THOMAS W. PHILLIPS, District Judge.
This matter is before the Court on Plaintiff's Motion for Judgment on the Pleadings [doc. 50], Plaintiff's Brief in Support of the Motion [doc. 54], Defendant's Response and Cross-Motion for Judgment on the Pleadings [doc. 65], Defendant's Brief in Support of the Cross-Motion [doc. 66], Plaintiff's Reply [doc. 78], Defendant's Sur-Reply [doc. 84], and Plaintiff's Response to Defendant's Sur-Reply [doc. 85]. For the reasons herein, the Court will deny both motions and will remand this action based on Defendant's contention that Plaintiff has failed to exhaust her administrative remedies.
Between 2008 and 2009, Plaintiff Beth Nichole Jordan, a nurse anesthetist, suffered a possible tick bite while camping, contracted Lyme disease, and began to experience various medical complications from the disease. [Compl., doc. 1, ¶¶ 8, 12-13; R. at 312, 709-10, 854-56, 1428-31]. She eventually filed for disability benefits under her employer's long-term disability policy, whose administrator is Defendant Reliance Standard Life Insurance Company ("Reliance"). [Compl. ¶¶ 9-11, 14-15; see R. at 317-22]. Reliance concluded that she qualified for long-term disability benefits under its policy, approved her claim, and provided her with benefits. [Compl. ¶ 16; R. at 303, 1606]. But a few years later, in 2015, Reliance terminated her benefits after finding that she did not meet the policy's definition of "Total Disability." [Compl. ¶¶ 22-23; R. at 9, 1606-10].
Ms. Jordan appealed Reliance's denial of her benefits on November 3, 2015, through Reliance's internal appellate-review process. [Compl. ¶ 24; R. at 1214]. While the appeal was ongoing, Reliance sent a letter to Ms. Jordan on December 16, 2015, informing her that it would require her to undergo an independent medical examination, [Compl. ¶ 27; R. at 1621]—which it is free to do under the policy's terms, [R. at 13]— and that it would "toll the statutory time frames for rendering an appeal determination pending completion of the examination and receipt of the physician's report," [id. at 1622; see Compl. ¶ 37]. Reliance's third-party vendor scheduled the exam to take place on January 12, 2016, with Stephen Dawkins, M.D., in Georgia. [Compl. ¶¶ 27-28; R. at 1335]. On the day of the exam, while Ms. Jordan was traveling to Dr. Dawkins' office, Dr. Dawkins had to respond to an emergency. [Compl. ¶ 29; R. at 237]. Although he could not keep his appointment with Ms. Jordan at the time that they had originally scheduled, he did offer to see her later in the afternoon on that same day. [Compl. ¶ 29; R. at 237]. She was unable, however, to meet with him on that day. [Compl. ¶ 30; R. at 237].
On January 29, 2016, Reliance contacted Ms. Jordan's counsel about rescheduling the appointment. [Compl. ¶ 31; R. at 237]. According to Ms. Jordan, the due date for a decision on her appeal was December 18, 2015, [Compl. ¶ 35; R. at 243], and her counsel informed Reliance that she was willing to attend the exam only if Reliance could reschedule it "quickly," [Compl. ¶ 31; R. at 243]. The earliest available date for another appointment with Dr. Dawkins, however, was apparently February 24, 2016. [Compl. ¶ 32; R. at 243, 1628].
On February 5, 2016, Ms. Jordan, without having received a final decision from Reliance regarding her appeal, filed suit in this Court under the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132(a)(1)(B), claiming that Reliance wrongfully denied her disability benefits under the policy and seeking a judgment entitling her to those benefits. [Compl. at 7-8].
