SONJA F. BIVINS, Magistrate Judge.
This action is before the Court on Defendants Prudential Insurance Company of America's (hereinafter "Prudential") and Principle Financial Group and Principle Life Insurance Company's (hereinafter "the Principle defendants") Motions to Dismiss Plaintiff's Amended Complaint (Docs. 92, 99). The motions, which have all been fully briefed and are ripe for resolution, have been referred to the undersigned for a report and recommendation pursuant to 28 U.S.C. § 636(b)(1)(B) and Local Rule 72.2(c)(3).
Upon consideration of all matters presented, the undersigned RECOMMENDS, for the reasons stated herein, that Prudential's motion to dismiss (Doc. 92) be
This is the second round of motions seeking the dismissal of this action in which Plaintiff Myrtlean Wasden seeks to collect life insurance benefits that she contends is owing as a result of the death of her husband, Charles Wasden. A full discussion of the facts surrounding this controversy are set forth in the Court's prior order; thus, the facts herein are abbreviated. Myrtlean Wasden, as the as the Executrix of the Estate of Charles Wasden, and as a beneficiary under his life insurance policy, alleges that her late husband, Charles Wasden, was a key employee of Monroeville Telephone Company Inc. for thirty-five years, and that his employer provided him a $90,000 life insurance policy in recognition of his lengthy service to the Company and upon his death, his employer's successors Citizens Communications d/b/a Frontier Communications and/or Frontier Corporation (collectively referred to as "Frontier") failed to pay her insurance claim. (Doc. 1-1). In her amended complaint, Plaintiff has named as Defendants Frontier, Principle Insurance Company, and Prudential Insurance Company. (Doc. 78). According to Wasden, Frontier provided her late husband, Charles Wasden, a $90,000 death benefit in recognition of his contribution of thirty-five (35) years of service to Monroeville Telephone Company. Wasden asserts that the terms of the life insurance policy were confirmed to Charles Wasden in a letter that was dated March 4, 1998 and was written on "Frontier letterhead." The letter reads in pertinent part as follows:
(Doc. 78-1).
According to the amended complaint, Charles Wasden relied on the policy in planning for his family's future, and Defendants or their predecessors never notified him of any change in the policy or benefits. Charles Wasden died on June 14, 2011 and subsequent thereto, Plaintiff submitted a claim for payment of the $90,000 death benefit. (Doc. 78 at 4). Plaintiff alleges that Defendants advised her that Charles Wasden had "$10,000" in coverage pursuant to a Prudential policy as opposed "90,000". Plaintiff further alleges that during subsequent discussions with Frontier officials, Frontier asserted that "only a $10,000 death benefit applied to Wasden" and that the March 4, 1998 letter that referenced a $90,000 policy may have been correct in 1998, but it was no longer effective and did not form the basis of Charles Wasden's life insurance coverage. (Doc. 78 at 5). Wasden asserts that she "appealed the denial of her claim for $90,000 in benefits and (without waiver) exhausted applicable administrative remedies." (
In count one of the amended complaint, Wasden asserts that her claims do not arise under ERISA, and in the alternative, she seeks to recover benefits and enforce her rights under ERISA pursuant to 29 U.S.C. § 1132(a)(1)(B). According to Wasden, she had been denied the proceeds of the life insurance policy/plan, and Defendants have breached "union fiduciary duties" owed her. (Doc. 78 at 6). In count two of her amended complaint, Wasden asserts that the life insurance benefit at issue is an accrued benefit; thus, any purported amendments are void or inapplicable pursuant to 29 U.S.C. 1054's Anti-Cutback provision. (
As noted supra, pending before the Court is Defendants Prudential and the Principle Defendants' respective motions seeking the dismissal of Plaintiffs' claims. (Docs. 92, 93, 99). In their motions, Prudential and the Principle Defendants contend that Wasden's claims should be dismissed for failure to state a claim. Specifically Defendants Prudential and the Principle Defendants assert that Wasden's claim for benefits should be dismissed because she failed to exhaust her administrative remedies with respect to the claims against them, and that her anti-cutback claim should be dismissed because the life insurance claim at issue does not concern pension benefits. In addition, Principle argues that even if Wasden's failure to exhaust is excused, Charles Wasden's policy with Principle expired over ten years prior to his death; thus, Wasden's claim for benefits should be dismissed as a matter of law. Finally, the Principle Defendants and Prudential also argue that Wasden's claim regarding the wrongful withholding of documents should be dismissed because Wasden has failed to allege that she filed written requests for documents.
In response, Wasden asserts that she did not exhaust her administrative remedies with respect to the $10,000 Prudential policy because doing so would have prejudiced her claim for $90,000 against Frontier. (Doc. 106). She requests that the court excuse her failure to exhaust and argues that doing so would have been futile. Wasden concedes that claim for the wrongful withholding of documents is "solely against the Frontier entity Defendants in this matter." (
With respect to the Principle Defendants, Wasden contends that she did not exhaust her remedies with Principle because Defendant Frontier withheld documents concerning the Principle policy, and as a result, she was unaware of Principle's involvement until after she filed the instant lawsuit. (Doc. 107). Wasden argues that Frontier's letter informed her that the administrative process was complete regarding the $90,000 policy and that a "reasonable plan participant" would have believed that the process was complete. (
In considering a Rule 12(b)(6) motion to dismiss for failure to state a claim, the court accepts the non-moving party's factual allegations as true.
