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Life Insurance Company of North America v. Sorilla

United States District Court, D. Arizona

May 27, 2015

Life Insurance Company of North America, Plaintiff,
v.
Sylvia M. Sorilla, et al., Defendants.

ORDER

DAVID G. CAMPBELL, District Judge.

Plaintiff Life Insurance Company of North America has filed a motion for judgment on the pleadings and the administrative record. Doc. 20. Defendant Jose Matus has joined the motion. Doc. 21. Defendant Sylvia Sorilla has filed a cross-motion for judgment on the pleadings. Doc. 25. The Court will grant Plaintiff's motion and deny Defendant Sorilla's motion.

I. Background.

Asencio Matus (the "insured") formerly worked for Casino of the Sun, owned by Pascua Yaqui Tribe Enterprises. He acquired through his employer a life-insurance policy that was regulated by the Employee Retirement Income Security Act of 1974 ("ERISA"). A.R. 38. Defendant Life Insurance Company of North America ("LINA") underwrote the policy and administered claims.

The policy included two types of coverage: "basic life insurance" and "voluntary term life insurance." On August 4, 2009, Matus filled out a beneficiary designation form for both types of coverage. A.R. 552. The one-page form contained a box for designating a beneficiary for the basic life insurance, and a separate box for designating a beneficiary for the voluntary life insurance. Id. The insured designated Defendant Sylvia Sorilla as the primary beneficiary of his basic life insurance, but left the beneficiary designation for the voluntary life insurance blank. Id.

The insured died on May 10, 2012. A.R. 186. LINA paid $25, 000 in benefits under the basic life insurance to Sorilla. A.R. 172-73. Because the insured had not designated a beneficiary for the voluntary life insurance, LINA decided that the benefits of this insurance should be paid according to the life insurance policy's "preference clause." A.R. 29. Under this clause, "[i]f there is no named beneficiary or surviving beneficiary, Death Benefits will be paid to the first surviving class of the following living relatives: spouse; child or children; mother or father; brothers or sisters; or to the executors or administrators of the Insured's estate." A.R. 29. LINA determined that the insured's closest living relative was his brother, Defendant Jose Matus, and paid him $110, 000 in benefits. A.R. 118-19.

Sorilla believed that she was entitled to the benefits of the voluntary life insurance. She contacted LINA several times to notify the company of her claim. A.R. 513, 528-29. LINA informed her that she was not entitled to the benefits because the insured had not designated her as the beneficiary. A.R. 529. Sorilla then filed suit in Pascua Yaqui Tribal Court against Jose Matus, claiming that she and not Matus was the correct beneficiary of the voluntary life insurance. See Doc. 1, ¶ 21; Doc. 9, ¶ 3. The result of this litigation is unclear, although Matus alleges that Sorilla's suit was dismissed with prejudice. Doc. 12, ¶¶ 5-6.

On August 12, 2014, LINA filed this lawsuit against Sylvia Sorilla and Jose Matus, seeking a declaratory judgment that "LINA correctly paid the benefits of the LINA Policy's Supplemental Group Term Life Insurance to Jose Matus in accordance with its Preference Clause." Doc. 1, ¶ 6. LINA has now filed a motion for judgment on the administrative record, Matus has joined LINA's motion, and Sorilla has filed a cross-motion for judgment on the pleadings. Docs. 20, 21, 25.

II. Claim & Issue Preclusion.

Defendant Matus argues that the previous litigation in Pascua Yaqui Tribal Court was dismissed with prejudice and therefore precludes whatever claims Sorilla might have against Matus. Doc. 21 at 2. "Claim preclusion, like issue preclusion, is an affirmative defense. Ordinarily, it is incumbent on the defendant to plead and prove such a defense[.]" Taylor v. Sturgell, 553 U.S. 880, 907 (2008). Broadly speaking, the doctrines of claim and issue preclusion do not apply unless there has been a final judgment on the merits of a claim or issue that a party is attempting to re-litigate. See Clark v. Bear Stearns & Co., 966 F.2d 1318, 1320 (9th Cir. 1992). "The party asserting preclusion bears the burden of showing with clarity and certainty what was determined by the prior judgment.... [T]he party must introduce a sufficient record of the prior proceeding to enable the trial court to pinpoint the exact issues previously litigated.'" Id. at 1321 (quoting United States v. Lasky, 600 F.2d 765, 769 (9th Cir. 1979)).

Matus argues that Sorilla sued him "in the Pascua Yaqui Tribal court on the subject matter of this controversy.... That case was dismissed with prejudice and is re[s] judicata as to all claims of Sorilla against Matus." Doc. 21 at 2. Matus has not submitted a record of the proceedings in the tribal court or evidence of the tribal court's decision. Matus' argument rests on a bare allegation, which the other parties have not addressed in their motions. Because Matus has not carried his burden of proving res judicata, the Court will not decide this case on that basis.

III. Legal Standard.

LINA styles its motion as a motion for "declaratory judgment on the pleadings and the administrative record, " and states that the motion is brought pursuant to Rule 52(a)(1). Doc. 20 at 1. Sorilla styles her response as a "cross-motion for judgment on the pleadings." Doc. 25 at 1. The Court concludes that these motions should be treated as cross-motions for summary judgment under Rule 56. They are not motions for judgment on the pleadings under Rule 12(c) because both parties rely on an administrative record that is outside the pleadings. See Fed.R.Civ.P. 12(d).[1] The Court also declines to rule on these motions under Rule 52(a). Although in some ERISA cases the Court may resolve factual disputes and "try the case on the record that the administrator had before it, " Kearney v. Standard Ins. Co., 175 F.3d 1084, 1095 (9th Cir. 1999) (en banc), this is unnecessary here. As discussed below, the relevant facts are not in dispute and the issues can be decided on summary judgment. ...


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