ERISA permits a participant
A participant, however, may also file suit before receiving a final decision if that decision is untimely under 29 C.F.R. § 2560.503-1(l)(2)(i). Under this regulation,
The Court begins by noting that the exhaustion of administrative remedies applies only to plan-based claims under ERISA; it is not an antecedent to a participant's right to bring a statutory violation of ERISA—like an alleged violation of ERISA's anti-cutback provisions under 29 U.S.C. § 1054(g) or an alleged violation of ERISA's fiduciary duties under 29 U.S.C. § 1104. Hitchcock v. Cumberland Univ. 403(b) DC Plan, 851 F.3d 552, 564 (6th Cir. 2017). Ms. Jordan, however, does not allege a breach of fiduciary duty or any other statutory violation of ERISA, asserting only a claim for the wrongful denial of benefits under the terms of Reliance's policy. [See Compl. ¶¶ 46-53].
Again, although she did not secure a final decision from Reliance by pursuing its internal appellate-review process to its end, she nonetheless argues that she has exhausted her administrative remedies and properly filed suit in this Court because Reliance never issued a timely final decision under the applicable deadline. [Id. ¶¶ 2, 35, 39; Pl.'s Br. at 20, 22-25]. She claims that because Reliance made no decision within forty-five days of her appeal, she did not have to wait for a decision. [Id.]. She also asserts that Reliance's letter from December 16, 2015—in which Reliance notified her of its intent to schedule an independent exam—does not constitute written notice of special circumstances and that Reliance was therefore not entitled to an additional forty-five-day extension based on this letter. [Compl. ¶ 36; Pl.'s Br. at 24-25]. In sum, she urges the Court to view her administrative remedies as exhausted under the deemed-exhausted provision.
But before delving into the issue of exhaustion, the Court must define the legal parameters for its analysis. Although courts have resolved ERISA cases through summary judgment and bench trials, the Sixth Circuit, in a concurring opinion, has advised courts not to use either procedure in these types of cases. See Wilkins v. Baptist Sys., Inc., 150 F.3d 609, 617-19 (6th Cir. 1998) (Gilman, J., concurring). Considering only the evidence that the parties presented to the administrator, courts should instead review the administrative record and, based on that review, issue findings of fact and conclusions of law. Id. at 619. But as to the specific issue of exhaustion, Reliance— importantly—does not ask for judgment on the administrative record; instead, it requests the dismissal of Ms. Jordan's claim: "Plaintiff . . . failed to exhaust her administrative remedies . . . . As a result, Plaintiff's claim must be dismissed[.]" [Def.'s Br. at 8 n.3 (citations omitted)]. The Court construes this argument as a request for dismissal under Federal Rule of Civil Procedure 12(b)(6).
In ERISA actions, when a defendant moves to dismiss a complaint for failure to exhaust administrative remedies, courts typically resolve the issue based on the face of the pleadings and not the administrative record. See Hill v. Blue Cross & Blue Shield of Mich., 409 F.3d 710, 721 (6th Cir. 2005) ("Plaintiffs have not sufficiently alleged that they exhausted the administrative remedies available to them[.]"); Weiner v. Klais & Co., 108 F.3d 86, 91 (6th Cir. 1997) (affirming dismissal of an ERISA claim for benefits because the plaintiff had "not alleged any factual basis" showing the exhaustion of remedies); Beamon v. Assurant Emp. Benefits, 917 F.Supp.2d 662, 666 (W.D. Mich. 2013) (stating that "exhaustion is an affirmative defense" and noting that "a district court may dismiss a complaint if the existence of a valid affirmative defense, such as the failure to exhaust, is . . . plain from the face of the complaint") (quoting Turley v. Gaetz, 625 F.3d 1005, 1013 (7th Cir. 2010))); Barix Clinics of Ohio, Inc. v. Longaberger Family of Cos. Grp. Med. Plan, 459 F.Supp.2d 617, 621-23 (S.D. Ohio 2005) (dismissing an ERISA claim for benefits after performing an analysis of the complaint and concluding that the plaintiff failed adequately to plead exhaustion).
After examining Ms. Jordan's allegations, the Court is not convinced that she has pleaded sufficient facts showing the exhaustion of her administrative remedies. She pleads that Reliance's final decision was due on December 18, 2015—the day on which the forty-five day deadline expired—and that none of Reliance's communications before that date constituted special circumstances for an extension. [Compl. ¶¶ 35-36].
