Gary Affonso v. Metropolitan Life Insurance , 580 F. App'x 581 ( 2014 )

FILED
NOT FOR PUBLICATION JUN 25 2014
MOLLY C. DWYER, CLERK
UNITED STATES COURT OF APPEALS U.S. COURT OF APPEALS
FOR THE NINTH CIRCUIT
GARY AFFONSO, No. 12-16250
Plaintiff - Appellant, D.C. No. 4:10-cv-5054-PJH
v.
MEMORANDUM*
METROPOLITAN LIFE INSURANCE
CO.,
Defendant - Appellee.
Appeal from the United States District Court
for the Northern District of California
Phyllis J. Hamilton, District Judge, Presiding
Argued and Submitted May 16, 2014
San Francisco, California
Before: McKEOWN and M. SMITH, Circuit Judges, and SELNA, District Judge.**
Gary Affonso appeals from the judgment of the district court granting
summary judgment to Metropolitan Life Insurance Company (“MetLife”) in this
Employee Retirement Income Security Act (“ERISA”) action arising from
*
This disposition is not appropriate for publication and is not precedent except as
provided by 9th Cir. R. 36-3.
** The Honorable James V. Selna, District Judge for the U.S. District Court for the
Central District of California, sitting by designation.
MetLife’s partial denial of benefits to Mr. Affonso under his wife, Nance’s,
supplemental life insurance policy. We have jurisdiction under 28 U.S.C. § 1291.
Reviewing de novo, Bilyeu v. Morgan Stanley Long Term Disability Plan, 683 F.3d
1083, 1088 (9th Cir. 2012), we affirm.
The unambiguous Morgan Stanley Benefits Plan (“Plan”) terms limited
Nance Affonso’s eligibility for supplemental life insurance coverage to $500,000
based on her benefits eligible earnings of $53,017.73, even though the Benefits
Center website permitted her to apply for $1,000,000 of coverage. The Summary
Plan Description and the 2010 Benefits Enrollment Highlights booklet, both
available to Mrs. Affonso, clearly limited coverage to “a maximum of the lesser of
ten times [the employee’s] Benefits Eligible Earnings . . . or $5,000,000.” The
Certificate of Insurance issued by MetLife contained the same limitation. This
clear coverage limitation and the Affonsos’ knowledge of it was affirmed by Plan
representatives, who repeatedly told the Affonsos they would be contacted to
adjust discrepancies in Mrs. Affonso’s application. Most tellingly, Mrs. Affonso
was sent a letter confirming the Plan’s supremacy over other representations.
Because the coverage limitation was unambiguous, Mr. Affonso’s
conditional receipt, waiver, and equitable estoppel defenses fail. Cf. Gaines v. The
Sargent Fletcher, Inc. Group Life Ins. Plan, 329 F. Supp. 2d 1198, 1216–23 (C.D.
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Cal. 2004) (finding defenses applicable because benefits plan language was
ambiguous). The deduction of a premium at the $1,000,000 coverage level at most
confirms Mrs. Affonso was covered when she died, but does not negate the clear
limitation on her coverage. Cf. Gaines, 329 F. Supp. 2d. at 1221–23 (where plan
language about approval and evidence of good health was ambiguous and
premiums were deducted, waiver and estoppel prohibited insurer from arguing
applicant was not covered).
AFFIRMED.
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