Jamison v. Aetna Life Insurance Company
Filing
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MEMORANDUM OPINION AND ORDER Signed by the Honorable Robert M. Dow, Jr on 11/2/2015. Defendant's motion 22 is granted in part and denied in part. Defendant's motion to dismiss Plaintiff's lawsuit as untimely based on the contractual limitations period in the plan is denied. Plaintiff's demand that Defendant pay her insurance premiums is voluntarily dismissed. Defendant's motion to strike Plaintiff's claim for pre judgment interest is granted to the extent that Plaintiff's claim references the Illinois prejudgment-interest statute. Defendant's motion to strike Plaintiff's claim for a jury trial is granted. This case is set for future status hearing on 11/17/2015 at 9:00 a.m. Mailed notice(cdh, )
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
FREDNELL JAMISON,
Plaintiff,
AETNA LIFE INSURANCE COMPANY,
Defendant.
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Case No. 15-cv-0078
Judge Robert M. Dow, Jr.
MEMORANDUM OPINION AND ORDER
Plaintiff, a participant in an employee benefit plan covered by the Employee Retirement
Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., brought a civil action under
§ 502(a)(1)(B) of that Act, 29 U.S.C. § 1132(a)(1)(B), to recover long-term disability benefits
allegedly due under the terms of the plan. Before the Court is Defendant’s motion to dismiss
Plaintiff’s amended complaint, and Defendant’s motion to strike Plaintiff’s request for a jury
demand and Plaintiff’s request for prejudgment interest [22]. For the reasons set forth below,
Defendant’s motion [22] is granted in part and denied in part. Defendant’s motion to dismiss
Plaintiff’s lawsuit as untimely based on the contractual limitations period set forth in the plan is
denied. Plaintiff’s demand that Defendant pay her insurance premiums is voluntarily dismissed.
Defendant’s motion to strike Plaintiff’s claim for prejudgment interest is granted to the extent
that Plaintiff’s claim references the Illinois prejudgment-interest statute. Defendant’s motion to
strike Plaintiff’s claim for a jury trial is granted.
I.
Background1
Plaintiff Frednell Jamison was employed as an office administrator to the Vice President
of Accounting and Financing with the Boeing Company up until February 25, 2009. At that time,
1
The Court accepts as true the facts alleged in Plaintiff’s amended complaint and makes all reasonable
inferences in her favor. See McReynolds v. Merrill Lynch & Co., 694 F.3d 873, 879 (7th Cir. 2012).
Plaintiff—who suffered from Hepatitis C, chronic joint pain, chronic fatigue, and other medical
impairments—became unable to work because of her medical conditions. Plaintiff applied for
long-term disability benefits under the terms of a group long-term disability insurance plan
underwritten and administered by Defendant Aetna Life Insurance Company for the benefit of
Boeing employees. Defendant awarded Plaintiff long-term disability benefits beginning on
August 29, 2009.
Approximately one year later, on August 25, 2010, Defendant informed Plaintiff that her
long-term disability benefits would be limited to 24 months because her claim was “primarily
due to mental illness,” and that her benefits would be terminated as of August 25, 2011.
At some point (the amended complaint does not say when), Plaintiff appealed this
decision in accordance with Defendant’s internal review procedures, arguing that her disability
stemmed from her Hepatitis C, and that her mental-health issues were only a side effect of the
numerous prescription medications she was taking to treat her Hepatitis C. Plaintiff claims that in
a letter dated January 14, 2014, Defendant explained to her that it had completed its review of
her appeal two years earlier (on January 19, 2012), claiming that it had sent her a letter stating as
much on that date. [12, ¶ 15.] The implication from Plaintiff’s complaint is that Plaintiff did not
receive Defendant’s January 19, 2012 letter, and potentially did not learn of the results of her
appeal until she received Defendant’s letter dated January 14, 2014.
Regardless, on June 18, 2013, Plaintiff sued Defendant in Illinois state court, allegedly
raising the same issues raised in this case. Plaintiff says that her state court case was sent to an
arbitrator pursuant to Illinois Supreme Court Rule 86, and that in December 2014, an arbitration
panel determined that it did not have jurisdiction over Plaintiff’s ERISA action.2 On January 7,
2015, Plaintiff filed her pro se complaint in federal court. The Court granted Plaintiff’s request
2
Plaintiff’s state court case was subsequently dismissed for want of prosecution. [See 28-1, at 4.]
