Stevens v. Hartford Life and Accident Insurance Company
MEMORANDUM AND ORDER granting 5 Motion to Dismiss for Failure to State a Claim. Signed by District Judge Eric F. Melgren on 4/2/2013. (alm)
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF KANSAS
Case No. 12-2574-EFM-GLR
HARTFORD LIFE AND ACCIDENT
MEMORANDUM AND ORDER
This case arises out of Defendant Hartford Life and Accident Insurance Company’s
denial of Plaintiff Michelle Steven’s husband’s life insurance benefits.
dismissal of Plaintiff’s claims. Because ERISA preempts Plaintiff’s alleged state law causes of
action, Plaintiff fails to state a claim under ERISA, and Plaintiff could not cure her deficient
ERISA claim by amending her pleadings, the Court grants Defendant’s motion to dismiss.
Factual and Procedural Background
On August 1, 2012, Plaintiff Michelle Stevens filed a four-page Petition in the District
Court of Cherokee County, Kansas. In the Petition, Plaintiff alleges that she was married to
Kraig Stevens (“Decedent”), who died on December 6, 2009. The Cherokee County Sheriff’s
Department allegedly conducted an investigation into Decedent’s death and concluded it was
caused by accidental discharge while cleaning a gun.
An autopsy conducted by Frontier
Forensics indicated Decedent died of a gunshot wound above the left eye and did not indicate the
manner of death.
The Death Certificate issued by the Kansas Department of Health and
Environment states Decedent’s cause of death was a gunshot wound to the head, and the manner
of death “could not be determined.”
Plaintiff asserts that at the time of Decedent’s death, he was employed by Via Christi
Health and was insured under a Group Accidental Death plan issued by Defendant Hartford Life
and Accident Insurance Company. She claims that she submitted a claim to Defendant, as the
beneficiary of Decedent’s life insurance benefits, which Defendant denied on May 24, 2010,
because the manner of Decedent’s death “could not be determined.”
Plaintiff attached a copy of Defendant’s Insurance Policy to her state court Petition,
which provides that if a claim is denied, the claimant has sixty days from the receipt of the claim
denial to appeal that determination. It also states that, before an action can be filed in court, the
claim appeal process must be completed. Plaintiff also attaches a copy of the May 24, 2010
denial letter. This letter states that if Plaintiff disagrees with Defendant’s decision, she has the
right to appeal the decision by writing to Defendant within sixty days of the date of the letter.
The denial letter also provides the specific address for which to send an appeal letter.1
Plaintiff alleges that Decedent’s death was accidental and requests the face amount of the
insurance policy in the amount of $47,704.80. She also requests interest from the date Defendant
Both parties reference these two documents, and language within these two documents, when discussing
Plaintiff’s claim. When deciding a motion to dismiss, “the district court may consider documents referred to in the
complaint if the documents are central to the plaintiff’s claim and the parties do not dispute the documents’
authenticity.” Jacobsen v. Deseret Book Co., 287 F.3d 936, 941 (10th Cir. 2002).
denied the claim on May 24, 2010, reasonable attorney fees, costs, and other relief that the Court
On August 31, 2012, Defendant removed the case from the District Court of Cherokee
County to this Court. In Defendant’s Notice of Removal, it asserted that Plaintiff sought to
recover Accidental Death Plan benefits from an “employee benefit plan,” and thus, her claim
arose under the Employee Retirement Income Security Act of 1974 (“ERISA”). Defendant
asserted that, because ERISA preempted Plaintiff’s state law causes of actions related to her
claim for Accidental Death Plan benefits, this Court had subject matter jurisdiction over
On September 7, 2012, Defendant filed a Motion to Dismiss for Failure to State a Claim
(Doc. 5). Defendant asserts that the Court should dismiss Plaintiff’s claims because (1) Plaintiff
attempts to assert only state law claims and ERISA preempts all such state law claims, (2)
Plaintiff fails to allege that any determination by Defendant was arbitrary and capricious, (3)
Plaintiff fails to allege that she exhausted her administrative remedies and indeed did not do so,
and (4) the time for Plaintiff to exhaust her administrative remedies expired long ago. Thus,
Defendant contends that Plaintiff’s Petition should be dismissed with prejudice.
“To survive a motion to dismiss, a complaint must contain sufficient factual matter,
accepted as true, to ‘state a claim for relief that is plausible on its face.’”2
metaphysical possibility that some plaintiff could prove some set of facts in support of the
pleaded claims is insufficient; the complaint must give the court reason to believe that this
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570
plaintiff has a reasonable likelihood of mustering factual support for these claims.”3 “The
court’s function on a Rule 12(b)(6) motion is not to weigh potential evidence that the parties
might present at trial, but to assess whether the plaintiff’s complaint alone is legally sufficient to
state a claim for which relief may be granted.”4 In determining whether a claim is facially
plausible, the court must draw on its judicial experience and common sense.5 All well-pleaded
facts in the complaint are assumed to be true and are viewed in the light most favorable to the
plaintiff.6 Allegations that merely state legal conclusions, however, need not be accepted as
A. Plaintiff’s Claims are Preempted by ERISA
Defendant first argues that the Court should dismiss Plaintiff’s claims because she only
attempts to assert state law claims, and ERISA preempts all such state law claims. Plaintiff does
not specifically address this assertion but instead argues that if the Court finds that her state law
claims are preempted by ERISA, she requests leave to amend her Petition to adequately state a
claim under ERISA.8
Ridge at Red Hawk, L.L.C. v. Schneider, 493 F.3d 1174, 1177 (10th Cir. 2007).
Dubbs v. Head Start, Inc., 336 F.3d 1194, 1201 (10th Cir. 2003).
Iqbal, 556 U.S. at 678.
See Zinermon v. Burch, 494 U.S. 113, 118 (1990); Swanson v. Bixler, 750 F.2d 810, 813 (10th Cir. 1984).
See Hall v. Bellmon, 935 F.2d 1106, 1110 (10th Cir. 1991).
Plaintiff does not specifically address her state law claims or attempt to distinguish them from an ERISA
cause of action. The Court notes that it is unclear what state law claims Plaintiff actually asserts in her Petition.
There are no identified causes of actions listed in her Petition as Plaintiff only includes factual allegations (entitled
“Plaintiff’s Factual Contentions and Legal Theories.”) In these allegations, she simply states that there is evidence
that her husband’s death was accidental, and Defendant denied her claim for benefits. She then asserts in her prayer
for relief that she is entitled to the face amount of the insurance policy.
ERISA contains a comprehensive remedial scheme in its civil enforcement provision, 29
U.S.C. § 1132(a).9 “[T]he ERISA civil enforcement mechanism is [a provision] with such
‘extraordinary pre-emptive power’ that it ‘converts an ordinary state common law complaint into
one stating a federal claim for purposes of the well-pleaded complaint rule.’ ”10 “[A]ny state-law
cause of action that duplicates, supplements, or supplants the ERISA civil enforcement remedy
conflicts with the clear congressional intent to make the ERISA remedy exclusive and is
ERISA § 502(a)(1)(B) provides that “[a] civil action may be brought by a participant or
beneficiary 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.”12
“This provision is relatively straightforward. If a participant or beneficiary believes that benefits
promised to him under the terms of the plan are not provided, he can bring suit seeking provision
of those benefits.”13
In this case, Plaintiff is the beneficiary of Decedent’s life insurance benefits. She alleges
that Defendant erroneously denied her claim for Decedent’s life insurance benefits because
Decedent’s death was accidental. Plaintiff seeks to recover the benefits of the policy as she
seeks the face amount of the life insurance policy. Thus, her cause of action falls within §
502(a)(1)(b). Accordingly, her state law cause of action is completely preempted by ERISA, but
David P. Coldesina, D.D.S. v. Estate of Simper, 407 F.3d 1126, 1137 (10th Cir. 2005) (citing Aetna
Health Inc. v. Davila, 542 U.S. 200, 209 (2004)).
Davila, 542 U.S. at 209 (quoting Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58, 65-66 (1987)).
29 U.S.C. § 1132(a)(1)(B).
Davila, 542 U.S. at 210.
instead of dismissal, it may be recharacterized as an ERISA claim.14 Plaintiff’s claim is subject
to dismissal if the allegations do not adequately state a claim under ERISA.
B. Plaintiff fails to state a claim under ERISA, and an amendment would be futile.
Defendant next argues that Plaintiff’s Petition fails to state a claim under ERISA because
Plaintiff fails to allege that Defendant’s denial of her claim was arbitrary and capricious.
Defendant also asserts that Plaintiff fails to allege that she exhausted her administrative
remedies. Finally, Defendant contends that Plaintiff did not exhaust her administrative remedies
because she failed to file an administrative appeal within sixty days of Defendant’s May 24,
2010, denial letter.15
Because the failure to file an administrative appeal and exhaust her
administrative remedies expired long ago, Defendant contends that Plaintiff’s Petition should be
dismissed with prejudice.
