JOAN B. GOTTSCHALL, District Judge.
Defendant The Prudential Insurance Company of America ("Prudential") moves to dismiss Plaintiff James Ayotte's Complaint pursuant to Federal Rule of Procedure 12(b)(6). Ayotte sued Prudential pursuant to §§ 502(a)(1)(B) and (g) of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1132(a)(1)(B) and (g). He seeks benefits allegedly due to him under a long-term disability policy ("the Plan"), provided to employees of ISI Telemanagement Solutions, Inc. ("ISI"), which was issued, underwritten, funded, and administered by Prudential. Prudential argues that the Complaint must be dismissed because an ERISA suit pursuant to § 1132(a)(1)(B) may be brought only against the Plan itself. The court holds that, despite the general rule that an ERISA plaintiff seeking benefits must sue the plan, Prudential is a proper party to Ayotte's suit. Prudential's motion to dismiss is denied.
According to the Complaint, Ayotte worked for ISI as vice president of engineering. He was forced to cease working on February 27, 2009, due to chronic headaches. On March 2, 2009, he began receiving benefits under a long-term disability policy underwritten and administered by Unum, ISI's disability insurance provider at the time. Ayotte attempted to return to full-time work on January 4, 2010, but was able to do so only until February 26, 2010. Ayotte worked part-time at ISI from
On September 27, 2011, Prudential notified Ayotte that it was terminating his long-term disability benefits effective October 1, 2011. Ayotte appealed that decision internally, and Prudential upheld its decision based on file reviews performed by nonexamining physicians. Ayotte then filed this suit against Prudential. He seeks an order reinstating his long-term disability benefits and further seeks to recover benefits that have accrued from October 1, 2011, to the present, along with interest on all overdue benefits.
Attached to Ayotte's Complaint is a copy of the Plan, called a "Group Insurance Contract for Short and Long Term Disability Coverage." The Plan states that the "Contract Holder" is "PruValue Insurance Benefits Trust." A section entitled "Certificate of Coverage" states that Prudential "welcomes you to the plan" and gives Prudential's address. (Compl. Ex. 1 (Plan) 6, ECF No. 1.) A "General Provisions" section defines the following terms: "
Under the terms of the Plan — which is also referred to as the "Prudential plan" (id. at 31) — Prudential approves applications for coverage, receives disability claims, determines whether someone is disabled under the terms of the Plan, evaluates eligibility for benefits, and provides benefits payments. The Plan defines the term "Payable claim" as "a claim for which Prudential is liable under the terms of the Group Contract." (Id. at 45.) A Summary Plan Description attached to the Plan states that Prudential "as Claims Administrator has the sole discretion to interpret the terms of the Group Contract, to make factual findings, and to determine eligibility for benefits. The decision of the Claims Administrator shall not be overturned unless arbitrary and capricious." (Id.)
A motion to dismiss pursuant to Rule 12(b)(6) should be granted if the plaintiff fails to "state a claim to relief that is plausible on its face." Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009) (citing Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007)). The factual allegations in a complaint must "raise a right to relief above the speculative level." Twombly, 550 U.S. at 555-56, 127 S.Ct. 1955; see also Swanson v. Citibank, N.A., 614 F.3d 400, 404 (7th Cir.2010) ("[P]laintiff must give enough details about the subject-matter of the case to present a story that holds together."). For purposes of a motion to dismiss, the court takes all facts alleged in the complaint as true and draws all reasonable inferences from those facts in the plaintiff's favor, although conclusory allegations that merely recite the elements of a claim are not entitled to this presumption of truth. Virnich v. Vorwald, 664 F.3d 206, 212 (7th Cir.2011).