2
for legal counsel [6], and Plaintiff’s appointed counsel then filed an amended complaint [12] on
Plaintiff’s behalf, along with a demand for a jury trial [13].
II.
Legal Standard
In reviewing the sufficiency of a complaint, a district court must accept all well-plead
facts as true and draw all permissible inferences in favor of the plaintiff. Agnew v. Nat’l
Collegiate Athletic Ass’n, 683 F.3d 328, 334 (7th Cir. 2012). The Federal Rules of Civil
Procedure require only that a complaint provide the defendant with “fair notice of what the * * *
claim is and the grounds upon which it rests.” Erickson v. Pardus, 551 U.S. 89, 93 (2007)
(quoting Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007)). The Supreme Court has
described this notice-pleading standard as requiring a complaint to “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). While factual allegations must be
accepted as true, legal conclusions may not be considered. Id.
III.
Analysis
A.
Contractual Limitations Period
Defendant’s main argument for dismissal is that Plaintiff failed to file her lawsuit within
the contractual limitations period set forth in the plan, arguing that Plaintiff’s time to file lapsed
on November 26, 2012. Plaintiff calculates the limitations period differently, alleging that her
time to sue ended on November 24, 2013.3 ERISA does not specify a statute of limitations for
3
The one-year disparity arises from how the parties calculate the “deadline for filing claims [for
benefits],” which is a main component to determining the contractual limitations period. In general, the
deadline for filing claims for benefits is a specific date (i.e., 90 days after the so-called “elimination
period,” which defendant claims is “the first 26 weeks of a period of disability” [see 24, at 3]), but that
date can be extended up to one year for those who fail to meet the deadline through no fault of their own,
or indefinitely for those who are legally incapacitated. Plaintiff awards herself an extra year in calculating
her limitations period, although it is unclear as to whether Plaintiff insists that this one-year add-on
applies to all limitations-period calculations, or whether it only applies to those who actually received the
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suits filed under § 502(a)(1)(B). However, “[a]bsent a controlling statute to the contrary, a
participant and a plan may agree by contract to a particular limitations period, even one that
starts to run before the cause of action accrues, as long as the period is reasonable.” Heimeshoff
v. Hartford Life & Acc. Ins. Co., 134 S. Ct. 604, 610 (2013).
Because Plaintiff did not file her complaint until January 7, 2015—i.e., years after the
end of limitations period as calculated by either party—the parties’ disagreement regarding the
end of the limitations period seems inconsequential to the Court’s determination regarding the
timeliness of this lawsuit. But Plaintiff apparently filed a similar lawsuit in Illinois state court on
June 18, 2013 (i.e., within the limitations period as calculated by Plaintiff), and she argues that
the limitations period should be tolled during the pendency of that case. Defendant disagrees.
The issue here is one of equitable tolling.
Although broad in application, equitable tolling can be defined narrowly as “[t]he
doctrine that if a plaintiff files a suit first in one court and then refiles in another, the statute of
limitations does not run while the litigation is pending in the first court if various requirements
are met.” Black’s Law Dictionary 579 (8th ed. 2004). Equitable tolling can apply in ERISA
cases, Tolle v. Carroll Touch, Inc., 977 F.2d 1129, 1141 (7th Cir. 1992), and, generally speaking,
is reserved for instances where the claimant “‘has made a good faith error (e.g., brought suit in
the wrong court) or has been prevented in some extraordinary way from filing [her] complaint in
time.’” Threadgill v. Moore U.S.A., Inc., 269 F.3d 848, 850 (7th Cir. 2001) (quoting Jones v.
Madison Service Corp., 744 F.2d 1309, 1314 (7th Cir. 1984)). If Plaintiff mistakenly filed her
one-year extension in filing their claim for benefits. Because the Court ultimately concludes that
Defendant’s motion to dismiss is premature based on the parties’ disagreement concerning the applicable
policy, the Court need not address this argument at this time. Should this issue remain relevant in any
future motions regarding the timeliness of Plaintiff’s complaint, the parties should be sure to set forth
their positions regarding the inclusion or exclusion of this one year add-on in calculating the limitations
period.
