Canlas v. Metropolitan Life Insurance Company
MEMORANDUM OPINION. Signed by Judge Deborah K. Chasanow on 12/22/2015. (sat, Chambers)
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MARYLAND
ERNEST H. CANLAS
Civil Action No. DKC 15-0702
METROPOLITAN LIFE INSURANCE
Presently pending and ready for review in this insurance
case is a motion to dismiss filed by Defendant Metropolitan Life
Insurance Company (“Defendant”).
(ECF No. 9).
issues have been briefed, and the court now rules, no hearing
being deemed necessary.
Local Rule 105.6.
For the following
denied in part.
Washington Airports Authority (“MWAA”) and the Kaiser Permanente
provided Plaintiff with a group long-term disability insurance
plan (the “Plans”).
(ECF Nos. 1 ¶ 8; 9-2; 9-3).1
In reviewing a motion to dismiss, courts may consider
documents referenced or relied upon in the complaint.
v. Wells Fargo Bank, N.A., 976 F.Supp.2d 660, 662 n.1 (D.Md.
2013) (citing Phillips v. LCI Int’l, Inc., 190 F.3d 609, 618 (4th
Plans are independent from each other, Defendant is the claim
administrator for both.
retroactively to 2013.
(ECF Nos. 1 ¶¶ 11-12; 1-4, at 1-2).
Disability Income (“SSDI”) benefits.
(ECF No. 1-5).
around November 8, 2014, Plaintiff received a $30,651.00 lump
sum for back payment of SSDI benefits owed.
This lump SSDI sum
accounted for monthly payments Plaintiff was owed beginning in
December 2013; and $2,463.50 beginning in January 2014.
No. 1-5, at 2).
In December 2014, Defendant notified Plaintiff
that it would reduce the amount he received under each Plan by
the amount of his SSDI benefits.
(ECF No. 1 ¶ 15).
sent Plaintiff a letter stating that the “Total Amount” due as a
result of overpayment on the two Plans was $73,367.63.
1-4, at 3).
Defendant denied Plaintiff’s administrative appeal
of its determination.
(ECF No. 1-3).
On March 12, 2015, Plaintiff filed a complaint alleging
that Defendant wrongly denied payment of his benefits under the
Cir. 1999)). Here, Plaintiff attaches part of the Plans to the
complaint and relies on their provisions.
Thus, it is
appropriate for the court to rely on the Plans in adjudicating
Defendant’s motion to dismiss.
(ECF No. 1).
On July 15, 2015, Defendant filed the
pending motion to dismiss.
(ECF No. 9).
After Plaintiff failed
Plaintiff’s counsel requesting that he promptly file a response
or advise the court if no opposition will be filed.
To date, Plaintiff has not responded.
Standard of Review
The purpose of a motion to dismiss under Rule 12(b)(6) is
to test the sufficiency of the complaint.
Presley v. City of
Charlottesville, 464 F.3d 480, 483 (4th Cir. 2006).
need only satisfy the standard of Rule 8(a), which requires a
“short and plain statement of the claim showing that the pleader
is entitled to relief.”
still requires a ‘showing,’ rather than a blanket assertion, of
entitlement to relief.”
544, 555 n.3 (2007).
Bell Atl. Corp. v. Twombly, 550 U.S.
That showing must consist of more than “a
formulaic recitation of the elements of a cause of action” or
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citations omitted).
At this stage, all well-pleaded allegations in a complaint
must be considered as true, Albright v. Oliver, 510 U.S. 266,
268 (1994), and all factual allegations must be construed in the
Westinghouse Savannah River Co., 176 F.3d 776, 783 (4th Cir.
1999) (citing Mylan Labs., Inc. v. Matkari, 7 F.3d 1130, 1134
(4th Cir. 1993)).
In evaluating the complaint, unsupported legal
Comm’rs, 882 F.2d 870, 873 (4th Cir. 1989).
couched as factual allegations are insufficient, Iqbal, 556 U.S.
at 678, as are conclusory factual allegations devoid of any
reference to actual events.
United Black Firefighters v. Hirst,
604 F.2d 844, 847 (4th Cir. 1979).
Defendant’s Ability to Reduce SSDI From Each Plan
Defendant incorrectly reduced payment under both Plans by the
amount of SSDI benefits he received, effectively doubling the
(ECF No. 1 ¶ 16).
Plaintiff asserts that applying
the reduction to both Plans is “contrary to the plan provisions,
. . . and is on its face arbitrary and capricious.”
(Id. ¶ 27).
Defendant contends that the reductions were proper because the
reduction in benefits based on SSDI payments.
Administrators of plans governed by the Employee Retirement
Income Security Act of 1974 (“ERISA”) must “look solely at ‘the
directives of the plan documents’ in determining how to disburse
. . .
In other words, a claim for benefits must
‘stand  or fall by the terms of the plan.’”2
Boyd v. Metro.