Under § 1132(a)(1)(B), a beneficiary of an ERISA plan may bring a civil action "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the
Prudential argues that Ayotte's claims must be dismissed because he has sued Prudential, the Plan's issuer and claims administrator, rather than the Plan itself, and ERISA claims brought pursuant to § 1132(a)(1)(B) must be brought against the ERISA plan. In support of its argument, Prudential cites Neuma, Inc. v. AMP, Inc., 259 F.3d 864, 872 n. 4 (7th Cir.2001), along with several other cases from the Seventh Circuit and this district. Prudential argues that this court is bound by controlling precedent to dismiss Ayotte's action because these cases have held that "ERISA permits suits to recover benefits only against the Plan as an entity." Id.
Ayotte responds that the Seventh Circuit cases cited by Prudential do not require the court to dismiss his claims against the insurer who issues the Plan. He further argues that Prudential is the logical defendant in this action. The court will first consider whether binding Seventh Circuit precedent requires it to dismiss the action.
In Neuma, in which an ERISA beneficiary sued an employer, the Seventh Circuit stated that in a suit pursuant to § 1132(a)(1)(B), an ERISA plaintiff could only recover benefits against the plan, not the employer. Id. Neuma cited Jass v. Prudential Health Care Plan, Inc., in which the Seventh Circuit upheld the dismissal of a claim against a plan administrator in her individual capacity, stating that a lawsuit against a plan was only enforceable against the plan as an entity. 88 F.3d 1482, 1490 (7th Cir.1996). That reasoning was in turn based on the aforementioned provision in § 1132(d)(2), which states that claims for benefits "shall be enforceable only against the plan as an entity and shall not be enforceable against any other person unless liability against such person is established in his individual capacity under this subchapter."
Since then, the Seventh Circuit has repeatedly stated that in a suit for ERISA benefits, the plaintiff is generally "limited to a suit against the Plan." See, e.g., Mote v. Aetna Life Ins. Co., 502 F.3d 601, 610 (7th Cir.2007). But the court has carved out an exception from the general rule for suits against plan administrators who are "closely intertwined" with the plan itself. In Neuma, for example, the Seventh Circuit refused to dismiss a suit against an employer because the record was "somewhat unclear as to the exact relationship between [the employer] and the relevant plan." 259 F.3d at 872 n. 4. In Riordan v. Commonwealth Edison Co., 128 F.3d 549, 551 (7th Cir.1997), a plaintiff was permitted to sue his employer to recover ERISA benefits because the plan documents referred to the employer and plan interchangeably. And in Mein v. Carus Corp., a suit against an employer was permitted because the employer was the plan administrator and the employer and the plan were "closely intertwined." 241 F.3d 581, 585 (7th Cir.2001). In Mote, however, the Seventh Circuit affirmed the dismissal of
Id. at 610.
629 F.3d 671, 673 (7th Cir.2011).
Notably, these cases indicate that the Seventh Circuit has never squarely held that § 1132(a)(1)(B) bars claims against an insurer who issues and administers a plan, determines eligibility for benefits, and pays all claims under the plan. And the proposition that a plan is the only proper defendant "is much less firmly established than [Prudential] would have us believe." Mein, 241 F.3d at 584. Prudential argues, however, that the exception to the general rule does not apply here. Before deciding whether the exception applies, the court must identify the contours of the exception.
Some courts in this district have held that the exception applies only to allow suits against employers, and that a plaintiff may never sue an insurance company that issues an ERISA plan pursuant to § 1132(a)(1)(B). See, e.g., Schultz v. Prudential Ins. Co., 678 F.Supp.2d 771, 776 (N.D.Ill.2010) ("The Court also finds that the exceptions the Seventh Circuit recognized in Mein and Riordan do not apply because Schultz is not proceeding against her employer, but rather is suing the issuer of the plan."); Tatera v. Prudential Ins. Co., No. 11 C 2667, 2011 WL 3876954, at *2 (N.D.Ill. Sept. 1, 2011) (rejecting claimant's argument that because Prudential was responsible for the denial of benefits, it was a proper defendant). Those decisions, of course, are not binding on this court.
