Rodriguez v. Aetna Life Insurance Company
Filing
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ORDER granting 25 Motion to Partially Dismiss Amended Complaint. Plaintiff may file a Second Amended Complaint by 5/29/2012. Alternatively, Plaintiff may file a Notice to proceed solely on the remaining relief sought by 5/29/2012. Signed by Judge James I. Cohn on 5/15/2012. (awe)
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF FLORIDA
Case No. 11-62684-CIV-COHN/SELTZER
CARMEN RODRIGUEZ,
Plaintiff,
v.
AETNA LIFE INSURANCE COMPANY
ADMINISTRATOR OF THE DOLLAR
FINANCIAL GROUP INC.
LONG TERM DISABILITY PLAN,
Defendants.
_________________________________/
ORDER GRANTING MOTION TO PARTIALLY DISMISS AMENDED COMPLAINT
THIS CAUSE is before the Court upon Defendant Aetna Life Insurance
Company’s Motion to Partially Dismiss Amended Complaint [DE 25]. The Court has
considered the Motion, Plaintiff Carmen Rodriguez’s Response [DE 27], Defendant’s
Reply [DE 29], the record in this case, and is otherwise fully advised in the premises.
I. BACKGROUND
On December 19, 2011, Plaintiff Carmen Rodriguez filed this action against
Defendant Aetna Life Insurance Company to enforce her rights under the Employment
Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”). See
Complaint [DE 1]. According to the Amended Complaint [DE 16], Plaintiff seeks judicial
reversal of an allegedly wrongful decision by Defendant, as a claim administrator for an
ERISA-governed employee welfare benefit plan, to deny Plaintiff long-term disability
benefits. Am. Compl. ¶¶ 8-11, 24-25, 33, 37, 50, 51. Plaintiff requests that the Court
grant her the following relief:
declaratory and injunctive relief, finding that [she] is entitled to all past due
short term and long term disability benefits yet unpaid under the terms of the
Plan, and that Defendant be ordered to pay all future short term and long
term disability benefits according to the terms of the Plan until such time as
Plaintiff is no longer disabled or reaches the benefit termination age of the
Plan.
Id. ¶ 52. Defendant seeks to dismiss Plaintiff’s requests for injunctive relief and future
benefits pursuant to Federal Rule of Civil Procedure 12(b)(6). See Mot. at 2-4.
II. LEGAL STANDARD
Under Rule 12(b)(6), a motion to dismiss lies for “failure to state a claim upon
which relief can be granted.” Fed. R. Civ. P. 12(b)(6). In order to state a claim, Federal
Rule of Civil Procedure 8(a)(2) requires “a short and plain statement of the claim
showing that the pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2). “While a
complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual
allegations, a plaintiff’s obligation to provide the ‘grounds’ of his ‘entitle[ment] to relief’
requires more than labels and conclusions, and a formulaic recitation of the elements of
a cause of action will not do.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 545 (2007)
(citations omitted). “To survive a motion to dismiss, a complaint must contain sufficient
factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’”
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Twombly, 550 U.S. at 570).
At this stage in the litigation, the Court must consider the factual allegations in
the Complaint as true, and accept all reasonable inferences therefrom. Jackson v.
Okaloosa Cnty., Fla., 21 F.3d 1531, 1534 (11th Cir. 1994). Nevertheless, the Court
may grant a motion to dismiss when, “on the basis of a dispositive issue of law, no
construction of the factual allegations will support the cause of action.” Marshall Cnty.
Bd. of Educ. v. Marshall Cnty. Gas Dist., 992 F.2d 1171, 1174 (11th Cir. 1993).
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III. ANALYSIS
Defendant argues that Plaintiff’s requests for injunctive relief and future benefits
must be dismissed because these forms of relief are unavailable. See Mot. at 2-4.
Plaintiff disagrees. See Resp. The Court addresses each form of relief in turn.
A. Injunctive Relief
Section 1132(a) describes the persons empowered to bring civil actions under
ERISA. See 29 U.S.C. § 1132(a). Sub-section (a)(1)(B) provides that a participant or
beneficiary may bring a civil action “to recover benefits due to him under the terms of
his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future
benefits under the terms of the plan.” 29 U.S.C. § 1132(a)(1)(B). A separate subsection, (a)(3), provides that a participant, beneficiary, or fiduciary may bring a civil
action “(A) to enjoin any act or practice which violates any provision of this subchapter
or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress
such violations or (ii) to enforce any provisions of this subchapter or the terms of the
plan.” 29 U.S.C. § 1132(a)(3). The Eleventh Circuit has ruled that “an ERISA plaintiff
with an adequate remedy under § 1132(a)(1)(B), cannot alternatively plead and
proceed under § 1132(a)(3).” Katz v. Comprehensive Plan of Group Ins., 197 F.3d
1084, 1088 (11th Cir. 1999) (affirming dismissal of § 1132(a)(3) claims because
complaint also asserted claim for benefits under § 1132(a)(1)(B)).
