JAMES T. TRIMBLE, JR., District Judge.
Before the court are two motions: (1)Motion for Leave to File Amended Complaint (R. #14) and (2) Defendant Dade Behring Life Insurance Plan's Motion to Dismiss and Opposition to Plaintiffs' Motion for Leave to File Amended Complaint" (R. #19). In their motion for leave to amend complaint, plaintiffs seek to add additional defendants and state additional claims. Defendants object to plaintiffs' motion for leave to amend. Contemporaneously with their objection, defendants seek to dismiss the instant lawsuit based on (1) prematurity, (2) inappropriate venue, (3) because the Plan terms do not permit the benefits plaintiffs seek and (4) Employee Retirement Income Security Act of 1974 ("ERISA") does not permit the monetary damages plaintiffs seek.
Plaintiffs filed the instant lawsuit seeking additional benefits they allege are due under a life insurance policy. Before his death, Martin French worked for Dade Behring, Inc. Plaintiffs, Mr. French's sisters, received life insurance benefits from the Dade Behring Life Insurance Plan ("Plan"), an employee welfare plan governed by ERISA, insured and administered by Hartford Life and Accident Insurance Company ("Hartford") and Continental Assurance Company ("CNA"). The Administrative Committee
When hired, Mr. French enrolled in both basic and optional life insurance benefits which would pay the beneficiaries up to five times his annual salary. Over time, Mr. French's salary increases allowed benefits that exceed $800,000.00. Upon his death, the Plan paid $321,942.66 to the beneficiary of his basic life insurance and $478,058 to plaintiffs as beneficiaries of his optional life insurance benefits. The Plan interpreted the policy to limit coverage benefits to $800,000. However, statements after his death revealed that Mr. French had $321,942.66 in basic life insurance benefits and $1,609,713.30 in optional life insurance benefits.
Hartford determined that the beneficiaries were only entitled to $800,000.00 in total benefits. To be eligible for benefits in excess of $800,000.00, the Plan determined that the insured was required to provide Evidence of Insurability ("EOI"), also known as Proof of Good Health. The Plan alleges that Mr. French failed to provide the EOI. Plaintiffs allege that either the Administrators failed to properly
Plaintiffs appealed the denial of their claim by Hartford for an additional $1,131,655 for optional life insurance to both Hartford and to the Dade Behring Administrative Committee ("Administrative Committee"). The denials were affirmed; the last appeal denial was by letter dated July 24, 2006.
On June 24, 2009, plaintiffs filed a lawsuit against the Plan in the Middle District of Louisiana entitled Linda French and Ann French Gonsalves v. Dade Behring Life Insurance Plan ("French I").
The Plan filed a motion to dismiss the complaint in French I based on improper venue. The court ultimately denied the motion finding that one of the plaintiffs was a resident of Louisiana in Livingston Parish, and that venue was proper because the lawsuit was filed in a district where plan payments were paid and allegedly remained payable to a designated beneficiary.
Thereafter, the Plan answered the complaint and provided the administrative record reviewed by the Plan Administrator. Plaintiffs disputed the thoroughness of the administrative record maintaining that the record submitted by the Plan was incomplete because it did not include the majority of the file generated by Hartford during its review of plaintiffs' file ("Hartford file"). Hartford argued that its files were irrelevant. Magistrate Judge Noland found that the Hartford files could not be part of the administrative record because the Administrative Committee had not considered the files during the appeals process.
The case was then transferred to this court for further proceedings which included a motion to remand and plaintiffs' motion for reconsideration of the previous ruling that the administrative record was complete. This court reversed the previous ruling finding that because the Hartford files were available and relevant to the Plan Administrator during its consideration of plaintiffs' claim, it was part of the administrative record as a matter of law. The Plan was ordered to produce and make available to plaintiffs the entire Hartford files, and the matter was remanded to the Plan Administrator for reconsideration of the full administrative record. In light of the remand, French I was dismissed without prejudice.
Initially, Hartford refused to produce its file without a subpoena, however, ultimately the file was produced to plaintiffs on March 19, 2012 after this lawsuit was filed.
