1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 7 PATRICIA WHITE, Case No. 20-cv-03591-HSG

8 Plaintiff, ORDER GRANTING MOTION TO DISMISS 9 v. Re: Dkt. No. 18 10 ANTHEM LIFE INSURANCE COMPANY, 11 Defendant. 12 13 Pending before the Court is Defendant’s motion to dismiss Plaintiff’s First Amended 14 Complaint (“FAC”).1 Dkt. No. 18. For the following reasons, the motion to dismiss is 15 GRANTED without leave to amend. 16 I. BACKGROUND 17 Plaintiff Patricia White filed her first amended complaint in this Employee Retirement 18 Income Security Act of 1974 (“ERISA”) action on July 24, 2020 against Defendant Anthem Life 19 Insurance Company. Dkt. No. 12. Plaintiff was a plan participant and a covered beneficiary under 20 her employer’s welfare plan, which was governed by ERISA and issued by Defendant (the 21 “Plan”). FAC ¶¶ 1,7. On October 11, 2012, in a written letter to Plaintiff, Defendant approved 22 her long-term disability benefits. FAC ¶ 8. On April 2, 2014, Defendant ceased payments of 23 Plaintiff’s disability insurance under the Plan. FAC ¶ 18. By letter dated October 1, 2014, 24 Defendant denied Plaintiff’s request for continued disability benefits. FAC ¶ 27. The letter 25 detailed the procedure Plaintiff had to follow if she wished to appeal Defendant’s decision, 26 including the requirement that an appeal must be made within 180 days of receipt of the denial 27 1 letter. White v. Anthem Life Ins. Co., 18-CV-019141-HSG,

, at *2 (N.D. Cal. 2 Sept. 4, 2019) (“White I”). In 2018, Plaintiff brought a claim before the Court seeking review of 3 Defendant’s denial of her continuing long-term disability benefits.

4 On September 4, 2019, the Court found that Plaintiff failed to exhaust her administrative 5 remedies before seeking judicial review and granted Defendant’s motion for summary judgment 6 on this basis. Id. at 4-5. Plaintiff appealed the Court’s summary judgment order to the Ninth 7 Circuit. FAC ¶ 32. Before the Ninth Circuit issued a decision, Plaintiff sent a letter to Defendant 8 on February 20, 2020 requesting that Defendant review its termination of her benefits. FAC ¶ 33. 9 Defendant replied to this letter on March 18, 2020, stating that Plaintiff is not eligible for an 10 appeal, her request for continued disability benefits beyond April 2, 2014 is denied, and her file 11 remains closed. FAC ¶ 34. Plaintiff then filed this action on May 29, 2020. FAC ¶ 35. On 12 October 21, 2020, the Ninth Circuit affirmed this Court’s grant of summary judgment in favor of 13 Defendant. White v. Anthem Life Ins. Co., No. 19-16954 (9th Cir. Oct. 19, 2020) (“Appellate 14 Decision”). 15 II. LEGAL STANDARD 16 Federal Rule of Civil Procedure 8(a) requires that a complaint contain “a short and plain 17 statement of the claim showing that the pleader is entitled to relief[.]” A defendant may move to 18 dismiss a complaint for failing to state a claim upon which relief can be granted under Federal 19 Rule of Civil Procedure 12(b)(6). “Dismissal under Rule 12(b)(6) is appropriate only where the 20 complaint lacks a cognizable legal theory or sufficient facts to support a cognizable legal theory.” 21 Mendiondo v. Centinela Hosp. Med. Ctr.,

(9th Cir. 2008). To survive a Rule 22 12(b)(6) motion, a plaintiff must plead “enough facts to state a claim to relief that is plausible on 23 its face.” Bell Atl. Corp. v. Twombly,

(2007). A claim is facially plausible 24 when a plaintiff pleads “factual content that allows the court to draw the reasonable inference that 25 the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal,

(2009). 26 In reviewing the plausibility of a complaint, courts “accept factual allegations in the complaint as 27 true and construe the pleadings in the light most favorable to the nonmoving party.” Manzarek v. 1 “accept as true allegations that are merely conclusory, unwarranted deductions of fact, or 2 unreasonable inferences.” In re Gilead Scis. Sec. Litig.,

