grant of summary judgment and remanded for further proceedings.

          OPINION

          BOLTON, District Judge.

         This appeal arises from the order of the district court granting summary judgment in favor of Plaintiffs Norman, Danielle, Lenai, and C. Mull on claims under the Employee Retirement Income Security Act of 1974 ("ERISA") against Defendants Motion Picture Industry Health Plan (the "Plan") and the Board of Directors of the Plan.

         The Plan is a self-funded multi-employer health and welfare benefit plan established under a Motion Picture Industry Plan Agreement and Declaration of Trust (the "Trust Agreement"). The Board of Directors are named fiduciaries and administrators of the Plan. The Board adopted the Motion Picture Industry Health Plan Summary Plan Description for Active Participants (the "SPD"), which specifies eligibility requirements, conditions for the receipt of benefits, the types of benefits, and the amount and duration of benefits provided to participants and their eligible dependents.

         Two related provisions of the SPD are relevant to this appeal. The SPD provides that no benefits will be payable in a third-party liability claim unless the participant, or applicable dependent, agrees to reimburse the Plan for any benefits previously paid upon receipt of a third-party recovery. The SPD further states that if reimbursement is requested but not received by the Plan, the amount of ...


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