Candelario v. Metropolitan Life Insurance Company (MetLife) et al
Filing
39
OPINION AND ORDER granting in part and denying in part 27 Motion for Reconsideration. After careful deliberation, the Court concludes that Plaintiff's suit is untimely and that summary judgment should have been granted in Defendants' favor. The Complaint is thus DISMISSED WITH PREJUDICE. Judgment shall be thus entered. Signed by Judge Juan M Perez-Gimenez on 5/22/2012. (JG)
THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO
LUIS CANDELARIO,
Plaintiff,
v.
CIV. NO. 10-1463 (PG)
METROPOLITAN
LIFE
INSURANCE
COMPANY
(METLIFE),
WYETH
PHARMACEUTICALS COMPANY,
Defendants.
OPINION AND ORDER
Defendants
Wyeth
Metropolitan
Pharmaceutical
Company
Life
Insurance
(“Wyeth”)
seek
Company
(“MetLife”)
reconsideration
from
and
the
Court’s previous Opinion and Order (Docket No. 26) denying their motion
for summary judgment (Docket No. 13). In their motion for reconsideration
(Docket
No.
manifest
27),
errors
persisted
Defendants
of
which
law
in
precluded
aver
the
Court
determining
dismissal
that
of
committed
three
material
issues
Plaintiff
Luis
distinct
of
fact
Candelario’s
complaint on period of limitations grounds. Namely, Defendants argue the
Court stumbled in determining that: (1) an explanation surrounding how
final
eligibility
Defendants
were
determinations
the
plan
for
plan
administrators
benefits
and
was
needed;
breached
(2)
regulatory
disclosure requirements; and (3) that Plaintiff had made a prima facie
showing of “equitable estoppel.” The Court will DENY the motion as to
points one and two, but for the following reasons, will GRANT the motion
as
to
point
three.
After
careful
deliberation,
the
Court
ultimately
determines that Plaintiff’s suit is time-barred and that summary judgment
should be granted in Defendants’ favor.
I. BACKGROUND
The Court recounts the following factual narrative which it has
gathered from the parties’ filings and the record as a whole. These facts
are the ones the Court deems relevant for the purposes of resolving
Defendants’ motion for reconsideration.
Plaintiff was an employee of Wyeth. Said company maintained an
employee welfare plan for its employees that is regulated by the Employee
Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et. seq. This
Civil No. 10-1463 (PG)
Page 2
plan provides for the payment of LTD benefits to participants who become
disabled,
as
that
term
is
defined
by
the
plan,
and
meet
all
other
requirements. LTD benefits are provided through a group insurance policy
issued
by
MetLife.
Plaintiff
alleges
that
on
February
of
1999,
he
suffered an accident that physically and mentally incapacitated him.
Around
that
time,
Plaintiff
requested
LTD
benefits
under
the
group
policy.1 On September 27, 2000 MetLife issued a decision denying coverage
to Plaintiff under the terms of the plan. Plaintiff apparently appealed
this decision on November 17, 2000 but MetLife decided to uphold it,
notifying Plaintiff via letter dated January 16, 2001. Plaintiff contends
that this decision was “arbitrary, unfounded, and in violation of the
terms of the policy and the law.” (Compl. ¶10). The letter failed to
apprise Plaintiff of his right to seek judicial review of MetLife’s
decision.
Nearly nine years later, around November of 2009, Plaintiff wrote a
letter to MetLife’s offices in San Juan and Oriskany, New York seeking to
obtain a copy of his LTD benefits claim before MetLife. On November 5,
2009 Plaintiff received a response from Ms. Laura D. Smith, an “LTD Unit
Leader” at MetLife Disability, who informed Plaintiff that his claim was
closed in 1999 and that the period of retention for said claim had been
exhausted. As such, Smith informed Plaintiff that his claim file had been
destroyed and that it was now impossible for MetLife to provide him with
a copy of it.
On May 27, 2010, Plaintiff filed the instant action under ERISA
§502(a)(1)(B) seeking to recover the LTD benefits he claims he was due
under the group policy. (Docket No. 1). On August 31, 2010 Defendants
filed a motion for summary judgment positing that said policy has a
three-year contractual limitations period for legal actions to recover
LTD benefits and that the limitations period commenced on January 1, 2000
and concluded on January 1, 2003. (Docket No. 13). Plaintiff opposed the
motion and retorted that Defendants never provided him with a copy of the
plan, the Summary Plan Description (SPD), or any other document regarding
his rights, appeal procedures and/or time limitation periods under the
1
Plaintiff has not pinpointed the exact date he requested the benefits,
the record only shows that on September 8, 2009 Plaintiff sent a fax to MetLife
requesting a copy of his “Record of Long Term Disability.” (Docket No. 19-1, at
4-5).
Civil No. 10-1463 (PG)
Page 3
plan. (Docket No. 14). As such, Plaintiff argued Defendants should be
equitably estopped from relying on the contractual limitations period as
a defense or in the alternative, that the contractual limitations period
should be tolled due to Defendants’ failure to furnish him with the
required
disclosures.2
In
its
Opinion
and
Order
the
Court
denied
Defendants’ motion for summary judgment, ruling that Plaintiff had made a
prima facie showing of equitable estoppel. (Docket No. 26).
Defendants timely filed a motion for reconsideration, arguing the
Court erred in determining that: (1) an explanation surrounding how final
eligibility determinations for plan benefits was needed; (2) Defendants
were
the
plan
administrators
and
breached
regulatory
disclosure
requirements; and (3) that Plaintiff had made a prima facie showing of
“equitable
estoppel.”
(Docket
No.
27).
Plaintiff
opposed
the
motion
(Docket No. 30) and also filed an informative motion containing the
recent First Circuit opinion in Ortega Candelaria v. Orthobiologics LLC,
661 F.3d 675, 679 (1st Cir. 2011)(Docket No. 31). Defendants filed a
reply thereto. (Docket No. 37). After reviewing these submissions and the
pertinent law, the Court will DENY the motion as to claims of error one
and two, but will GRANT the same as to claim three. For the reasons that
follow, and in light of the First Circuit’s opinion in Ortega Candelaria,
the Court will revisit its ruling determining that Plaintiff has advanced
enough facts to make a prima facie showing of equitable estoppel or
equitable tolling.
II. STANDARD OF REVIEW
Rule 59(e) of the Federal Rules of Civil Procedure preserves the
district court’s right to alter or amend a judgment after it is issued.
Fed. R. Civ. P. 59(e). Motions to alter or amend an order or a judgment
are appropriate where they involve reconsideration of matters properly
encompassed in the decision on the merits. See White v. New Hampshire
Department
of
Employment,
455
U.S.
445,
451
(1982).
The
case
law
acknowledges the following four grounds that justify altering or amending
an order or a judgment: (1) to incorporate an intervening change in law;
(2) to reflect new evidence not available at the time of trial; (3) to
2
Plaintiff in his pleadings argues for the
tolling” and “equitable estoppel” interchangeably.
doctrines
of
“equitable
Civil No. 10-1463 (PG)
Page 4
correct a clear legal error; and (4) to prevent a manifest injustice. See
Landrau-Romero v. Banco Popular de Puerto Rico, 212 F. 3d 607 (1st Cir.
2000); Zimmerman v. City of Oakland, 255 F. 3d 734 (9th Cir. 2001); and
Servants of Paraclete v. Does, 204 F. 3d 1005 (10th Cir. 2000).
Thus,
for example, a Rule 59(e) motion is “appropriate where the court has
misapprehended the facts, a party’s position, or the controlling law.”
Id. at 1012; See also Continental Casualty Co. v. Howard, 775 F. 2d 876
(7th Cir. 1985), cert. denied, 475 U.S. 1122 (1986).
III. DISCUSSION
In his opposition to Defendants’ motion for summary judgment as
well
as
his
opposition
to
Defendants’
motion
for
reconsideration,
Plaintiff interchangeably invokes the doctrines of equitable estoppel and
equitable tolling against Defendants. He invariably suggests that the
three-year period of limitations should not be enforced against him as
Defendants failed to furnish him with any information reflecting his
right to appeal the adverse determination taken against his LTD benefits
claim in 2001. Defendants, on their part, argue that neither doctrine is
applicable, and point to Plaintiff’s failure to identify any definite
misrepresentation on their part meant to entice him to miss the filing
deadline. They also point to Plaintiff’s lack of diligence in prosecuting
his
claims,
as
his
lawsuit
comes
more
than
seven
issues
to
years
after
the
contractual limitations period expired.
The
Court
will
thus
analyze
the
determine
whether
Plaintiff is entitled to equitable estoppel or equitable tolling. Since
the First Circuit has repeatedly noted that the doctrines of equitable
estoppel and equitable tolling are distinct, albeit closely related, the
Court
will
evaluate
them
separately.
See
Vistamar,
Inc.
v.
Fagundo-
Fagundo, 430 F.3d 66, 71 (1st Cir. 2005); and Benítez-Pons v. Com. Of
Puerto Rico, 136 F.3d 54, 61 (1st Cir. 1998).
A. Equitable Estoppel
A plaintiff who knows of his cause of action but reasonably relies
on a defendant’s conduct or statements in failing to bring suit may be
entitled to equitable estoppel. Ramírez-Carlo v. United States, 496 F.3d
41, 48 (1st Cir. 2007). In order to make a showing of equitable estoppel
Civil No. 10-1463 (PG)
Page 5
the party seeking the estoppel must establish that: (1) the party to be
estopped made a “definite misrepresentation of fact to another person
having reason to believe that the other [would] rely upon it”; (2) the
party seeking estoppel relied on the misrepresentations to its detriment;
and (3) the “reliance [was] reasonable in that the party claiming the
estoppel did not know nor should it have known that its adversary's
conduct was misleading.” Id. at 49 (citing Heckler v. Community Health
Services, 467 U.S. 51, 59. (1984)). A plaintiff must present evidence
showing that the defendant had an “improper purpose” or “constructive
knowledge of the deceptive nature of his conduct in the form of some
definite, unequivocal behavior fairly calculated to mask the truth or to
lull an unsuspecting person into a false sense of security.” Ortega
Candelaria, 661 F.3d 675, 679 (1st Cir. 2011)(citing Vera v. McHugh, 622
F.3d 17, 30 (1st Cir. 2010))(internal quotations omitted).
In this case, nothing in the record supports the assertion that
Defendants made a “definite misrepresentation of fact” or engaged in
unequivocal,
intentionally
deceptive
conduct
aimed
at
dissuading
Plaintiff from filing within the three-year limitations period. In Ortega
Candelaria,
the
First
Circuit
was
reticent
to
conflate
a
plan
administrator’s failure to provide the requisite disclosures to a plan
beneficiary with a deliberate misrepresentation meant to encourage the
beneficiary to miss the filing deadline, absent any “credible allegation”
to the contrary. There, the plaintiff was not informed of his right to
sue after defendant rejected his claim for benefits. He was not even
informed of the fact that the plan in his case had been amended to
include a limitations period of one year, even though he had requested a
copy of the plan barely four weeks before. The court held that such
behavior was not enough to constitute the “active steps to sabotage [a
plaintiff’s] suit” needed to advance a claim of equitable estoppel. Id.
at 679. Although Plaintiff in this case claims that Defendants employed a
“practice” of not furnishing their employees with copies of the LTD plan,
he provides no evidence of this other than his own say-so and two sworn
statements of former co-workers who claim they could not remember whether
they were provided with copies of the plan. The Court is thus hesitant to
find that these allegations are enough to create a genuine issue of
material
fact
as
to
whether
Defendants
made
any
definite
Civil No. 10-1463 (PG)
Page 6
misrepresentations of fact. Therefore, it finds Plaintiff’s equitable
estoppel argument to be unavailing. See City of Hope Nat. Medical Center
v. HealthPlus, Inc., 156 F.3d 223, 229 (1st Cir. 1998)(stating that the
party
to
be
charged
misrepresentation
of
with
equitable
fact
to
estoppel
another
“must
make
person.”(internal
a
definite
quotations,
citations and brackets omitted)).
B. Equitable Tolling
Equitable
available
tolling
only
when
its
is
a
“sparingly
proponent
can
invoked
establish
doctrine”
“that
that
is
extraordinary
circumstances beyond his control prevented a timely filing or that he was
materially misled into missing the deadline.” Ortega Candelaria, 661 F.3d
675, 679-80 (1st Cir. 2011)(citing Dawoud v. Holder, 561 F.3d 31, 36 (1st
Cir. 2009) and Trenkler v. United States, 268 F.3d 16, 25 (1st Cir.
2001)). It is an “extraordinary measure that applies only when plaintiff
is prevented from filing despite exercising that level of diligence which
could reasonably be expected in the circumstances.” Veltri v. Building
Service 32B-J Pension Fund, 393 F.3d 318, 322 (2nd Cir. 2004). Moreover,
it will only suspend the running of the limitations period “if the
plaintiff,
in
the
exercise
of
reasonable
diligence,
could
not
have
discovered information essential to [his claim].” Ortega Candelaria, 661
F.3d at 679-80. A lack of diligence “weighs strongly against tolling the
limitations period.” Clark v. NBD Bank, N.A., 3 Fed. Appx. 500, 505 (6th
Cir. 2001). Courts must apply equitable tolling on a case by case basis
and avoid mechanical rules in order to promote flexibility. Holland v.
Florida, 130 S.Ct. 2549, 2562 (2010).
In Ortega Candelaria, the First Circuit found that Defendants had
materially
misled
Plaintiff
into
missing
the
filing
deadline
by
not
informing him of his right to sue after they denied his initial claim for
benefits.
regulatory
As
here,
duty
by
that
not
court
found
informing
that
Plaintiff
Defendants
about
his
violated
their
plan’s
review
procedures, the time limits applicable to those procedures, and his right
to bring a civil action under ERISA. Ortega Candelaria, 661 F.3d at 680
(citing 29 C.F.R. § 2560.503-1(g)(1)(iv)). The court also reminded the
parties that in “appropriate circumstances” lack of notice may give rise
to equitable tolling. Id. at 681. (citing Baldwin Cty. Welcome Ctr. v.
Civil No. 10-1463 (PG)
Page 7
Brown, 466 U.S. 147, 151 (1984)). However, the appellate panel also
emphasized
that
plaintiff
had
shown
reasonable
diligence;
he
had
requested a copy of the most current version of the plan toward the end
of his appeal and before he filed suit in federal court. Id. As the copy
of the plan he was provided did not contain a limitations period, the
court
found
that
plaintiff
was
under
the
reasonable
impression
that
Puerto Rico’s 15-year residual limitations period applied.
The instant case before the Court is different, however. Here,
Plaintiff has failed to allege any fact aimed at establishing reasonable
diligence on his part. Following the denial of his claim for benefits in
2001, he never requested a copy of the plan policy or at least a SPD.
Almost nine years after this event, for some unknown reason it dawned on
Plaintiff to contact MetLife’s offices in the hopes of obtaining a copy
of his claim file. But by then, it was too late, his claim file had
already been destroyed due to the length of time which had elapsed from
its closing. Although Plaintiff argues that like the plaintiff in Ortega
Candelaria he too was under the reasonable impression that he had 15
years to file suit, this is a false comparison. The plaintiff in Ortega
Candelaria reasonably believed that the 15 year statute of limitations
applied
because
the
copy
of
the
plan
he
requested
contained
no
limitations period. And even though he thought he had 15 years to sue,
the plaintiff in that case filed suit almost four years after the denial
of his claim for benefits. Here, Plaintiff made no effort to obtain a
copy of the plan and he waited almost nine years after the denial of his
claim for benefits to file suit.3 Thus, he is on different footing than
the plaintiff in Ortega Candelaria. See also Baldwin, 466 U.S. at 151
(“One who fails to act diligently cannot invoke equitable principles to
excuse that lack of diligence.”)
Moreover, when evaluating whether equitable tolling proceeds courts
must also take into account the degree to which the delay prejudices the
defendant. Kale v. Combined Ins. Co. of America, 861 F.2d 746 (1st Cir.
3
As mentioned earlier, in his complaint Plaintiff expresses that the
denial of his claim for benefits was “arbitrary, unfounded, and in violation of
the terms of the policy and the law.” (Compl. ¶10). It is unclear to the Court
how Plaintiff is certain that the denial of his claim was “in violation of the
terms of the policy” if as he says he never had a copy of the policy in the
first place.
Civil No. 10-1463 (PG)
Page 8
1988). Here, Defendants have made an adequate showing of prejudice by
pointing
out
the
amount
of
time
that
has
elapsed
since
plaintiff’s
injury-eleven years-and the fact that the claim file in this case has
been destroyed. Defendants warn the Court will be in a tenuous position
when reviewing the administrative denial of Plaintiff’s claim, due to the
destruction of the claim file. Moreover, they suggest that at this point
in time it would be extremely prejudicial to gather evidence about events
that transpired more than a decade ago. The Court is in agreement with
these assessments and thus finds that Defendants have made an adequate
showing of prejudice.
The
court
should
also
point
out
that
Defendants
briefed
their
argument that Plaintiff had not acted with reasonable diligence several
times in their pleadings for reconsideration. Plaintiff never addressed
these arguments in any of his pleadings, nor did he refute Defendants’
showing of prejudice stemming from the destruction of the claim file. The
Court
construes
this
as
Plaintiff
waiving
any
objection
to
these
arguments. Hence, the Court finds that the circumstances of this case
weigh
heavily
against
granting
the
“extraordinary
measure”
that
is
equitable tolling. As the Court has also decided that equitable estoppel
is not applicable to this case, it is clear that Plaintiff’s judicial
suit for LTD benefits is untimely and must be dismissed accordingly.
IV. CONCLUSION
For
the
reasons
expounded
above,
Defendant’s
motion
for
reconsideration is GRANTED IN PART AND DENIED IN PART. The Court finds
that
Plaintiff’s
suit
is
untimely,
and
therefore
it
must
GRANT
Defendants’ Motion for Summary Judgment and DISMISS the complaint WITH
PREJUDICE.
IT IS SO ORDERED
In San Juan, Puerto Rico, May 22, 2012.
s/ Juan M. Pérez-Giménez
JUAN M. PEREZ-GIMENEZ
SENIOR U.S. DISTRICT JUDGE
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