United States District Court, N.D. Alabama, Southern Division
K. KALLON, UNITED STATES DISTRICT JUDGE
Allen filed this lawsuit against Hartford Life and Accident
Insurance Company, alleging violations of the Employee
Retirement Income Security Act of 1974 (“ERISA”),
29 U.S.C. 1101 et seq. Doc. 1. Allen contends that
Hartford wrongfully denied her long-term disability
(“LTD”) benefits due to its duplicative requests
for documentation, breach of fiduciary duty, bad faith,
conflict of interest, and inability to provide a full and
fail review. Id. at 5-18. Before the court is
Hartford's motion to dismiss, or in the alternative,
motion for summary judgment, doc. 7. The motion, which is
fully briefed, docs. 14 and 15, and which the court addresses
as one for summary judgment, is due to be granted.
LEGAL STANDARD FOR SUMMARY JUDGMENT
“the law is less clear as to what requirement governs
when considering dismissal for failure to exhaust
administrative remedies in an ERISA case, ” the
Eleventh Circuit has affirmed district courts' decisions
on ERISA claims and exhaustion requirements under both Rule
12(b)(6) and Rule 56 of the Federal Rules of Civil Procedure.
See, e.g. Davis v. Prudential Ins. Co. of Am., No.
2:14CV43-MHT, 2018 WL 3094885, at *2 (M.D. Ala. June 22,
2018) (affirming dismissal of ERISA claim for a failure to
exhaust under Rule 12(b)(6)) and Perrino v. S. Bell Tel.
& Tel. Co., 209 F.3d 1309, 1315 (11th Cir. 2000)
(same under Rule 56).
light of both parties submitting evidence and affidavits in
support of and opposition to Hartford's motion,
court considers this matter pursuant to the provisions of
Rule 56 of the Federal Rules of Civil Procedure. Day v.
Taylor, 400 F.3d 1272, 1276 (11th Cir. 2005) (“The
district court generally must convert a motion to dismiss
into a motion for summary judgment” once the court
looks at matters outside of the pleading). Under Rule 56(a)
of the Federal Rules of Civil Procedure, summary judgment is
proper “if the movant shows that there is no genuine
dispute as to any material fact and the movant is entitled to
judgment as a matter of law.” Fed.R.Civ.P. 56.
“Rule 56 mandates the entry of summary judgment,
after adequate time for discovery and upon motion, against a
party who fails to make a showing sufficient to establish the
existence of an element essential to that party's case,
and on which that party will bear the burden of proof at
trial.” Celotex Corp. v. Catrett, 477 U.S.
317, 322 (1986) (alteration in original). The moving party
bears the initial burden of proving the absence of a genuine
issue of material fact. Id. at 323. The burden then
shifts to the nonmoving party, who is required to “go
beyond the pleadings” to establish that there is a
“genuine issue for trial.” Id. at 324
(citation and internal quotation marks omitted). A dispute
about a material fact is genuine “if the evidence is
such that a reasonable jury could return a verdict for the
nonmoving party.” Anderson v. Liberty Lobby,
Inc., 477 U.S. 242, 248 (1986).
summary judgment motions, the court must construe the
evidence and all reasonable inferences arising from it in the
light most favorable to the non-moving party. Adickes v.
S. H. Kress & Co., 398 U.S. 144, 157 (1970); see
also Anderson, 477 U.S. at 255. Any factual disputes
will be resolved in the non-moving party's favor when
sufficient competent evidence supports the non-moving
party's version of the disputed facts. See Pace v.
Capobianco, 283 F.3d 1275, 1276, 1278 (11th Cir. 2002)
(a court is not required to resolve disputes in the
non-moving party's favor when that party's version of
events is supported by insufficient evidence). However,
“mere conclusions and unsupported factual allegations
are legally insufficient to defeat a summary judgment
motion.” Ellis v. England, 432 F.3d 1321, 1326
(11th Cir. 2005) (per curiam) (citing Bald Mountain Park,
Ltd. v. Oliver, 863 F.2d 1560, 1563 (11th Cir. 1989)).
Moreover, “[a] mere ‘scintilla' of evidence
supporting the opposing party's position will not
suffice; there must be enough of a showing that the jury
could reasonably find for that party.” Walker v.
Darby, 911 F.2d 1573, 1577 (11th Cir. 1990) (citing
Anderson, 477 U.S. at 252).
worked as an insurance claims adjuster for Infinity Property
and Casualty Corporation until 2017 when she stopped working
due to various medical ailments. Docs. 1; 13-1 at 59; 13-3 at
5-20. Thereafter, Allen applied in March 2017 for disability
benefits through Infinity's Hartford-sponsored policy.
Doc. 7-1. In April 2017, Hartford found Allen eligible for
short-term disability (“STD”) benefits, which it
deemed to be “not payable beyond June 28, 2017.”
Doc. 7-4. Sometime in June, Hartford began a concurrent
review of Allen's eligibility for LTD benefits and
notified Allen that this inquiry would require a separate
approval process. Id.
this period, the parties engaged in a flurry of
correspondence regarding requests for and supplements to
Allen's medical record. See docs. 7-1 through
7-14 and 13-1 through 13-5. Eventually, in September 2017,
Hartford informed Allen of its decision to terminate her LTD
benefits due to Allen's failure to provide proof of her
ongoing disability and her “lack of response and lack
of medical information.” Doc. 7-3 at 1. Hartford also
notified Allen that she may “perfect her claim”
by providing the necessary information, or “if [she is]
unable to or do[es] not wish to provide the requested
information, [she] may appeal submit an appeal of [the]
decision to the Appeal Unit.” Id. at 4-5.