(9th Cir. 2008). 3 III. DISCUSSION 4 Defendant moves to dismiss Plaintiff’s FAC, contending that the facts as alleged establish 5 that Plaintiff failed to timely exhaust her administrative remedies. Dkt. No. 18 at 20. Plaintiff 6 argues that the Court should deny the motion to dismiss because her February 2020 letter served to 7 effectively appeal Defendant’s denial of benefits and thus exhausted her administrative remedies. 8 Dkt. No. 25 at 6. The Court agrees with Defendant that Plaintiff failed to file a timely appeal with 9 Defendant, notwithstanding her February 2020 request. Because the Court finds this threshold 10 issue dispositive, the Court need not address the other arguments included in Defendant’s motion 11 to dismiss. 12 It is well settled that an ERISA plaintiff “must avail himself or herself of a plan’s own 13 internal review procedures before bringing suit in federal court.” White I at *3; see Vaught v. 14 Scottsdale Healthcare Corp. Health Plan,

(9th Cir. 2008) (quotations and 15 citations omitted). Under ERISA, an employee benefit plan must “provide adequate notice in 16 writing to any participant or beneficiary whose claim for benefits under the plan has been denied, 17 setting forth specific reasons for such denial, written in a manner calculated to be understood by 18 the participant.”

(1). 19 The Court previously found, and the Ninth Circuit affirmed, that (1) “the Plan requires 20 exhaustion as a mandatory prerequisite to bringing suit”; and (2) “to obtain ‘reconsideration’ of a 21 denied claim, a [Plan] participant must appeal any adverse determination ‘no more than 180 days 22 after” receiving notice of Anthem’s decision.’” White I at *3. Defendant’s October 2014 letter to 23 Plaintiff “provided adequate notice that her claim had been denied such that it triggered the 180- 24 day administrative appeal deadline.” Appellate Decision at *5. Therefore, Plaintiff had 180 days 25 to file a timely administrative appeal, but she failed to do so. White I at *4 (explaining that as of 26 March 29, 2018, more than 3 years after the adverse determination, “the undisputed record shows 27 that Ms. White did not file an appeal after Anthem's decision on October 1, 2014, meaning that 1 On February 20, 2020—after the Court granted Defendant’s motion for summary 2 || judgement and while the appeal to the Ninth Circuit was pending—Plaintiff made a written 3 || request to Defendant asking Defendant to review its termination of her benefits. FAC ¥ 33. 4 || Plaintiff is of the position that the February 2020 letter constitutes an “unambiguous and 5 consolidated” appeal that fulfills the administrative exhaustion requirement. Dkt. No. 25 at 4. But 6 || Plaintiff's February 2020 letter clearly falls outside of the 180-day administrative appeal window 7 that this Court has already found to be applicable and therefore does not cure her failure to exhaust 8 administrative remedies. 9 Plaintiff argues, based on a colloquy during the summary judgment hearing, that the Court 10 || “deferred consideration of whether plaintiff was barred from [exhausting her administrative 11 remedies] by a 180-day appeal clause in the defendant’s plan.” Dkt. No. 25 at 3. But □□□□□□□□□□□ 12 || interpretation of the Court’s hearing questions is inconsistent with the Court’s written order on 13 summary judgment and the Ninth Circuit’s affirmance, both of which found that the 180-day 14 administrative appeal deadline was triggered. White I at *3-5; Appellate Decision at *5. 15 Therefore, Plaintiff failed to timely exhaust her administrative remedies, and dismissal is a 16 appropriate. Because the pleading cannot be cured by the allegation of other facts, the Court does 3 17 not grant leave to amend. See Lopez v. Smith,

(9th Cir. 2000). 18 IV. CONCLUSION 19 The Court GRANTS Defendant’s motion to dismiss Plaintiffs first amended complaint 20 || without leave to amend. The Court directs the Clerk to close the case. 21 22 IT IS SO ORDERED. 23 || Dated: 2/2/2021 Alawpred 8 Mbt) HAYWOOD S. GILLIAM, JR. 25 United States District Judge 26 27 28