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original lawsuit in state court in good-faith (and there is no indication that she did otherwise),
then she most likely would be eligible for equitable tolling. But that would only save Plaintiff’s
claims under her calculation of the applicable limitations period; tolling the limitations period
during the pendency of the state court proceedings does not save Plaintiff’s case under
Defendant’s calculation of the limitations period.4
This brings the Court to the key difference between the parties’ respective approaches,
which is their reliance on separate written policies. Plaintiff relies on the Group Life and Long
Term Disability Insurance Policy issued September 2, 1999, attached to her amended complaint
as Exhibit A [see 12-1]; Defendant relies on a Non-Union Long Term Disability Policy (which it
calls a “Booklet-Certificate”) and a Summary of Coverage issued January 17, 2006,5 attached to
its motion to dismiss as Exhibits A and B, respectively [see 24-1, 24-2]. Plaintiff questions the
authenticity of Defendant’s exhibits (Defendant did not provide an affidavit attesting to their
authenticity), arguing that the Court should disregard and/or strike Defendant’s exhibits.
As a preliminary matter, a court normally cannot consider documents outside the
complaint without converting it into a motion for summary judgment. See Fed. R. Civ. P. 12(d);
Tierney v. Vahle, 304 F.3d 734, 738 (7th Cir. 2002). That being said, a court can consider
documents attached to a motion to dismiss if the document is part of the pleadings that are
referred to in the plaintiff’s complaint, are central to her claim, and are properly authenticated (or
4
Plaintiff also makes an equitable estoppel argument, claiming that Defendant should be estopped from
litigating over the timeliness of Plaintiff’s complaint. [28, at 8–9.] For example, Plaintiff argues that
Defendant made oral misrepresentations to her regarding her rights of appeal, and that Defendant’s
misrepresentations were compounded by ambiguities in the plan. Because Plaintiff’s arguments are
dependent on disputed facts (e.g., what Defendant told Plaintiff about her rights to contest their decisions,
and which plan applies), they are premature. See, e.g., Gallegos v. Mt. Sinai Med. Ctr., 210 F.3d 803, 809
(7th Cir. 2000) (contemplating estoppel arguments in an ERISA case at the summary judgment stage).
5
It appears that Defendant attached this Summary of Coverage because it defines a term (i.e.,
“elimination period”) that is necessary to compute the limitations period as set forth in Defendant’s
primary exhibit (the “Booklet-Certificate”), in which the term “elimination period” is not defined.
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authenticity is conceded). See Hecker v. Deere & Co., 556 F.3d 575, 582 (7th Cir. 2009);
Tierney, 304 F.3d at 738–39; Wright v. Associated Ins. Cos. Inc., 29 F.3d 1244, 1248 (7th Cir.
1994); Venture Assocs. Corp. v. Zenith Data Systems Corp., 987 F.2d 429, 431 (7th Cir. 1993).
The requirement of authenticity cannot be overlooked, and a court’s failure to
acknowledge a lack of authenticity in ruling on a motion to dismiss is a reversible error. See
Hecker v. Deere & Co., 556 F.3d 575, 582 (7th Cir. 2009) (“The district court * * * found that
[documents attached to Defendant’s motion to dismiss] were all documents to which the
Complaint had referred, that the documents were concededly authentic, and that they were
central to the plaintiffs’ claim. If the court erred in this respect, we would be able to dispense
with most of the rest of this appeal, since it would be necessary to remand on this basis alone.”
(emphasis added) (internal citation omitted)). Because Defendant did not authenticate its
exhibits, the Court cannot consider them in ruling on Defendant’s motion.
But looking at the bigger picture, the parties have submitted excerpts from two separate
policies (or perhaps three, counting Defendant’s exhibits separately), each arguing that their
version of the policy governs. Plaintiff says that Defendant’s policy is incomplete, ambiguous,
and not authenticated. [28, at 2.] Defendant says that Plaintiff’s policy is outdated and/or is not
applicable in this matter. [24, at 5 n.2; 32, at 6–7.] Based on the parties’ representations, the
Court is unable to determine whether Plaintiff’s policy, Defendant’s policy, or some third,
unknown policy applies. These are all indications that a legal determination as to the contractual
limitations period is premature at the motion to dismiss stage.
As a closing point, the Court notes that a contractual limitations period is enforceable “as
long as the period is reasonable.” Heimeshoff, 134 S. Ct. at 610; id. at 612 (“We must give effect
to the Plan’s limitations provision unless we determine * * * that the period is unreasonably short
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* * *.”). In Heimeshoff, the start of the contractual limitations period was based on the date that
the participant’s proof of loss was due. Because ERISA and its regulations require plans to
complete an internal review after participants submit proof of loss, and because a participant’s
legal cause of action does not accrue until the plan’s internal review is complete, the three-year
limitations period applicable in Heimeshoff began to run before the participant’s legal cause of
action accrued (i.e., before the plan completed its internal review). The Supreme Court
concluded that this arrangement was reasonable, based on the fact that (a) the typical internal
review lasted only one year, leaving most participants with two years to file suit, and (b) in
Heimeshoff’s case, even though his internal review took two years, he still had one year to file
suit before the expiration of his limitations period. Id. at 613.
Here, according to both policies submitted to the Court, Plaintiff’s limitations period is
measured based on the deadline for filing a claim for benefits, which itself is measured based on
the date on which Plaintiff incurred her disability. Notably, the limitations period is not tied to
any events relating to Plaintiff’s loss of benefits. Under this rubric, and according to Defendant’s
calculations, Plaintiff’s three-year contractual limitations period ended on November 26, 2012.
Defendant claims that it notified Plaintiff that it completed its internal review process of her
appeal on January 19, 2012, meaning that Plaintiff had approximately 10 months remaining in
her limitations period when her cause of action arose—two months less than the 12-month period
that the Supreme Court deemed “reasonable” in Heimeshoff. In Plaintiff’s amended complaint,
however, she implies that she did not receive notice of the completion of her appeal until January
14, 2014. [See 12, ¶ 16.] If Defendant’s internal review ended on January 14, 2014, that would
mean that Plaintiff’s cause of action accrued more than a year after her limitations period
expired. This would certainly be more than an “unreasonably short” period of time to file a civil
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suit; it would be a nonexistent period of time. But because these factual details remain
unresolved, the Court cannot address the reasonableness of the contractual limitations period
applicable here. Once the parties determine which policy applies to Plaintiff’s claims and the
date upon which Plaintiff’s cause of action arose, they should consider the Supreme Court’s
reasonableness requirement as articulated in Heimeshoff, as well as the other legal principles
discussed herein, before raising any additional contractual-limitations arguments. For the time
being, Defendant’s motion to dismiss Plaintiff’s claim based on its alleged untimeliness is
denied.
C.
Insurance Premiums
In addition to arguing that Plaintiff’s complaint, as a whole, is untimely, Defendant takes
a second bite at a particular component of Plaintiff’s prayer for relief: namely, Plaintiff’s request
that Defendant be held responsible for the payment of her life insurance premiums. [See 24, at 5–
6.] Plaintiff responded with a single sentence: “Plaintiff withdraws this claim, and moves for
voluntary dismissal of this claim only.” [28, at 10.] Accordingly, Plaintiff’s request “that the
Court order Defendant to pay Plaintiff’s life insurance under a waiver of premium” [12, at 5] is
dismissed without prejudice.6 This dismissal does not impact any of the remaining forms of relief
that Plaintiff seeks in her amended complaint.
D.
Demand for Jury Trial
Defendant also seeks dismissal of Plaintiff’s demand for a jury trial, arguing that there is
no right to a jury trial in an ERISA case. [See 24, at 6; 32, at 11–13.] Plaintiff argues that she is
entitled to a jury trial because she is pursuing an action in law, and is not seeking equitable relief.
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Defendant’s basis for dismissal is an alleged failure to comply with Federal Rule of Civil Procedure 8,
which, if successful, also would have resulted in a dismissal without prejudice. As such, the Court need
not address the merits of Defendant’s argument.
8
Plaintiff’s suit is brought pursuant to ERISA § 502(a), 29 U.S.C. § 1132(a), which allows
a participant to 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.” 29 U.S.C. § 1132(a)(3)(A)–(B). The statute also allows a participant to bring a civil
action “to recover benefits due to [her] under the terms of [her] plan, to enforce [her] rights under
the terms of the plan, or to clarify [her] rights to future benefits under the terms of the plan.” Id.
§ 1132(a)(1)(B). These forms of relief are inherently equitable. See Smith v. State Farm Grp.
Long Term Disability Plan for U.S. Employees, 2013 WL 4538516, at *1–2 (N.D. Ill. Aug. 27,
2013) (“Because a suit by a beneficiary seeking to enforce the terms of a plan is equitable in
nature, plaintiff is not entitled to a jury trial.” (citing Cigna Corp. v. Amara, 131 S. Ct. 1866,
1879 (2011))). As such, “all eleven Circuit Courts that have reviewed the issue of whether there
is a right to a jury trial under § 502(a) of ERISA have concluded that there is no such right.”
Zuckerman v. United of Omaha Life Ins. Co., 2011 WL 2173629, at *6 (N.D. Ill. May 31, 2011)
(citing Patton v. MFS/Sun Life Fin. Distribs., 480 F.3d 478, 484 (7th Cir. 2007) (concluding that
“the plaintiff ha[d] no right to a jury trial” in an ERISA case); McDougall v. Pioneer Ranch Ltd.
P’ship, 494 F.3d 571, 575–76 (7th Cir. 2007) (“The general rule in ERISA cases is that there is
no right to a jury trial because ‘ERISA’s antecedents are equitable, not legal.’” (quoting Mathews
v. Sears Pension Plain, 144 F.3d 461, 468 (7th Cir. 1998)))); see also Advanced Ambulatory
Surgical Cntr., Inc. v. Cigna Healthcare of Ill., 2014 WL 4914299, at *6 (N.D. Ill. Sept. 30,
2014) (striking jury demand for ERISA claims); Brown v. Club Assist Road Service U.S., Inc.,
2013 WL 5304100, at *10 (N.D. Ill. Sept. 30, 2013) (noting “that there is no right to a jury trial
on [an] ERISA claim” (citing Ponsetti v. GE Pension Plan, 614 F.3d 684, 689 (7th Cir. 2010))).
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Plaintiff is not entitled to a jury trial on her ERISA claim. Defendant’s motion to strike
Plaintiff’s demand for a jury trial is granted.
E.
Prejudgment Interest
In her amended complaint, Plaintiff requests that the Court order Defendant to pay her
prejudgment interest at a rate of 9% per annum on all benefits that have accrued prior to the date
of judgment in accordance with 215 ILCS 5/357.9 or 5/357.9a. [See 12, at 5.] Defendant moved
to dismiss this request, arguing that state statutes do not govern an award of prejudgment interest
in an ERISA case. Defendant is correct that the Illinois statute that Plaintiff cited in her
complaint does not apply in this case. See, e.g., Curtis v. Hartford Life & Accident Ins. Co., 64 F.
Supp. 3d 1198, 1224 (N.D. Ill. 2014). That being said, there remains a presumption in favor of
prejudgment interest in ERISA cases, Fritcher v. Health Care Service Corp., 301 F.3d 811, 820
(7th Cir. 2002), and the Seventh Circuit has suggested that district courts use “the prime rate for
fixing prejudgment interest where there is no statutory interest rate.” Gorenstein v. Quality
Enterprises, Inc., 874 F.2d 431, 436 (7th Cir. 1989).
To the extent that Plaintiff’s claim for prejudgment interest references the Illinois
prejudgment-interest statute, the claim is dismissed. Plaintiff may still proceed on her claim for
prejudgment interest, although should Plaintiff be entitled to prejudgment interest in this case,
the calculation of that amount will be determined in accordance with Gorenstein v. Quality
Enterprises, Inc., 874 F.2d 431 (7th Cir. 1989), absent any binding authority to the contrary.
F.
