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Spears v. Liberty Life Assurance Company of Boston

United States District Court, D. Connecticut

May 25, 2018




         Before the Court is Defendants' Motion to Dismiss Plaintiff's Second Amended Complaint. For the reasons set forth below, Defendants' Motion is GRANTED.

         I. Procedural Background

         On 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. ¶¶ 33-45.

         Defendants 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.]

         After 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.

         Liberty 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)].

         Plaintiff 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.

         a. Allegations of the Amended Complaint

         Plaintiff's 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.

         Plaintiff's 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 follows:

         The 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[1] 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.

         Plaintiff 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 ¶ 28.

         In her capacity as an Executive Administrative Assistant at UTC, Plaintiff alleges that the material duties of her job were as follows:

[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 error.” Id.

         Plaintiff 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.

         Her 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.

         Plaintiff 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.

         On 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 ΒΆ 15. Plaintiff worked part time, with restrictions, through March 23, 2009 and then stopped working due to ...

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