Bay Area Roofers Health & Welfare Trust v. Sun Life Assurance Co. of Canada

ORDER

(1) GRANTING IN PART AND DENYING IN PART DEFENDANT’S MOTION FOR SUMMARY JUDGMENT

(2) GRANTING PLAINTIFFS’ MOTION FOR PARTIAL SUMMARY JUDGMENT

This ease involves interpretation of provisions of a stop-loss insurance policy issued by Defendant Sun Life Assurance Company of Canada (“Sun Life”) regarding the scope of its contractual obligation to reimburse Plaintiff Bay Area Roofers Health and Welfare Trust (“the Trust”) for claims paid on behalf of a worker’s minor children for medical care. Sun Life asserts that coverage is precluded because *1157 the worker obtained his employment by fraud through submission of a false Social Security Number (“SSN”). The Trust asserts that it determined that the worker was an eligible employee under the Health and Welfare Plan and thus, as required by the Policy, Sun Life is contractually obligated to reimburse it for its claims. Cross-motions for summary judgment are presently before the Court.

Plaintiffs are a Trust created for the purpose of providing health care benefits for employees and their dependents in the roofing industry, and two of its Trustees. The Trust purchased a stop-loss insurance policy (“the Policy”) from Sun Life in…