Plaintiffs submit that these files contained information that the Plan for approximately ten years, did not notify its employees of an alleged requirement that they provide an EOI (evidence of insurability) in order to receive increases in coverage of $50,000 or more and that after Martin French died, Hartford and the Plan amended the policy to remove the particular EOI requirement without notifying or obtaining the consent of plaintiffs. The file also contained documents that revealed that the amendment was made retroactive to 1994.
Meanwhile, the instant lawsuit ("French II") was filed on February 15, 2012 again asserting that plaintiffs were entitled to the additional benefits. Plaintiffs maintain in this lawsuit that their claims for additional benefits should be "deemed denied and/or the administrative remedies exhausted."
On May 31, 2012, plaintiffs submitted to the Administrative Committee of Siemens Corporation
On July 20, 2012, plaintiffs filed a motion for leave to file an amended complaint. The amended complaint asserts four new causes of action and adds seven new defendants. The proposed amended complaint asserts that plaintiffs are owed benefits under the terms of the Plan, that defendants are estopped from denying additional life insurance benefits, and that certain defendants breached their fiduciary duties. It requests that these defendants pay plaintiffs an amount equal to the additional life insurance benefits claimed under the Plan.
Federal Rule of Civil Procedure 12(b)(6) allows dismissal of a complaint when it fails to state a claim upon which relief can be granted. The test for determining the sufficiency of a complaint under Rule 12(b)(6) is that "`a complaint should not be dismissed for failure to state a claim unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.'"
Under Rule 8 of the Federal Rules of Civil Procedure, the pleading standard does not require a complaint to contain "detailed factual allegations," but it demands "more than an unadorned, the defendant-unlawfully-harmed-me accusation."
To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to "state a claim to relief that is plausible on its face."
Defendants maintain that the complaint should be dismissed because it is premature and/or because of improper venue.
Defendants maintain that the instant lawsuit is premature because the Plan Administrator has not decided plaintiffs' claim. Defendants argue that should the Administrative Committee grant plaintiffs' claim for additional life insurance benefits, plaintiffs would have no injury and their lawsuit would be moot.
Plaintiffs remark that they completed an administrative review and exhausted their remedies in July 2006. The only reason the matter had to be remanded for a second administrative review was because the Plan claims it failed to review the Hartford file in the 2006 review. Then despite a court order, the Plan either could not or would not produce the Hartford file and therefore could not go through with the court-ordered administrative review. Thus, plaintiffs were forced to re-file their suit on February 15, 2012. Plaintiffs remark that when they filed the complaint, the Plan had exceeded the time allowed for administrative review under both the terms of the Plan and ERISA regulations. Thus, plaintiffs submit that the review is futile or deemed denied.
Plaintiffs maintain that the Plan's motion to dismiss is a breach of an agreement
In their reply brief, defendants inform the court that the Administrative Committee denied plaintiffs' claim for additional life insurance benefits based on its review of the administrative record, which included the Hartford file. Defendants then argue that exhaustion of the administrative process is of no consequence, and cites case law which holds that a party must have standing at the time the complaint is filed,
Plaintiffs maintain that the matter is ripe for adjudication either (1) because administrative remedies are deemed denied or futile, or (2) pursuant to the agreement of the parties to complete the administrative process. Because the administrative review process is now complete and also due to the procedural posture of this case and Hartford's unwarranted delay tactics despite this court's order to produce the entire Hartford file, we find that this matter is ripe for adjudication.
Defendants maintain that the instant complaint should be dismissed pursuant to Federal Rule of Civil Procedure 12(b)(3) because the action is brought in an improper venue. An ERISA cause of action is proper either in "the district where the plan is administered, where the breach took place, or where a defendant resides or may be found."
Defendants remind the court of the previous Magistrate Judge's ruling that venue would not be proper under the first prong of ERISA's venue provision because the Plan was administered in Illinois. However, the Magistrate concluded that venue was proper in the Middle District of Louisiana because that is where the breach arose.
