United States District Court, D. Connecticut
MEMORANDUM OF DECISION GRANTING MOTION TO
VANESSA L. BRYANT UNITED STATES DISTRICT JUDGE
the Court is Defendants' Motion to Dismiss
Plaintiff's Second Amended Complaint. For the reasons set
forth below, Defendants' Motion is GRANTED.
November 21, 2011, Plaintiff Haley Spears initiated an ERISA
action under 29 U.S.C. § 1132(a)(3), contesting the
denial of her disability benefits under her employer's
long term disability (“LTD”) benefit plan. [Dkt.
1 (Compl.)] Plaintiff brought suit against her former
employer, United Technologies Corporation
(“UTC”); her employer's sponsored plan, the
Group Life Insurance and Disability Plan of UTC aka the UTC
Choice Integrated Disability Benefit Program (the
“Plan”); and the Plan insurer, Liberty Life
Assurance Company (“Liberty”). Id.
¶¶ 5-7. The Complaint alleged that Defendants
denied Plaintiff LTD benefits in November 2010. Id.
¶ 23. Plaintiff claimed that Defendants breached the
terms of the Plan and ERISA “by failing to provide
adequate notice in writing setting forth the specific reasons
for such denial and by failing to afford a reasonable
opportunity to Spears for a full and fair review by the
appropriate named fiduciary of the decision her claim for
benefits.” Id. ¶ 37. She sought
enforcement of the plan terms under § 502(a)(1)(B) of
ERISA, equitable remedies under § 502(a)(3) of ERISA,
and attorney's fees and costs. See Id.
filed a Motion to Dismiss the initial Complaint on February
6, 2012, [Dkt. 14] which the Court granted in part on August
3, 2012. [Dkt. 22 (Mem. Decision on Mot. Dismiss) at 12-13].
In that decision, the Court dismissed Plaintiff's claims
for equitable remedies, finding that the Summary Plan
Description (“SPD”) was not “false or
misleading” in violation of § 502(a)(3). [Dkt. 22
(Mem. Decision on Mot. Dismiss) at 12-13]. In addition, the
Court dismissed UTC as a party because the Complaint alleged,
and the Policy confirmed, that Liberty was the LTD plan
administrator and made all claim determinations. Id.
at 15; [Dkt. 14-1 (Policy) at DEF000034.]
the close of discovery, Plaintiff filed a Motion for Summary
Judgment on April 28, 2014, and Defendant filed a Motion for
Judgment, which the Court construed as a Motion for Summary
Judgment. [Dkt. 82 (Mot. Summ. J.); Dkt. 85 (Mot. J.)]. The
Court determined that Liberty was vested with “the
authority, in its sole discretion, to construe the terms of
th[e] policy and to determine benefit eligibility
[t]hereunder. . . .” [Dkt. 103 (Mem. Decision on Mot.
Summ. J.) at 41]. The Court found that Liberty failed to
support its LTD determination with substantial evidence and
procedurally erred in the review process. Id. at 76.
Accordingly, the Court remanded the matter back to Liberty
“with instructions to consider additional evidence
unless no new evidence could produce a reasonable conclusion
permitting a denial of the claim or remand would otherwise be
a useless formality.” Id. at 76. On remand,
the Court instructed Defendants to: (1) consider whether
medical evidence rendered Plaintiff disabled within the
meaning of the LTD plan; (2) take greater care in posing
questions to peer reviewers, order an independent medical
examination (“IME”), or have medical consultants
communicate with Plaintiff's treating physicians; (3)
perform a full and fair review in compliance with the ERISA
claims regulations; and (4) consider post-elimination period
medical records or dismiss such records with a reasonable
explanation. Id. at 79-81. The Court elected not to
award attorney's fees and civil penalties as premature,
but instructed that “[s]hould Spears seek an award of
civil penalties in the future, she should address these
issues in her memorandum of law in support of her
motion.” Id. at 82. The Court ordered the
Clerk to close the case file.
advised Plaintiff's counsel on July 24, 2015 that it
would initiate review on remand and requested additional
information from Plaintiff. [Dkt. 106 at 4]. From August 2015
until March 2016, the parties exchanged medical records and
other documentation, renewed medical analyses, and obtained
an IME. See generally Id. at 4-17. At the end of
this period, due to the length of time that had passed,
Plaintiff filed a Motion to Reinstate Summary Judgment. [Dkt.
105 (Mot. Reinstate Summ. J.) (filed Feb. 27, 2016). The
Court found on April 1, 2016 that the motion was procedurally
improper, as “final judgment was entered in this case
and the matter was closed over a year ago.”
See [Dkt. 108 (Order)].
filed a new action on April 11, 2016. [16-cv-572
(“Spears II”)]. The pleadings in
Spears II contained many of the same allegations as
those raised in the above-captioned case (“Spears
I”), in addition to new issues arising from the
remand. On August 21, 2017, the Court sua sponte
dismissed Spears II and instructed that the parties
could move to reopen Spears I to proceed with
litigation. [Spears II at Dkt. 75]. On August 30,
2017, Plaintiff filed an Amended Complaint in Spears
I, the Court reopened the case, and Defendants filed the
instant motion to dismiss.