Other district courts have applied an exception to the general rule based on the
The court concludes that the proper interpretation of this circuit's precedent is that a claim may proceed against a party other than the ERISA plan itself where the identity of that party — be it an employer, an insurance company, or another third-party administrator — is "closely intertwined" with the plan, and where the party controls eligibility for benefits and makes benefits payments. In other words, a party may be sued when it acts as an "obligor" to an ERISA plan beneficiary. Feinberg, 629 F.3d at 673.
Under that reading, the exception applies here. The Plan documents attached to Ayotte's Complaint refer interchangeably to Prudential and the Plan. For example, the definition section states:
In addition, Prudential issued the terms of the Plan, had the sole discretion to interpret those terms and to determine eligibility for benefits, and was obligated to pay benefits under the Plan. Appeals of denied claims were made to Prudential. (Id. (Summary of Plan Description).) Prudential thus appears to be the only party that could provide the benefits allegedly due under the Plan, and is therefore the logical defendant for Ayotte's action.
Accepting Ayotte's allegations as true for purposes of a motion to dismiss, the
In addition, although the court is obviously not bound by out-of-circuit case law, the court notes that barring a suit against Prudential would go against the prevailing law in other circuits. Jass relied on a Ninth Circuit case, Gelardi v. Pertec Computer Corp., 761 F.2d 1323, 1324 (9th Cir. 1985), for the rule that "ERISA permits suits to recover benefits only against the Plan as an entity." But the Ninth Circuit overruled Gelardi in 2011, holding en banc that an ERISA plan insurer was a proper defendant to an action seeking recovery of benefits, because the insurer was responsible for paying the claims and determining benefit eligibility. Cyr v. Reliance Standard Life Ins. Co., 642 F.3d 1202, 1207 (9th Cir.2011) (en banc).
In part, the Ninth Circuit rested its decision on the Supreme Court's interpretation of who could be a proper defendant under 29 U.S.C. § 1132(a)(3).
The Ninth Circuit also addressed the language in § 1132(d)(2) stating that "[a]ny money judgment ... against an employee benefit plan shall be enforceable only against the plan as an entity and shall not be enforceable against any other person unless liability against such person is established in his individual capacity under this subchapter." It concluded that the "unless" language indicated that other parties could be sued under § 1132(a)(1)(B) if their individual liability was established. Cyr, 642 F.3d at 1206-07. It then examined the role the defendant insurer played with respect to benefits claims and concluded that that role made the insurer a proper defendant:
Id. at 1207.
Other circuits have similarly considered whether an entity exercised authority over a benefits claim in evaluating whether that entity is a proper defendant in an ERISA suit. See, e.g., Gomez-Gonzalez v. Rural Opportunities, Inc., 626 F.3d 654, 665 (1st Cir.2010) (explaining that "the party that controls administration of the plan" is the
The prevailing logic in these other circuits is that entities responsible for administering a plan that exercise discretion as to benefit payments are proper parties to a § 502(a)(1)(B) suit. This court finds that logic sound. Given the role played by Prudential with respect to Ayotte's benefits, the court concludes that Prudential is a logical defendant for Ayotte's action. The court cautions Ayotte, however, that his case against Prudential hinges on rather murky Seventh Circuit case law, and that this court's interpretation of that precedent conflicts with that of some of its fellow district courts, which have dismissed insurers as defendants on facts similar to those alleged here. See, e.g., Tatera, 2011 WL 3876954, at *2. Given this uncertain terrain, in the interest of securing any relief to which he may be entitled should he prevail on his claims, Ayotte may deem it prudent to amend his Complaint to add the Plan as a defendant. See Mein, 241 F.3d at 585 ("[I]t is silly not to name the plan as a defendant in an ERISA suit.").
Because Prudential is closely intertwined with the Plan and is the logical defendant for this action, Prudential's motion to dismiss Ayotte's Complaint is denied. If Ayotte wishes to amend his Complaint to add the Plan as a defendant, he must file an Amended Complaint by October 10, 2012. Prudential is to answer or otherwise plead by November 7, 2012.