United States District Court, M.D. Alabama, Northern Division
MEMORANDUM OPINION AND ORDER
W. KEITH WATKINS, Chief District Judge.
Plaintiff Susan Till sues Defendants Lincoln National Life Insurance Company ("Lincoln"), Gilliard Health Services, Inc. Disability Plan (Plan 504), and Gilliard Health Services, Inc. Group Term Life Plan (Plan 503) (collectively "the Plans") for various violations of the Employee Retirement Income Security Act of 1974 ("ERISA"). See 29 U.S.C. § 1101 et seq. Before the court is Defendants' motion to dismiss. (Doc. # 9.) Plaintiff opposes the motion to dismiss (Doc. # 14) and has filed a motion to strike Defendants' Document # 9-1, the "Summary Plan Description, " attached to Defendants' motion to dismiss (Doc. # 15). Defendants have replied to Plaintiff's opposition brief and oppose her motion to strike. (Docs. # 17, 18.) Upon consideration of the complaint, the parties' arguments, and relevant law, the court concludes that Defendants' motion to dismiss is due to be granted in part and denied in part and that Plaintiff's motion to strike is due to be denied.
I. JURISDICTION AND VENUE
The court has subject-matter jurisdiction pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e). Defendants do not contest personal jurisdiction or venue.
II. STANDARDS OF REVIEW
When evaluating a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6), the court must take the facts alleged in the complaint as true and construe them in the light most favorable to the plaintiff. Resnick v. AvMed, Inc., 693 F.3d 1317, 1321-22 (11th Cir. 2012). To survive Rule 12(b)(6) scrutiny, "a complaint must contain sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face.'" Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). "[F]acial plausibility" exists "when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Id. (citing Twombly, 550 U.S. at 556).
Plaintiff resides in Butler County, Alabama, and was employed as a radiology technician by Gilliard Health Services, d/b/a Evergreen Medical Center ("Gilliard"). Gillard purchased long term disability insurance and group life insurance for its employees, including Plaintiff. Lincoln sold and underwrote Plaintiff's policies.
On December 4, 2012, Plaintiff injured her back at work while assisting a heavy patient on and off an x-ray table. She immediately stopped working on December 5, 2012, because she was experiencing pain in her lower back and legs - pain that persists today. Plaintiff's doctors have diagnosed her with spondylotic disease of the thoracic spine and multilevel spondylotic disease of the lumbar spine and have concluded, after consulting with neurosurgeons, that Plaintiff's back problems are too severe for operation and that surgery would not likely yield any significant benefits.
Plaintiff alleges that she meets the Disability Plan's definition of "disabled, " but Lincoln refuses to extend long term disability benefits to her. Per the disability insurance policy, Plaintiff says she should have been provided with twenty-four months of benefits under the policy's "own occupation" definition for disability. During that period, Plaintiff said that she had a "total disability, " which is defined as an insured's inability to perform each of the main duties of her regular occupation. Following the passage of that twenty-four month period, Plaintiff claims she will remain totally disabled and eligible to receive additional benefits for her inability to work in any "gainful occupation, " which is defined as her ability to earn a certain amount of her pre-disability earnings. The Social Security Administration has deemed Plaintiff incapable of working in any occupation and has designated her disabled as of December 5, 2012.
Lincoln denied Plaintiff's first claim on March 18, 2013. Plaintiff alleges that Lincoln hired a third party to find a "reasonable" basis for denying the claim. She asserts that the third party misclassified her job as "light" even though her employer provided documentation showing that she performed heavy lifting. Plaintiff appealed the denial with the assistance of counsel and submitted additional evidence of her disabilities, but Lincoln denied the claim again on November 1, 2013. She appealed a second time, presenting years of medical record evidence to satisfy Lincoln, but Lincoln denied the claim a third time on July 9, 2014. She alleges that Lincoln concocted new reasons to deny the claim each time she appealed.
Plaintiff asserts that Lincoln is a Plan fiduciary charged with certain duties under ERISA and that Lincoln has breached several of its duties. She also alleges that Lincoln is a de facto Plan administrator, and that it failed to provide requested documents to her, pursuant to federal law, which supported its decisions to deny benefits. The complaint does not set out numbered counts against Defendants. Plaintiff seeks to recover "all benefits under the Plan to which she may be entitled, " "waiver of premium benefits under disability, life, accidental death and dismemberment or accident policies, " and "any other benefits available through [t]he Plan." (Doc. # 1, at ¶ 2.) Plaintiff further seeks an award of past benefits, prejudgment interest, costs and expenses including attorney's fees, a declaratory judgment concerning Plaintiff's entitlement to future benefits, and other injunctive relief. ( See Doc. # 1, at 17-18.) She requests, as an alternative form of relief, that the court "remove Lincoln from its fiduciary role in the administration of [t]he Plan(s), and to appoint a special master to substitute for [Lincoln]." (Doc. # 1, at 17-18.)
A. Failure to State Claims ...