As discussed supra, Prudential and the Principle Defendants contend that Wasden's complaint should be dismissed because she failed to exhaust their administrative remedies prior to filing the instant suit. Although the text of ERISA is silent on the matter, the Eleventh Circuit Court of Appeals requires that a plaintiff exhaust her available administrative remedies before bringing ERISA claims in federal court.
The undersigned finds, in viewing the facts in the light most favorable to Wasden, that she made a good faith effort to exhaust her administrative remedies with respect to the $90,000 life insurance policy. Wasden has alleged and has produced a November 16, 2011 letter, the authenticity of which has not been challenged, which reflects that Wasden's attorney contacted Frontier to appeal the denial of her claim for the $90,000 life insurance policy. Frontier advised that it had terminated the policy at issue, and replaced it with a $10,000 policy, which was the only policy in existence at the time of Charles Wasden's death. (Doc. 107-4). In the letter, Wasden was advised that her appeal challenging the denial of benefits under the $90,000 policy was denied, and that:
Based on the language in the November 16th letter, the undersigned finds that Wasden was lead to believe that she had done all that was necessary to exhaust her administrative remedies with respect to the $90,000 policy
In addition, the record reflects that while Frontier cautioned Plaintiffs of the necessity to exhaust remedies with Prudential before filing suit Frontier never mentioned the Principle defendants when confirming that Plaintiffs' had the "right to bring a civil action under ERISA Section 502(a) now that the administrative procedures for claims and appeals have been exhausted." (Doc. 107-4, at 3). Thus, it stands to reason that Plaintiffs reasonably relied on Frontier's assertion that their claim for the $90,000 in benefits was fully exhausted and that Plaintiffs were entitled to sue to recoup the $90,000 in benefits. Accordingly, the Court finds that Plaintiffs reasonably relied on Frontier's assertion that they had properly exhausted their administrative remedies regarding the $90,000 policy.
In addition to exhausting her administrative remedies, Wasden is also required to plead sufficient facts to state a claim against each Defendant named in her lawsuit.
As noted supra, Wasden alleges, in her amended complaint, in 1998, Frontier provided a letter to Charles Wasden confirming that Charles Wasden had a $90,000 term life policy, which would extend throughout his lifetime. (Doc. 78 at 4). Wasden further contends that upon Charles Wasden's death, Wasden, as his beneficiary under the policy, submitted a claim to Frontier for the $90,000 in benefits, and that said claim was denied by Frontier. According to Wasden, in the denial letter, Frontier informed her that in 2007, the $90,000 policy was replaced with a $10,000 policy issued through Prudential. Wasden further asserts that post litigation, she discovered that the Principle Defendants had issued the $90,000 policy. Wasden contends that the $90,000 Principle policy was wrongfully replaced by the $10,000 Prudential policy and, in doing so, "Defendants breached union fiduciary duties owed to Plaintiffs." (Doc. 78, 6).
Taking Wasden's assertions as true, they are insufficient to hold the insurers, Prudential and Principle, liable for recovery of the benefits and violation of ERISA's anti-cutback provision. At best, Wasden's assertions establish that Prudential and Principle merely served as the administrators of insurance policies that Charles Wasden was provided through his employer, Frontier. The facts, as alleged by Wasden, further establish that Frontier, as Charles Wasden's employer, replaced the $90,000 Principle policy with the $10,000 Prudential policy. Thus, taking Wasden's assertion as true, they establish that the insurers merely issued the insurance policies at the direction of Frontier and, at the points at which Frontier altered their policies, the insurers adjusted the policies according to Frontier's directions and the premiums paid by Frontier. Thus, Wasden has failed to provide sufficient facts to establish that Prudential or Principle wrongfully withheld benefits under the $90,000 Principle policy. Instead, a plain reading of the Principle letter dated July 25, 1991, the authenticity of which has not been challenged, clearly reflects that the life benefits under the $90,000 Principle policy would reduce to $67,500 on February 10, 1996, and further reduce to zero on February 10, 2001. (Doc. 107-5). In light of these facts, Wasden cannot state a claim against Principle for wrongfully withholding benefits under the $90,000 policy. Additionally, with respect to Defendant Prudential, Wasden does not allege, and there is no evidence that Defendant Prudential played any role in the issuance of the $90,000 policy. As such, Wasden's assertions are insufficient to support a claim against the insurers, Prudential and Principle, for the wrongful denial of benefits or for breach of fiduciary duties.
Wasden's assertions are also not sufficient to support a claim for violation of ERISA's anti-cutback provisions. ERISA provides elaborate requirements for the vesting of pension benefits, but it does not provide automatic vesting of welfare benefits.
In count thee, Plaintiff asserts a claim against the defendants for wrongful withholding of plan documents in violation of 29 U.S.C. § 1132(c). While ERISA provides a cause of action to a plan participant or beneficiary who requested but did not receive documents a Plan Administrator is required to produce,
Furthermore, as outlined supra, Plaintiffs concede that their wrongful withholding of documents claim in count three is "solely against the Frontier entity Defendants in this matter." (Doc. 106, at 3, fn.1). As such, Plaintiffs' wrongful withholding of document claims against Prudential and the Principle Defendants are due to be dismissed.
In sum, the undersigned finds that Wasden has failed to state a claim against Prudential or the Principle Defendants; thus, Wasden's claims against these Defendants are due to be dismissed for failure to state a claim.
A copy of this report and recommendation shall be served on all parties in the manner provided by law. Any party who objects to this recommendation or anything in it must, within fourteen (14) days of the date of service of this document, file specific written objections with the Clerk of this Court.
For the reasons set forth above, the undersigned recommends that Defendants Prudential and the Principle Defendants' motions to dismiss (Docs. 92, 99) be