Plaintiffs argue that venue is still proper because the deceased's employer and Plan Sponsor, Dade Behring, Inc. were both registered with the Secretary of State to do business in the State of Louisiana and listed its principal place of business in Baton Rouge, Louisiana. Dade Behring had 18 employees in Louisiana and the Plan provided life insurance to those employees. The court agrees with plaintiffs that venue is proper in the Middle District of Louisiana where the initial breach took place — the underpayment of life insurance benefits — received by Ms. French in Denham Springs, Louisiana. For the foregoing reasons, the motion to dismiss the complaint will be denied.
Plaintiffs have asserted Counts III-V which include (1) equitable relief under § 502(a)(3) for violation of fiduciary duties regarding notification for the need for EOI under the $800,000 provision, (2) equitable relief under § 502(a)(3) for violation of fiduciary duties regarding notification of the need for EOI under the $50,000 provision, and (3) equitable relief under § 502(a)(3) for breach of fiduciary duty for concealing that the $50,000 provision was in effect during Martin French's life.
Defendants maintain that the motion for leave to file the first amended complaint should be denied because it is futile and because it unduly prejudices the Plan. Defendants argue that the amended complaint is futile for the following reasons: (1) it does not cure the deficiencies of the pending complaint, (2) plaintiffs' estoppel claim in Count II fails as a matter of law, (3) plaintiffs cannot plead a claim under ERISA § 502(a)(1)(B) and 502(a)(3), (4) the amended complaint does not establish that certain defendants were fiduciaries, (5) plaintiffs' claims for breach of fiduciary duties are insufficiently pled, and (6) Counts III-V of the first amended complaint are barred by ERISA's statute of limitations.
Defendants maintain that the proposed amended complaint suffers the same deficiencies as the complaint — prematurity due to failure to exhaust administrative remedies. As previously noted, this argument is now moot because the administrative process is now complete.
Defendants likewise maintain that venue is improper. Again, as noted above, we find this argument without merit.
Plaintiffs allege that they are entitled, pursuant to 29 U.S.C. § 1132(a)(1)(B) [ERISA § 502(a)(1)(B)] and ERISA estoppel, to recover the balance of voluntary life insurance benefits from the Plan and the Insurers for misleading acts and written misrepresentations made to Martin French concerning his life insurance coverage.
Defendants cite a district court case which held that extraordinary circumstances can only be established through allegations of bad faith or fraud on the part of the employer or plan.
The Third Circuit has also suggested that extraordinary circumstances may exist where a plaintiff repeatedly and diligently inquired about benefits and was repeatedly misled.
Relying on CIGNA v. Amara,
The first amended complaint alleges that either the defendants failed to adequately notify Mr. French and other employees of the need for EOI, and/or if the employees, including Mr. French, were adequately notified, Mr. French provided EOI, but due to poor record keeping, the Plan and/or the insurers were unable to locate same. The proposed amended complaint alleges that defendants concealed
The complaint alleges that the administrators/fiduciaries breached their fiduciary duty of maintaining records, and timely and accurately notifying employees of the requisites (providing EOI) to maintain benefits.
The court does not believe that the Supreme Court intended to eliminate the element of extraordinary circumstances in an estoppel claim under § 502(a)(1)(B). A thorough reading of the opinion leads one to believe that the Court was analyzing how to provide other appropriate equitable relief under § 502(a)(3) by reforming the terms of a Plan because § 502(a)(1)(B) did not give the district court the authority to reform the plan. We base this conclusion on the following analysis of the Supreme Court:
We further conclude based on our understanding of Fifth Circuit jurisprudence and a conscious reading of Amara, that estoppel is still cognizable under § (a)(1)(B). In Amara, the Supreme Court held that the remedy being ordered by the district court — changing or reforming the terms of the Plan —
Taken as true, it is obvious to this court that had Mr. French received the proper notice requirement for EOI under the $50,000 provision, he would have provided EOI and been entitled to the additional life insurance benefits that are the subject of this lawsuit, notwithstanding the requirement of EOI when coverage exceeded $800,000. If taken as true, the amended complaint alleges defective notice of EOI requirements, an active attempt to conceal a significant change in the Plan and an active attempt to conceal the date of the amendment which we find alleges sufficient
Defendants maintain that because plaintiffs have asserted a cause of action under ERISA § 502(a)(1)(B), they cannot also sue for breach of fiduciary duty under ERISA § 502(a)(3). Defendants argue that this would be an attempt to obtain the same benefits underlying their § 502(a)(1)(B) claims.