So Ms. Jordan—by her own account—elected to delay the filing of her claim in this Court when the opportunity arose at the end of forty-five days, in favor of pursuing her administrative remedies under Reliance's policy for a period of nearly two more months. Although this Court is unaware of any case in which a court in this circuit has had to reconcile with this somewhat unusual scenario, courts elsewhere have dealt with relatively similar facts and declined to deem administrative remedies exhausted. See Hall v. United of Omaha Life Ins. Co., 741 F.Supp.2d 1348, 1357 (N.D. Ga. 2010) ("[The plaintiff] could have filed suit once the original deadline had passed, but he chose to wait. Thus, [the administrator's] alleged delay in providing an initial claim decision does not trigger the deemed exhaustion provision." (footnote omitted)); Tindell v. Tree of Life, Inc., 672 F.Supp.2d 1300, 1311, 1312 (M.D. Fla. 2009) ("[I]f a plan administrator fails to issue a timely decision on a claim for benefits or an appeal the claimant may deem her administrative remedies exhausted and immediately proceed to court. However, if the claimant waits for the plan administrator to issue a determination, then the claimant should pursue the administrative route to its end. . . . [E]xcusing exhaustion in such a circumstance would permit a claimant who opted to wait indefinitely for a decision to then effectively circumvent the administrative appeal process altogether." (citation omitted)); cf. Borman v. Great Atlantic & Pacific Tea Co., 64 F. App'x 524, 529 (6th Cir. 2003) (recognizing that "the attempted circumvention" of ERISA's exhaustion requirement "ordinarily should not be tolerated" (citing Baldwin Cty. Welcome Ctr. v. Brown, 466 U.S. 147, 152 (1984))); see also [Pl.'s Reply at 5 (acknowledging that an administrator has "no more than 45 days to make a decision on a disability appeal" and that if it fails to meet this deadline, the participant may proceed "directly to court" (emphasis added) (citation omitted))].
In addition, the Court would be remiss if it did not note that Ms. Jordan has not pleaded—not even in perfunctory fashion—that the exhaustion of her administrative remedies would be futile. See Weiner, 108 F.3d at 91 (stating that futility—that is, a plaintiff's assertion that an administrative route would be a pointless or an inadequate remedy—is as an exception to the exhaustion requirement if properly pleaded); see also Coomer v. Bethesda Hosp., Inc., 370 F.3d 499, 505 (6th Cir. 2004) (stating that the plaintiff did not properly plead futility); see also Zhou v. Guardian Life Ins. Co. of Am., 295 F.3d 677, 680 (7th Cir. 2002) ("When a party has proffered no facts indicating that the review procedure that he initiated will not work, the futility exception does not apply." (emphasis added) (citation omitted)). In fact, Ms. Jordan even concedes that a remand of this action would not be futile at all but a suitable "alternative" remedy to judgment on the administrative record: "In the alternative . . . Reliance Standard [should] conduct a medical exam within a set amount of time, and . . . produce a decision within a set amount of time thereafter." [Pl.'s Br. at 35].
The Court will oblige her request for a remand, due to her failure to plead plausible facts showing the exhaustion of her administrative remedies and Reliance's request for dismissal. The Court will remand this action so that Reliance can perform an independent medical exam and make a final determination regarding Ms. Jordan's right to disability benefits based on a complete factual record. See Shelby Cty. Health Care Corp. v. Majestic Star Casino, 581 F.3d 355, 373 (6th Cir. 2009) (observing that remand is "appropriate in a variety of circumstances, particularly where the . . . administrative record is factually incomplete").
Ms. Jordan's allegations fall short of establishing that she has exhausted her administrative remedies. Because she continued to pursue her administrative remedies rather than file suit when Reliance did not render a decision by the forty-five-day deadline, the Court is not willing to deem her administrative remedies exhausted. She must now pursue the administrative pathway to its end. As a result, the Court orders as follows: