STEARNS, District Judge.
Plaintiff Linda Pingiaro brought this action in the Massachusetts state court against Standard Insurance Company (Standard) and her former employer, Eaton Vance Management (EVM), asserting claims related to Standard's denial of her application for disability benefits. Pingiaro variously alleges breach of contract, breach of the implied covenant of good faith and fair dealing, violations of Mass. Gen. Laws ch. 93A and ch. 176D, and promissory estoppel. Defendants removed the case to the U.S. District Court, invoking federal preemption under Section 514(a) of the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1144(a).
Defendants now move separately for summary judgment. Pingiaro opposes
Linda Pingiaro was employed at EVM, an investment management firm based in Boston, Massachusetts, from December of 1982, until her termination in March of 2010. During 2009 and 2010, EVM offered certain benefits to its employees, including a short-term disability (STD) plan, as well as a long-term disability (LTD) plan. Standard was the administrator of both plans. At the time of her termination, Pingiaro was employed as an internal wholesaler team leader, and, at all relevant time periods, was a participant in the STD and LTD plans.
EVM was self-insured with respect to its STD plan.
The STD plan provided a review procedure in the event of the denial of a claim. Subpart "H," under "CLAIMS" and titled "Review Procedure," read as follows: "If all or part of a claim is denied, you may request a review. You must request a review in writing within 60 days after receiving notice of the denial."
EVM was fully insured by Standard with respect to its LTD plan.
The waiting period for eligibility under the LTD plan was 180 days. The LTD Plan also provided a review procedure in the event of a claim denial. The time period for requesting a review was 180 days.
Linda Pingiaro requested STD benefits on August 6, 2009, after taking a leave from work on August 5, 2009, in anticipation of a laparoscopic excision of an ovarian cyst. She provided Standard, through EVM, with a signed authorization for access to her medical treatment records as part of her application for STD benefits. Pingiaro underwent the surgery on August 7, 2009.
After the initial approval, Standard twice extended Pingiaro's STD benefits, first to September 9, 2009, and then to December 13, 2009, after receiving additional medical documentation from Dr. Sotrel and Dr. Paul J. Feiss, Pingiaro's primary care physician.
Although the STD benefits continued to be paid, Pingiaro received a confounding series of letters from Standard notifying her either that her physicians' statements were incomplete, or that Standard needed additional medical documentation to continue her benefits. She also received letters informing her that her benefits had been terminated, but that she could request an administrative review of the decision within 180 days.
In November of 2009, Pinigiaro was contacted by Judith Levy, who, according to Pingiaro, identified herself as a "medical caseworker" for Standard tasked with helping Pingiaro make the transition from STD to LTD. Pingiaro alleges that Levy did not reveal herself as a "vocational case manager" whose real job was to assess Pingiaro's ability to return to work. It appears from the record that Levy's actual assignment (whatever her title) was to determine the nature of Pingiaro's job at EVM to inform Standard's decision as to whether she was disabled from her "own occupation." On November 24, 2009, Levy submitted a "detailed job specialty report"
On November 25, 2009, Bafaro informed Pacheco that Pingiaro's STD benefits had been extended through December 13, 2009. Bafaro recorded the extension in Standard's records. The same day, Standard sent a letter to Pingiaro stating that her benefits were scheduled to expire on December 13, 2009, the date her doctor had given for her anticipated return to work. Pingiaro was again told that she had 180 days to request a review of the claims decision.
Pingiaro alleges that Standard and EVM colluded to mislead her as to her eligibility for LTD benefits because Standard did not want the expense, and EVM had no desire to have her back on its payroll. Pingiaro points to a case note entered by Bafaro on December 29, 2009, stating that "[Levy] will call [Pingiaro] one more time if we are accepting liability by extending claim and rolling into LTD."
On January 13, 2010, Dr. Feiss provided Standard with an updated APS stating that Pingiaro would not be able to return to work until her need for pain medication subsided.
On January 21, 2010, Bafaro notified Pacheco that Pingiaro's disability benefits should have been terminated on December 12, 2009. Bafaro apparently called Pacheco before notifying Pingiaro about the benefits decision. On January 28, 2010, Bafaro entered a case note indicating that she had spoken to Pingiaro by telephone informing her that she would be receiving a detailed denial letter, and that she also "gave her information for appeal."
Although Standard ultimately found Pingiaro eligible for STD benefits through December 13, 2009 only (as detailed in the February 4, 2010 letter), she had continued to receive payments from EVM. On January 30, 2010, EVM stopped paying benefits to Pingiaro.
In a letter dated February 4, 2010 (the Termination Letter), Standard informed Pingiaro that it had determined that, as of December 14, 2009, she no longer met the "Definition of Disability" in the group policy and that Standard was therefore "unable to approve benefits beyond December 13, 2009."
The letter also explained the process of requesting a review of the claims decision. Beneath an underscored heading titled "The following is information regarding your right to a review," the letter stated: "If you want us to review your claim and this decision you must send us a written request within 180 days after you receive
On February 22, 2010, Standard received a letter from Attorney M. Katherine Sullivan requesting a copy of Pingiaro's claims file.
Two days later, on February 24, 2010, Sullivan faxed a letter to Standard that stated: "I am writing to withdraw our request dated February 22, 2010 for a copy of Ms. Pingiaro's Plan documents and claims file. As this firm does not represent Ms. Pingiaro, please disregard our correspondence dated February 22, 2010."
On January 18, 2011 (five and a half months after the expiration of the 180 day appeal period that began to run on February 4, 2010), Pingiaro's current attorney, Katherine Fallon, sent Standard a letter protesting the termination of Pingiaro's STD benefits and demanding a settlement offer.
On Feb. 10, 2010, Dr. Feiss provided EVM with an APS, iterating that Pingiaro was no longer able to work because of severe chronic pain and requesting that she be transitioned from STD to LTD.
Section 514(a) of ERISA, 29 U.S.C. § 1144(a), preempts any and all state claims "related to" an employee benefit plan (other than state laws that "regulate insurance." 29 U.S.C. § 1144(b)(2)(A)). A claim "relates to" an ERISA-covered plan if it (1) has a connection with, or (2) has a reference to, such a plan. Cal. Div. of Labor Standards Enforcement v. Dillingham Constr., 519 U.S. 316, 324, 117 S.Ct. 832, 136 L.Ed.2d 791 (1997).
In her Complaint, Pingiaro alleges claims for breach of contract (both defendants), breach of the implied covenant of good faith and fair dealing (both defendants), promissory estoppel (EVM only), and violations of Mass. Gen. Laws ch. 93A and ch. 176D (Standard only). Counts I and II allege that EVM and Standard breached their contractual duties to Pingiaro by denying her employee benefits and by failing to comply with their obligations under the contracts of insurance that were part of her employee benefit plan. Counts III and IV, alleging breach of the implied covenant of good faith and fair dealing, involve EVM's and Standard's conduct in denying Pingiaro's disability benefits. Count Valleges Pingiaro detrimentally relied on EVM's promises regarding her employment benefits, while Count VI alleges that Standard's decisions in administering EVM's employee benefit plan with respect to Pingiaro violated the consumer protection provisions of Mass. Gen. Laws ch. 93A and ch. 176D. All of these claims "relate to" an employee benefit plan and are thus preempted by ERISA.
A motion for summary judgment is the procedural vehicle by which the denial of a benefits claim is tested under ERISA. Orndorf v. Paul Revere Life Ins. Co., 404 F.3d 510, 517 (1st Cir.2005). Summary judgment is, however, a misnomer as a "trial is usually not an option: in a very real sense, the district court sits more as an appellate tribunal than as a trial court. It does not take evidence, but, rather, evaluates the reasonableness of an administrative determination in light of the record compiled before the plan fiduciary." Leahy v. Raytheon, Co., 315 F.3d 11, 18 (1st Cir.2002). Because summary judgment is simply a procedural vehicle for deciding the issue of disability, "the non-moving party is not entitled to the usual inferences in its favor." Orndorf, 404 F.3d at 517.
As a prerequisite to bringing a suit to recover benefits, a claimant must exhaust the administrative remedies available under her ERISA plan. See Terry v. Bayer Corp., 145 F.3d 28, 40 (1st Cir.1998); Drinkwater v. Metro. Life Ins. Co., 846 F.2d 821, 825-826 (1st Cir.1988). There is no genuine dispute of fact over whether Pingiaro exhausted her administrative remedies in this case. She clearly did not.
Standard's termination letter of February 4, 2010, explicitly stated that Pingiaro's STD benefits were being terminated, and Pingiaro does not contend she understood it to say anything else. (Nor does she contest the fact that she received the
By waiting until January 18, 2011, almost five months after the 180-day appeal period expired on August 3, 2010, to reinitiate contact with Standard (a contact that had been broken off by attorney Sullivan on February 24, 2010), Pingiaro forfeited any right she had to an administrative appeal, and consequently any right she otherwise would have had to seek judicial relief under ERISA. There is a firmly established federal policy favoring exhaustion of remedies in ERISA cases. McMahon v. Digital Equip. Corp., 162 F.3d 28, 39-40 (1st Cir.1998). The purpose of the requirement is to encourage resolution of claim disputes without litigation. See, e.g., Terry, 145 F.3d at 40-41. "The same principles which inform the ERISA exhaustion requirement also counsel that part of that internal administrative process includes the responsibility on the claimant's part to file appeals in a timely fashion." Id. at 40.
Pingiaro claims that because Standard "treated" her January 18, 2011 letter as an appeal, it "waived" the exhaustion requirement. Even assuming that Standard's response to the January 18, 2011 letter — that it saw no reason to reconsider its decision to end Pingiaro's benefits — could be construed as a waiver (which is doubtful), the common-law doctrine of waiver has little, if any, place in ERISA law. See Thomason v. Aetna Life Ins. Co., 9 F.3d 645, 648-649 (7th Cir.1993) (waiver principles did not apply in an ERISA action where plaintiff could not show that she had detrimentally relied on misleading letters sent by the insurer).
Finally, Pingiaro attempts to invoke the futility exception to the exhaustion requirement; she argues that Standard would not have dealt with an appeal fairly had she in fact brought one. Courts, however, have repeatedly held that "blanket assertion[s], unsupported by any facts, [are] insufficient to call the futility exception into play." Madera v. Marsh USA, Inc., 426 F.3d 56, 63 (1st Cir.2005).
For the foregoing reasons, defendants' motions for summary judgment are ALLOWED. Pingiaro's cross-motions for summary judgment are DENIED. The
SO ORDERED.