Plaintiffs maintain that Rule 8 of the Federal Rules of Civil Procedure allows both alternative and inconsistent pleadings. Plaintiffs recognize that the district courts in the Fifth Circuit are split on whether courts should always dismiss a claim for breach of fiduciary duty under § (a)(3) if the plaintiff has asserted a claim for benefits under § (a)(1)(B).
In Varity Corp. v. Howe,
Plaintiffs argue that their breach of fiduciary duty claim is not duplicative and therefore may be pled in the alternative. In other words, if plaintiffs cannot succeed under § 502(a)(1)(B) by enforcing the terms of the Plan, alternatively, they seek an equitable remedy pursuant to § 502(a)(3) for breach of fiduciary duty and the resulting harm caused. Plaintiffs note that the court in North Cypress Medical Center Operating Co. Ltd. v. Principal Life Ins. Co.,
Plaintiffs assert that their claims under § (a)(1)(B) are wholly different than their claims under § (a)(3). The claims under § (a)(1)(B) seek life insurance benefits pursuant to the terms and conditions of the Plan and the underlying insurance policy, and questions whether, under those terms and conditions, Mr. French provided EOI or was required to provide EOI. This claim enforces the terms of the Plan.
Plaintiffs remark that if it is found that they are not entitled to benefits under the terms of the plan, they will be without a remedy due to the misrepresentations made to Martin French. Thus, they would have to rely on § (a)(3) for adequate relief. We agree and are inclined to allow plaintiffs to plead both claims in the alternative, but not allow recovery under both ERISA provisions.
Defendants maintain that plaintiffs' attempt to amend the complaint is futile because plaintiffs do not seek appropriate equitable relief under ERISA § 502(a)(3). Defendants maintain that plaintiffs cannot seek monetary damages (the monetary value of lost policy proceeds) under ERISA § 502(a)(3). Defendants argue that this type of relief is the "classic form of legal relief" not available under the statute.
Plaintiffs argue that when, as may occur here, a claimant cannot prevail in a claim for benefits because of misrepresentations made outside of the claims process, and the claims process being limited to the terms of the plan cannot provide relief for those misrepresentations, § (a)(1)(B) does not provide "adequate relief." Thus, plaintiffs argue that the court should fashion appropriate equitable relief pursuant to § (a)(3).
In CIGNA Corp. v. Amara,
The Court further noted that the District Court injunctions required the plan administrator to pay to already retired beneficiaries money owed them under the plan as reformed. "But the fact that this relief takes the form of a money payment does not remove it from the category of traditionally equitable relief. Equity courts possess the power to provide relief in the form of monetary `compensation' for a loss resulting from a trustee's breach of duty, or to prevent the trustee's unjust enrichment."
Where Congress has provided a remedy for a particular plaintiff's injury in some other section of ERISA, "there will likely be no need for further relief, in which case such relief normally would not be `appropriate.'"
We find that the relief requested for the alleged harm caused is not prohibited by ERISA § 502(a)(3), and further conclude that plaintiffs should be able to pursue a remedy under ERISA § (a)(3) consistent with the limitation set forth above. Accordingly, we find no justification to dismiss this claim.
Defendants maintain that the first amended complaint fails to allege that the Individual Defendants (Salvatore S. Dadouche, Paul Ingraham and Candace Davis) had any discretionary authority or control over the management or administration of the Plan. "Fiduciary status under ERISA is to be construed liberally, consistent with ERISA's policies and objectives," and is defined "`in functional terms of control and authority over the plan, ... thus expanding the universe of persons subject to fiduciary duties — and to damages....'"
Plaintiff asserts that the first amended complaint alleges that at "all relevant times, ... the Individual Defendants, and the Insurers were fiduciaries with respect to their exercise of authority over the management and administration of the Plan."
The court finds that the factual allegations, if taken as true, support plaintiffs' assertions that the Individual Defendants were fiduciaries.
Defendants maintain that plaintiffs' claims of fiduciary breach in Counts III-V are insufficiently pled because the Administrative Committee has yet to decide plaintiffs' claims for additional life insurance benefits. As previously noted, this argument is now moot.
