United States District Court, D. Connecticut
GARY B. TUTTLE, Plaintiff,
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA, Defendant.
RULING ON DEFENDANT'S MOTION TO DISMISS
A. Bolden United States District Judge
Tuttle (“Plaintiff”) filed this lawsuit on
January 23, 2018, alleging that the Prudential Insurance
Company of America (“Prudential” or
“Defendant”), failed to provide him with long
term disability benefits. Compl., ECF No. 1. Prudential has
now moved to dismiss the Complaint. See Def. Mot.
Dismiss, ECF No. 12.
reasons stated below, the motion to dismiss is
FACTUAL AND PROCEDURAL BACKGROUND
Tuttle, a resident of Connecticut, Compl. ¶ 1, worked as
a Field Service Representative for CDK Global, Inc., a
company based in Illinois. Id. ¶¶ 7-8.
an insurance company incorporated in New Jersey, id.
¶ 2, issued a long term disability group policy
(“the policy”) to CDK Global, Inc., for the
benefit of CDK Global employees who would, in return, pay
premiums to maintain the policy. Id. ¶¶ 8,
policy provided “financial protection” for
employees by paying a portion of their income “while
[they] have a long period of disability.” CDK Global,
Inc. Group Contract G- 51856-IL (“Policy”) at 21,
Def. Mot. to Dismiss, Ex. A, ECF No. 12-2. An employee's
income before any disability determined the amount of
disability benefits an employee could receive, and the policy
allowed “[i]n some cases, you can receive disability
payments even if you work while you are disabled.”
policy included the following definition:
disabled when Prudential determines that:
. you are unable to perform the
material and substantial duties of
your regular occupation due to your
. you are under the regular
care of a doctor; and
. you have a 20% or more loss in your
monthly earnings due to that
sickness or injury. After 24 months of payments, you are
disabled when Prudential determines that due to the same
sickness or injury:
. you are unable to perform the duties of
any gainful occupation for which you are reasonably fitted by
education, training or experience; and . you
are under the regular care of a doctor.
Id. at 30 (emphasis in original). The policy further
defines “material and substantial duties” as
those “normally required for the regular
performance” of an employee's job and which
“cannot be reasonably omitted or modified . . .
policy also includes several other relevant definitions.
Under the policy, regular occupation “means the
occupation you are routinely performing when your disability
begins.” Id. Regular care is defined as
meaning “you personally visit a doctor as frequently as
is medically required” and that “you are
receiving the most appropriate treatment and care, ”
both according to “generally accepted medical
standards.” Id. at 31.
individual covered under the policy meets the definition of
disability, he or she is entitled to either sixty percent of
the monthly earnings or $15, 000, whichever is less.
Id. at 33. The policy also specifies several
deductible sources of income that might reduce the award.
Id. The policy does not cover pre-existing
conditions. Id. at 41.
order to claim benefits, an employee must follow the claims
procedure specified in the policy. A covered employee must
submit a claim within 90 days after a set period, accompanied
by documentation of the injury, medical care, and earnings.
Id. at 46. The policy further provided that an
employee “can start legal action regarding your claim
60 days after proof of claim has been given and up to 3 years
from the time proof of claim is required, unless otherwise
provided under federal law.” Id. at 48. Once
filed, Prudential had forty-five days to respond to a claim.
Summary Plan Description at 55, Def. Mot. to Dismiss, Ex. A,
ECF No. 12-2. If denied, “in whole or in part, [the
employee or] authorized representative will receive a written
notice” explaining the denial. Id.
that written notice, an employee “may appeal [his or
her] denied claim in writing to Prudential within 180 days of
the receipt of the written notice of denial or 180 days from
the date such claim is deemed denied.” Id. at
56. Prudential would then have an additional forty-five days
to respond to the appeal. After the appeal decision was
rendered, an employee “may take a second, voluntary
appeal” within one hundred and eighty days. The claims
policy noted: “Your decision to submit a benefit
dispute to this voluntary second level of appeal has no
effect on your right to any other benefits under this plan.
If you elect ...