Allen, through her attorney, contacted Hartford's Appeals
Unit in January 2018. The correspondence relayed Allen's
intent to revoke Hartford's access to the HIPAA
authorization she previously provided, her decision to appeal
the adverse LTD determination, and her submission of
additional medical information Hartford previously requested.
later, the Appeals Unit acknowledged receiving Allen's
letter and documents, but construed the submission as a
response to perfect the denied LTD claim. Consequently, the
Appeals Unit “forward[ed] [Allen's] letter and
attachments to the Maitland Claim Office” for further
evaluation of her claim in light of additional materials
which appeared in response to prior requests for
documentation. Doc. 7-6. Thereafter, Tameka Caldwell, a
senior disability analyst in the Maitland Claim Office, noted
the receipt of the documents included in “Allen's
request for an appeal, ” and requested additional
information from Allen, including past and present
neuropsychological exams, as well as medical records from Dr.
Aaron Fobian who had treated Allen since March 2017. Doc.
7-7. Allen's attorneys subsequently provided updated
medical records from various physicians, including Dr.
Fobian. Counsel also inquired about Hartford's delay in
reinstating Allen's benefits, contending that their
submission of additional documents fully addressed the
grounds for the denial of the claim. Doc. 13-2 at 41.
responded that it initially denied the LTD claim due to
incomplete records and that “an appeal is not necessary
at this time until a decision is made.” Doc. 7-8.
Hartford also informed counsel of the difficulties it had in
obtaining a “neuropsychological evaluation documented
in the medical records.” Doc. 7-8. Nearly a month
later, Hartford warned that it would make a determination on
the LTD claim based on the records it had received, which
might result in a denial, and inquired again about the
missing medical records, including past and present
neuropsychological exams and Dr. Fobian's mental health
records. Doc. 7-9. In response, Allen's attorneys sent
additional records they had recently received from Dr.
Fobian. Doc. 13-3 at 34. The submission proved incomplete,
however, causing Hartford to respond that Allen's LTD
claim remained under review because its clinical staff needed
Allen's neuropsychological exams. Id. at 45.
Hartford explained a few days later that while it understands
that Allen did not want to undergo a new neuropsychological
exam, it needed a copy of the 2016 exam. Doc. 7-10 at 1.
Counsel for Allen refused to provide the 2016
neuropsychological exam, stating that “it is not
relevant as to whether Ms. Allen is disabled as of the date
this benefit is to commence” and “precedes the
date of disability for the STD claim which was paid.”
Doc. 13-3 at 51. Counsel also explained that Allen would not
answer the request for more assessments and that they
expected to receive a timely determination on Allen's
Hartford requested a list of Allen's current treatment
providers, attending physician's statement, and
neuropsychological evaluation reports. Doc. 7-11 at 2.
Allen's attorneys responded with a request for
clarification on what additional information Hartford needed
to review the LTD claim. Doc. 13-3 at 56. The following day,
Hartford explained that it needed a list of Allen's past
and current treatment providers and that if Allen refuses to
provide the information, she “may submit an appeal to
the Appeals Unit at the time a decision is made based on the
information currently in the claim file.” Doc. 7-12.
Counsel for Allen responded that they had already provided a
list of Allen's medical providers. Doc. 13-3 at 61.
Roughly a month later, counsel expressed concern over the
“endless cycle” of document requests in the six
months since Allen submitted documentation for her LTD claim
and asked Hartford to explain why Allen should not file a
lawsuit. Id. at 62. The following day, Hartford
notified Allen that it “has completed [its] review of
her claim for benefits and [has] determined that [it is]
unable to complete [the] investigation. Because of this, [it]
must deny her claim.” Doc. 7-13 at 1. Hartford
explained that Allen may perfect her claim by providing the
necessary information or she may appeal the decision.
Id. at 5. Allen filed this lawsuit in response. Doc.
ERISA does not include an exhaustion requirement, the
Eleventh Circuit strictly enforces this requirement with
narrow exceptions for exceptional circumstances, such as
where the administrative scheme is unavailable, futile, or
fails to offer an adequate legal remedy. Perrino,
209 F.3d at 1315. Exhaustion is not excused even for
“technical violations of ERISA regulations that do not
deny plaintiffs meaningful access to an administrative remedy
procedure through which they may receive an adequate
remedy.” Id. at 1317. As the Circuit puts it,
“[a]dministrative claim-resolution procedures reduce
the number of frivolous lawsuits under ERISA, minimize the
cost of dispute resolution, enhance the plan's
trustees' ability to carry out their fiduciary duties
expertly and efficiently by preventing premature judicial
intervention in the decision-making process, and allow prior
fully considered actions by pension plan trustees to assist
courts if the dispute is eventually litigated.”
Mason v. Cont'l Grp., Inc., 763 F.2d 1219, 1227
(11th Cir. 1985). Consequently, “if a reasonable
administrative scheme is available to a plaintiff and offers
the potential for an adequate legal remedy, then a plaintiff
must first exhaust the administrative scheme before filing a
federal suit.” Id. Ultimately, the plaintiff
“must carry the burden of proof, demonstrating that
[s]he is entitled to recover under ERISA's civil