Defendants maintain that Counts III-V do not satisfy the pleading requirements necessary to allege an ERISA breach of fiduciary duty claim. Defendants complain that the first amended complaint does not specify which Individual Defendant breached which fiduciary duty and argues that not differentiating between the actions of the defendants requires denial of plaintiffs' motion for leave to amended the complaint.
The first amended complaint alleges that the Individual Defendants are members of the Administrative Committee.
Plaintiffs maintain that the first amended complaint details factual allegations made against each of the Individual Defendants. For instance, the amended complaint alleges that each of the Individual Defendants breached their fiduciary duty requiring prudent maintenance of records and timely and accurate notification of the requisites for maintaining benefits. The amended complaint alleges that the Administrative Committee which was controlled by the Individual Defendants actively prevented plaintiffs from discovering that the policy had been amended after Mr. French died. The amended complaint alleges that the Administrative Committee failed to provide, refused to provide and objected to producing the Hartford files which contained information about the concealment. Specifically, Individual Defendants,
The amended complaint details miscommunications and/or lack of notification, regarding the requirements for EOI, or if EOI was provided, it was lost. The complaint further alleges that alternatively, assuming EOI was required, Dade, the Individual Defendants and the Insurers breached their fiduciary duty by misleading Mr. French and other employees concerning their need for EOI and either provided no notification or inadequate notifications of the need for EOI.
The first amended complaint further alleges that the policy also required EOI for Voluntary Life Insurance in excess of $800,000,
Plaintiffs allege that the benefit statements provided by Dade Behring and the Insurers to Mr. French during his life confirm that he had full coverage (his insurance was not capped) and also confirmed that EOI was not required.
The amended complaint alleges the specific procedures to inform employees who needed to provide EOI and that procedure was rarely, if ever, followed.
Plaintiffs' claims against the Administrators, and the Individual Defendants for breach of fiduciary duty include (1) failure to properly prepare and maintain records necessary to determine the rights and benefits of employees, participants and beneficiaries or other persons, (2) misleading Mr. French and other employees and failing to properly notify them of the need to provide EOI, (3) repeated reports to Mr. French and other employees that their life insurance coverage was in an amount exceeding $800,000 and deduction of premiums for such coverage, even though the employees allegedly had not submitted EOI and therefore allegedly were not entitled to the amounts of coverage reported; (4)and other grounds to be shown at trial or in motions.
The court finds that plaintiffs' claims against Dade Behring, the Insurers and the Individual Defendants for breach of fiduciary duty are sufficiently pled.
Defendants allege that Counts III-V are barred by ERISA's statute of limitations. ERISA § 413 provides the following regarding the statute of limitations for fiduciary breaches:
Defendants maintain that all three causes of action are time barred because they were not brought within six years after the date of the last action which constituted a part of the breach of fiduciary duty. Defendants assert that because Martin French died on July 19, 2005, the complaint must have been filed on July 19, 2011 because the alleged breach of fiduciary duty occurred prior to Mr. French's death. We disagree. Plaintiffs could not have filed a claim until they were denied benefits.
Alternatively, defendants maintain that the date of the plan amendment — November 28, 2005 — should be the starting date. We disagree. The amended complaint alleges that the amendment was intentionally concealed from plaintiffs, thus, because of the alleged concealment, the commencement date would be the date of discovery of such breach.
Plaintiffs maintain that the motion for leave to amend was filed on July 20, 2012, four days before the six-year anniversary of the final denial. Plaintiffs rely on the date of the final denial — July 24, 2006 — as the date of the last action which constituted a part of the breach or violation, or in the case of an omission, the latest date on which the fiduciary could have cured the breach or violation. The starting date with which to toll the statute of limitations could be either the date the plaintiffs discovered the alleged concealment or the date of the final denial of additional life
Defendants argue that they are unduly prejudiced to be forced to defend this lawsuit because it is not ripe for adjudication. For reasons set forth above, we find this argument moot.
For the reasons set forth above, the motion to dismiss will be denied and the motion for leave to file the first amended complaint will be granted.