Allegations of the Amended Complaint
Amended Complaint, like the initial Complaint, alleges that
Defendants improperly denied her LTD benefits in violation of
ERISA. [Dkt. 110-2 (Amended Compl.).] As in her initial
Complaint, Plaintiff seeks (1) a declaration that she is
entitled to Plan benefits under ERISA § 502(a)(1)(B) and
an award of unpaid Plan benefits; (2) a declaration that
Defendants breached their fiduciary duty under §
502(a)(3) of ERISA and an award of equitable remedies; and
(3) attorney's fees. Id. at 16. As in the
initial Complaint, Plaintiff names Liberty, UTC, and the Plan
as Defendants. Id. at 1.
Amended Complaint was filed as an “Amended/Supplemental
Complaint, in order to bring this Court up to date on
proceedings following the 2015 judgment” closing the
case. [Dkt. 110 at 1.] The Amended Complaint repeats the
majority of the allegations in the initial Complaint, as
Plaintiff, Haley Spears, is a former employee of UTC.
[Amended Compl. at ¶ 4]. She was employed as an
Executive Administrative Assistant immediately prior to being
disabled and was allegedly covered by UTC's employee
benefits plan. Id. Plaintiff alleges that UTC is the
Plan Administrator. Id. at ¶ 6. The UTC Plan
included both short-term and long-term disability
(“STD” and “LTD” respectively)
sections. Id. at ¶ 7. The LTD plan is fully
insured by Liberty. Id. at ¶ 5. All LTD
premiums are paid to Liberty, which in turn pays covered
claims for qualifying disabilities. Id. Plaintiff
alleges that both Liberty and UTC make LTD claim
determinations. Id. ¶ 5. The STD plan is
self-insured by UTC. Id. at ¶ 8. UTC contracts
with Liberty to process STD claims, and pays for these claims
and services out of a designated trust. Id. at
¶ 8. Plaintiff alleges STD claim determinations are made
by Liberty and UTC, and that UTC is the Plan Administrator
for STD benefits. Id.
acknowledges that the definition of disabled is different
under the STD than it is under the LTD. She alleges that the
policy defines being disabled, for purposes of STD coverage,
as being “unable to perform the material and
substantial duties of your current or a similar job for more
than 5 consecutive scheduled workdays” and having
physician-provided medical evidence supporting that
assessment of your condition. Id. at ¶13. On
the other hand, the policy defines being disabled for
purposes of LTD coverage as being unable to perform your
“own occupation” for the first 24 months, after
which you are only disabled for purposes of the LTD plan if
you are unable to perform the duties of “Any
Occupation” as defined by the plan. Id. at
capacity as an Executive Administrative Assistant at UTC,
Plaintiff alleges that the material duties of her job were as
[S]end and edit letters, order supplies for two departments,
do internet research, organize executive desks and papers,
keep a reference guide book updated, change computer settings
and fix office equipment on a basic level. She was
responsible for communication with the maintenance
department. She communicated verbally and by e-mail. Accuracy
was essential. She processed expense reports by entering data
into the computer, filed documents, and made travel
arrangements. She processed invoices and followed through to
ensure that they were paid. She generated briefing material
for senior level meetings. She completed internal and
external training to better understand United Technologies
Corporation business practices and company objectives.
Id. ¶ 10. Plaintiff also alleges that her
position was a desk job, although it did require her to be on
her feet, walking around the department, and occasionally
lifting packages, printer paper, files, or supplies.
Id. at ¶ 11. Reportedly, “[t]he job was
fast paced. She needed to be alert. There was no room for
allegedly began feeling sick around 2008 and began taking
sick days. Id. at ¶ 12. Her symptoms allegedly
included fevers, night sweats, respiratory problems, and
coughing. Id. Her boss told her to see a doctor.
Id. She was treated first for “asthma
symptoms” and then later for migraines at the St.
Francis Hospital emergency room. Id.
symptoms “became debilitating in the summer of
2008.” Id. At that point, Ms. Spears alleges
that she “could not do her job.” Id. at
¶ 13. She reports migraines, blurry vision, an inability
to focus or think straight, memory problems, difficulties
understanding what her boss wanted, and a general daze.
Id. Plaintiff allegedly stopped working and applied
for STD benefits in September 2008. Id. Those
benefits were granted on September 27, 2008. Id. at
¶¶ 13, 16. Plaintiff alleges that the Defendants
first denied her LTD benefits on January 30, 2009 because the
“LTD elimination period was not met.”
Id. at ¶ 17.
has reportedly received a large number of varying diagnoses
from various doctors, for which she does not provide specific
dates for her diagnoses. Id. ¶ 16. However,
Plaintiff does specifically allege that she tested positive
for Borrelia burdorferi IgM antibodies (associated with Lyme
disease) on February 2, 2009, and that at that time her
“pain was constant.” Id. at 15.
February 9, 2009, Plaintiff's treating physician reported
that Plaintiff could work up to four hours per day, mornings
only, and UTC's medical department cleared her to return
to work for four hours per day with exertional restrictions.
Id. at ¶ 15. Plaintiff worked part time, with
restrictions, through March 23, 2009 and then stopped working
due to ...