Plaintiff does not address Defendant’s first contention and apparently concedes that she
did not allege this fact. With respect to Defendant’s second contention, Plaintiff implicitly
agrees that she did not allege that she exhausted her administrative remedies. Plaintiff instead
argues that the Court should allow her to amend her Petition to state a claim under ERISA by
alleging that she attempted to exhaust her administrative remedies.
Plaintiff claims that she approached the policy’s Plan Administrator Human Resources
representative at Via Christi Health System and asked for assistance. The Human Resources
See Rutherford v. Reliance Standard Life Ins. Co., 2010 WL 4942128, *3 (D. Kan. Nov. 30, 2010) (citing
Metropolitan Life Ins. Co. v. Taylor, 481 U.S. at 63-67; Carling v. Metropolitan Life Ins. Co., 935 F.2d 1114, 1119
(10th Cir. 1991)).
The Court notes that this factual contention is outside the Petition as there are no facts addressing the
exhaustion of administrative remedies in the Petition. Plaintiff, however, addresses the contention in her response
when she asserts that the Court should allow her leave to amend her complaint to allege facts with respect to the
exhaustion of administrative remedies. Thus, the Court must consider whether Plaintiff alleges sufficient facts to
allow an amendment to the Petition and allow her claim to go forward.
representative apparently wrote the Cherokee County Coroner on June 9, 2010, requesting that
he amend the Death Certificate. Plaintiff asserts that it was her belief that the Plan Administrator
was completing the appeal process on her behalf, but apparently the Plan Administrator did not
complete any follow up with Defendant within the sixty days required by the policy.16 Thus, she
contends that she did attempt to exhaust the administrative remedies before filing suit.
Before suing for benefits under an ERISA plan, a plaintiff must first exhaust her
In this case, Plaintiff admits that she did not exhaust her
administrative remedies because she failed to file an administrative appeal. Thus, Plaintiff fails
to state a claim under ERISA.
“[U]nder Fed. R. Civ. P. 15(a), leave to amend shall be given freely, although the district
court may deny leave to amend where amendment would be futile. A proposed amendment is
futile if the complaint, as amended, would be subject to dismissal.”18 Attempting to exhaust
administrative remedies is not akin to actually exhausting administrative remedies. Defendant’s
May 24, 2010, denial letter clearly states that an appeal must be filed within sixty days and
directs Plaintiff to send an appeal letter to a specific address. Plaintiff does not contend that she,
or any alleged representative, performed this action.
Instead, she asserts that her alleged
representative sent a letter to the coroner. And she concedes that her alleged representative did
not timely complete any follow up within the sixty days provided by Defendant’s policy. Thus,
Plaintiff did not attach a proposed Amended Complaint, and all of these allegations are contained in her
response to Defendant’s Motion to Dismiss.
See McGraw v. Prudential Ins. Co. of America, 137 F.3d 1253, 1263 (10th Cir. 1998). Although a
district court may waive the exhaustion requirement, it is generally only done when “resort to administrative
remedies would be futile” or “when the remedy provided is inadequate.” Id. Plaintiff does not assert that the Court
should waive the exhaustion requirement on either of these two bases. In addition, Plaintiff does not argue that she
would file an administrative appeal.
Lind v. Aetna Health, Inc., 466 F.3d 1195, 1199 (10th Cir. 2006) (quotation marks and citation omitted).
Plaintiff’s amendment would be futile because she would still fail to state a claim under ERISA
because she cannot allege that she exhausted her administrative remedies. Accordingly, it is
appropriate to dismiss Plaintiff’s petition with prejudice.19
IT IS ACCORDINGLY ORDERED this 2nd day of April, 2013, that Defendant’s
Motion to Dismiss (Doc. 5) is hereby GRANTED.
IT IS SO ORDERED.
ERIC F. MELGREN
UNITED STATES DISTRICT JUDGE
See Brereton v. Bountiful City Corp., 434 F.3d 1213, 1219 (10th Cir. 2006) (citing Grossman v. Novell,
Inc., 120 F.3d 1112, 1116 (10th Cir. 1997) (“A dismissal with prejudice is appropriate when a complaint fails to
state a claim under Rule 12(b)(6) and granting leave to amend would be futile.”). See also Gayle v. United Parcel
Service, Inc., 401 F.3d 222, 230 (4th Cir. 2005) (citations omitted) (“But since the pursuit and exhaustion of internal
Plan remedies is an essential prerequisite to judicial review of an ERISA claim for denial of benefits, and since this
is impossible here, [Plaintiff’s] claims are barred. In such situations dismissal with prejudice is required.”).
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