Life Ins. Co., 636 F.3d 138, 140 (4th Cir. 2011) (quoting Kennedy
administer each plan in accordance with its respective language.
See Renfro v. Funky Door Long Term Disability Plan, 686 F.3d
Isner v. Minnesota Life Ins. Co., 677
F.Supp.2d 950 (E.D.Mich. 2009).
Indeed, a plan administrator
has a separate fiduciary duty to each plan it administers.
U.S.C. § 1104(a)(1).
reduce Plaintiff’s benefits under both Plans.
In Renfro, the
United States Court of Appeals for the Ninth Circuit upheld the
district court’s grant of summary judgment for a defendant that,
686 F.3d at 1052-54.
Much like Plans here,
“[n]either of the Plans contains any language that makes an
exception for this deduction in a case where an employee is
covered under two separate plans.
The plain language of the
The MWAA plan is not governed by ERISA because it is a
29 U.S.C. § 1002(32); see also Canady v.
Washington Metro. Area Transit Auth., 909 F.Supp. 324, 327
(D.Md. 1995) (holding that ERISA does not apply to a Washington
Metropolitan Area Transit Authority employee’s insurance plan).
This distinction is irrelevant for the current discussion.
Under Maryland law, the interpretation of the plan similarly
would be governed by the plain meaning of its unambiguous terms.
See Nova Research, Inc. v. Penske Truck Leasing Co., 405 Md.
435, 448 (2008).
Plans expressly mandates the actions that [the defendant] took.”
Id. at 1053.
The Ninth Circuit also held that the fact that one
entity administered both plans “does not detract from the fact
that [the plaintiff] was covered under two different plans,”
each of which must be read separately.
Id. at 1054.
in Isner, the district court granted the defendant’s motion to
F.Supp.2d at 957-58.
The court noted that, although the result
considered language on the occasional hard case.”
Id. at 957
(citations and internal quotation marks omitted).
granted the motion to dismiss because “[t]he plans expressly
authorize [reduction] of all Social Security benefits, without
regard for whether any other plan [reduces] the same benefits
[and because] . . . each plan ‘has the absolute right to enforce
its contract’ with Plaintiff, even if the result is harsh.”
at 958 (quoting McBarron v. S & T Indus., Inc., 771 F.2d 94, 9899 (6th Cir. 1985)).
identical facts is persuasive.
Here, the language of both Plans
Disability benefit by the amount of All Other Income.”
Nos. 9-2, at 44; 9-3, at 41).
“Other Income” includes any
benefits that Defendant receives because of his disability, such
as benefits under the “Federal Social Security Act.”
Defendant reduce Plaintiff’s benefit by the amount he receives
Accordingly, Plaintiff has not stated a claim that
reducing the amount of SSDI benefits from each Plan.
Calculation of Reduction
Plaintiff contends that the alleged overpayment of $73,367.00 is
more than he received in SSDI benefits from August 2013 through
(ECF Nos. 1 ¶ 18; 1-4, at 1).
that this “fails to account for additional SSDI benefits that
(ECF No. 9-1, at 4 n.4).
Rounding down to the nearest
dollar, Defendant asserts that it reduced Plaintiff’s benefits
under each Plan by the following: $2,397 from August through
(ECF No. 1-3, at 3).3
Defendant sent Plaintiff a letter regarding the reduction
of benefits under both Plans.
Although the letter distinguishes
Defendant did not include the cost-of-living adjustment in
its reduction calculation (ECF No. 9-1, at 4 n.3), but these
amounts otherwise comport with the amounts Plaintiff received in
SSDI (see ECF No. 1-5, at 2).
between two different claim and group numbers, it is not clear
to which Plan each section of the letter refers because both
Disability Group Plan.”
(See ECF No. 1-4, at 1, 2).
number 611305216861 appears to be calculated correctly.
month is reduced by the appropriate amount of SSDI benefits that
calculation as to how it reached the $28,609.53 reduction under
initially states that Plaintiff was overpaid by the gross amount
(Id. at 3).
This sum is not, however, supported
by the rest of Defendant’s letter, which appears to include
incorrect calculations and contradicts the initial figure.
example, a chart used for calculations asserts that Plaintiff
through October 2014.
In this chart, Defendant seeks to
reduce the monthly amount by $3,070.43, significantly more than
the amount that Plaintiff received in SSDI benefits.
In all, this portion of the letter indicates that Defendant
It appears that the initial $25,973.30 figure for
Plaintiff was actually overpaid by $54,582.83.
letter itself notes that the “Total Amount Due” is $73,367.63,
reduction to Plaintiff’s monthly payments.
factual allegations in the complaint as true, and examining the
Defendant incorrectly calculated the amount of overpayment and
Accordingly, Defendant’s motion to dismiss will be
denied as to its calculation of the reductions in benefits under
For the foregoing reasons, the motion to dismiss filed by
separate order will follow.
DEBORAH K. CHASANOW
United States District Judge
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?