Although the Amended Complaint does not specify the sub-section under which
Plaintiff seeks relief, Defendant contends that Plaintiff brings her claim under
§ 1132(a)(1)(B), not § 1132(a)(3), because a suit for recovery of benefits, such as this
one, is brought pursuant to § 1132(a)(1)(B). See Mot. at 3 (citing Featherston v. Met.
Life Ins. Co., 389 F. Supp. 2d 1302, 1315 (N.D. Fla. 2005)). Plaintiff does not argue
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otherwise. See Resp. at 2, 3 (reiterating that “Defendant notes that Plaintiff pursues
benefits pursuant to Section 11132(a)(1)(B),” and arguing “Section 1132(a)(1)(B) does
permit a civil action for clarification of rights to future benefits.”).
Defendant asserts that any request for injunctive relief must therefore be
dismissed. However, Plaintiff responds that “if this Honorable Court interprets that an
enforcement of [Plaintiff’s] rights under the statute is a form of injunctive relief,
[Defendant’s] argument fails.” Resp. at 3.
As noted above, because Plaintiff brings her claims under § 1132(a)(1)(B), she
may not pursue relief under § 1132(a)(3). Therefore, any request for injunctive relief
under § 1132(a)(3) is improper and will be dismissed. See Chiroff v. Life Ins. Co. of N.
Am., 142 F. Supp. 3d 1360, 1365-66 (S.D. Fla. 2000) (dismissing § 1132(a)(3) claim
because plaintiff asserted a § 1132(a)(1)(B) claim)). However, because § 1132(a)(1)(B)
permits enforcement of a plaintiff’s rights under the statute, Plaintiff may seek an order
enforcing her rights. Therefore, although the request for injunctive relief will be
dismissed without prejudice, Plaintiff will have an opportunity to replead her request for
relief in accordance with the above standards if she so desires.
B. Future Benefits
As a recent Southern District of Florida case noted, “There is [ ] no question that
the Court may not award payment for disability benefits beyond the date of final
judgment.” Herring v. Aetna Life Ins. Co., No. 11-CV-81091, 2010 WL 456667, at *3
(S.D. Fla. Feb. 14, 2012). Nonetheless, in this case, Plaintiff seeks an order directing
Defendant to pay benefits “until such time as Plaintiff is no longer disabled.” Am.
Compl. ¶ 52. As Defendant notes, “such an order would [ ] be improper and prejudicial
because benefits may be terminated in the future for other reasons besides a cessation
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of disability.” Mot. at 4. For instance, the Certificate of Coverage [DE 25-1 at 4-22]
indicates that benefits end if the claimant fails to furnish proof that she is disabled,
refuses to be examined by a physician, or ceases to be under the regular care of a
physician, among other reasons. See Certificate of Coverage at A-2457. Although the
Court could judicially reverse Defendant’s benefits decision, Defendant would retain the
right to initiate further review of Plaintiff’s continuing eligibility for long-term disability
benefits in the future. See Halpin v. W.W. Grainger, Inc., 962 F.2d 685, 697 (7th Cir.
1992) (affirming reinstatement of benefits as of date of termination, but recognizing that
administrator “remains free in the future to initiate further review of [plaintiff’s] continuing
eligibility for long-term disability benefits.”).
In Plaintiff’s Response, she cites § 1132(a)(1)(B) for the proposition that “a
participant may sue to recover benefits due, to enforce rights to future benefits, or to
clarify rights to future benefits,” Resp. at 3, but the Amended Complaint requests “that
Defendant be ordered to pay all future short term and long term disability benefits
according to the terms of the Plan until such time as Plaintiff is no longer disabled or
reaches the benefit termination age of the Plan,” Am. Compl. ¶ 52. Although an order
enforcing Plaintiff’s rights to future benefits or an order clarifying her rights to future
benefits would be a proper form of relief, an order requiring Defendant to pay benefits
until Plaintiff is no longer disabled, without permitting Defendant to terminate benefits
for other reasons in the Certificate of Coverage, would be improper. Accordingly, the
request for an order requiring Defendant to pay future benefits will be dismissed without
prejudice. As with the request for injunctive relief, Plaintiff will have an opportunity to
replead her request for relief in accordance with the above standards if she so desires.
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IV. CONCLUSION
Based on the foregoing, it is hereby
ORDERED AND ADJUDGED as follows:
1.
Defendant Aetna Life Insurance Company’s Motion to Partially Dismiss
Amended Complaint [DE 25] is GRANTED;
2.
Plaintiff’s requests for injunctive relief and for an order requiring
Defendant to pay future benefits are DISMISSED without prejudice;
3.
Plaintiff may file a Second Amended Complaint consistent with the above
standards by no later than May 29, 2012. Alternatively, Plaintiff may file a
Notice to proceed solely on the remaining relief sought, that is
“declaratory . . . relief, finding that [she] is entitled to all past due short
term and long term disability benefits yet unpaid under the terms of the
Plan”;
4.
Defendant’s Answer will be due 14 calendar days from the filing of an
Second Amended Complaint or a Notice.
DONE AND ORDERED in Chambers at Fort Lauderdale, Broward County,
Florida, on this 15th day of May, 2012.
Copies provided to:
Counsel of record via CM/ECF
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