Motion to Amend the Complaint
In her response to Defendant’s motion to dismiss, Plaintiff says that her claims are not
time-barred because Defendant failed to provide her with adequate notice regarding her right to
sue as required by the ERISA statute, citing the Department of Labor’s regulations governing
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ERISA, codified at 29 C.F.R. § 2560.503-1(g)(1)(iv). Whether and to what extent Defendant
provided Plaintiff with notice is a fact-bound issue inappropriate for resolution at the motion to
dismiss stage. However, Plaintiff says that “if this Court determines the allegations [regarding
Defendant’s lack of compliance with ERISA’s notice requirements] are necessary to state a
cause of action, Plaintiff requests leave to file a Second Amended Complaint.” [28, at 5.]
Defendant interprets this comment as a motion for leave to file a second amended complaint, and
argues that Plaintiff’s “motion” should be denied. [32, at 13.]
Because Defendant’s untimeliness argument is an affirmative defense (i.e., Defendant
carries the burden), Plaintiff’s ability to defend herself against this allegation is not limited by the
scope of her complaint. Thus, as presented here,7 Plaintiff’s allegation that Defendant failed to
comply with ERISA’s notice requirements is not an independent cause of action; it is a rebuttal
to an affirmative defense.8 See, e.g., Reinwand v. Nat’l Elec. Benefit Fund, 2015 WL 5009973, at
*4–5 (W.D. Wisc. Aug. 18, 2015) (concluding that Defendant’s failure to comply with ERISA’s
notice requirements excused the plaintiff’s failure to exhaust the fund’s administrative remedies);
Heimeshoff v. Hartford Life & Acc. Ins. Co., 2012 WL 171325, at *6–7 (D. Conn. Jan. 20, 2012)
(concluding that the defendant’s failure to comply with ERISA’s notice requirements “d[id] not
affect the untimeliness of [the plaintiff’s] Complaint”). As such, Plaintiff can make her lack-of-
7
In other instances, failure to comply with ERISA’s notice requirements can preclude a federal court’s
ability to substantively review a denial of benefits. See Halpin v. W.W. Grainger, Inc., 962 F.2d 685, 697
(7th Cir. 1992).
8
Whether Defendant’s alleged notice-providing deficiencies will excuse the purported untimeliness of
Plaintiff’s complaint is a “fact-intensive” inquiry, see Ponsetti v. GE Pension Plan, 614 F.3d 684, 693
(7th Cir. 2010), where a failure to comply with ERISA’s notice requirements does not automatically
excuse a delay in filing. See Schorsch v. Reliance Std. Life Ins. Co., 693 F.3d 734, 470 (7th Cir. 2012)
(noting that Seventh Circuit cases relating to a defendant’s failure to comply with ERISA’s notice
requirements “suggest[ed] that [the defendant’s] notice may have been less than perfect, but deficiencies
in the notice would not necessarily excuse [the plaintiff’s] failure to exhaust her administrative remedies”
(citing Schneider v. Sentry Grp. Long Term Disability Plan, 422 F.3d 621, 625–26, 628 (7th Cir. 2005);
Robyns v. Reliance Std. Life Ins. Co., 130 F.3d 1231, 1236, 1238 (7th Cir. 1997))).
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notice argument in response to Defendant’s contractual-limitations defense without the need to
amend her complaint.
If, however, Plaintiff wishes to use this lack-of-compliance argument in another manner
(i.e., other than to rebut an affirmative defense) and feels that amending her complaint is
necessary in order to make such an argument, Plaintiff may seek leave from the Court in
accordance with Fed. R. Civ. P. 15(a)(2) to do so.
IV.
Conclusion
For the foregoing reasons, Defendant’s motion [22] is granted in part and denied in part.
Defendant’s motion to dismiss Plaintiff’s lawsuit as untimely based on the contractual limitations
period in the plan is denied. Plaintiff’s demand that Defendant pay her insurance premiums is
voluntarily dismissed. Defendant’s motion to strike Plaintiff’s claim for prejudgment interest is
granted to the extent that Plaintiff’s claim references the Illinois prejudgment-interest statute.
Defendant’s motion to strike Plaintiff’s claim for a jury trial is granted. This case is set for future
status hearing on 11/17/2015 at 9:00 a.m.
Dated: November 2, 2015
_______________________________
Robert M. Dow, Jr.
United States District Judge
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