United States District Court, M.D. Alabama, Southern Division
REPORT AND RECOMMENDATION
A. BAKER UNITED STATES MAGISTRATE JUDGE
Cantrice Gray, sues Defendant, Aetna Life Insurance Company,
(“Aetna”) in a single-count complaint seeking to
enforce her rights and recover benefits as the beneficiary to
supplemental life insurance benefits under a policy of group
life insurance issued by Aetna. (Doc. 1). All claims are
brought pursuant to the Employee Retirement Income Security
Act of 1974, as amended, 29 U.S.C. § 1001, et
seq. (“ERISA”). This matter is before the
Court on Aetna's motion to dismiss. (Doc. 11). Plaintiff
filed a response in opposition (Doc. 14) and Defendant
replied (Doc. 18). The court heard argument on August 7,
2018. For the reasons that follow, the Magistrate Judge
recommends that Aetna's motion to dismiss be
court has subject matter jurisdiction over this dispute
pursuant to 28 U.S.C. § 1331. Personal jurisdiction and
venue are not contested by the parties, and the court finds
sufficient basis in the record to support both. See
28 U.S.C. § 1391. On August 13, 2018, the above-styled
matter was referred for review and recommendation by United
States District Judge Emily C. Marks. (Doc. 24); see
also 28 U.S.C. § 636(b); Rule 72, Fed. R. Civ. P.;
United States v. Raddatz, 447 U.S. 667 (1980);
Jeffrey S. v. State Board of Education of State of
Georgia, 896 F.2d 507 (11th Cir. 1990).
BACKGROUND AND STATEMENT OF FACTS 
January 29, 2018, Plaintiff Cantrice Gray
(“Gray”) filed a Complaint against Defendant
Aetna under ERISA, claiming she is the beneficiary of
proceeds of a policy of insurance issued to Bennie Joe
Willis, Jr., who was employed by Performance Food Group, Inc.
(“PFG”) (Doc. 1). Subsequent to Willis' hire
by PFG, he requested Supplemental Life Insurance coverage in
the amount of $126, 000 under the group life insurance policy
made available to PFG employees through a benefit plan issued
by Aetna (“the Plan”). Id. ¶ 7.
Because the request was made more than sixty days after his
eligibility date, Aetna required Willis to submit evidence of
good health which he submitted via an Evidence of
Insurability Statement to Aetna on December 22, 2014.
Id. ¶ 8. Aetna approved the application and
issued the Supplemental Life Insurance coverage under the
Plan effective on January 1, 2015. Id. Gray alleges
that while the Supplemental Life Insurance coverage was in
force, Willis died from injuries sustained in an automobile
accident on January 5, 2016. Id. ¶ 9.
paid benefits to Gray in the amount of $42, 129.05 under the
Basic Life Coverage of the Policy and $178, 000 under the
Accidental Life Insurance Coverage of the Policy.
Id. ¶ 12. Gray demanded Aetna pay the
Supplemental Life insurance benefits under the policy, but
Aetna denied Gray's claim on May 9, 2017. Id.
¶¶ 11, 13. Gray attaches to her Complaint a copy of
the May 9, 2017 letter from Aetna to her denying her claim
for Supplemental Life insurance benefits. (Doc. 1-1). Based
on Aetna's review of Willis' medical records, Aetna
concluded that full disclosure did not occur on the Evidence
of Insurability submitted by Willis with his application for
insurance. Id. at 4. Aetna states that had his
medical conditions been disclosed, his application for
Supplemental Life insurance benefits would have been denied
under its Medical Underwriting guidelines. Id. The
letter advised that in order to have the denial reviewed, the
written request seeking review “must be mailed or
delivered within 60 days following receipt of this
explanation.” Id. at 5.
October 5, 2017, Gray, through counsel, challenged the denial
of her benefits and requested information from Aetna. (Doc.
1, ¶ 14). She attaches a copy of the October 5 letter to
her complaint. (Doc. 1-2). On October 19, 2017, Aetna
requested a signed authorization in order to release
Willis' medical records. (Doc. 1, ¶ 15). Gray's
counsel forwarded the signed authorization on October 27,
2018. Id. ¶ 16. Gray alleges that Aetna did not
respond to her lawyers' letters of October 5 and 27, nor
did it provide the requested information. Id. ¶
18. She asserts that Aetna violated the Plan and the ERISA
statute in failing to review her claim on appeal.
Id. ¶ 19. She alleges she has exhausted all of
her claim remedies or exhaustion is otherwise futile.
Id. ¶ 21.
single-count complaint, she seeks to enforce her rights under
the Plan as regulated by ERISA. (Doc. 1). She alleges that
Aetna's actions in denying her benefits was wrongful and
she seeks $126, 000 in Supplemental Life insurance benefits,
interest on past due benefits, and any other relief
available. Id. ¶¶ 22-28.
moves to dismiss Gray's complaint for failure to timely
appeal and exhaust her administrative remedies. (Doc.
Aetna contends that Gray's claim is barred for failing to
timely appeal the denial of her claim. It further asserts
that her arguments of futility and that her claim should be
deemed exhausted do not otherwise save her claim.
response, Gray submits that the court has discretion to
determine whether to apply the exhaustion requirement. (Doc.
14 at 2). Where, as here, Aetna controlled the Plan documents
and denied Gray access to them, she argues the court should
exercise its discretion to not require the exhaustion
requirement be met given she was denied meaningful access to
the Policy's procedures and Aetna's basis for denial
of her claim. Id. at 8-14.
STANDARD OF REVIEW
Rule of Civil Procedure 8 provides that a complaint must
contain “a short and plain statement of the claim
showing that the pleader is entitled to relief.”
Fed.R.Civ.P. 8(a)(2). The pleader must allege “enough
facts to state a claim to relief that is plausible on its
face.” Bell Atl. Corp. v. Twombly, 550 U.S.
544, 570 (2007). “[D]etailed factual allegations”
are not required, but mere “labels and
conclusions” or “a formulaic recitation of the
elements of a cause of action” are not enough.
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). On a
motion to dismiss under Federal Rule of Civil Procedure
12(b)(6), a court “accept[s] the allegations in the
complaint as true and constru[es] them in the light most
favorable to the plaintiff.” Hill v. White,
321 F.3d 1334, 1335 (11th Cir. 2003).