O'Dell v. Sun Life Assurance Co.
| Decision Date | 03 February 2021 |
| Docket Number | Case No. 2:20-cv-2098 |
| Parties | KELLEY A. O'DELL, Plaintiff, v. SUN LIFE ASSURANCE COMPANY OF CANADA, et al., Defendant. |
| Court | U.S. District Court — Southern District of Ohio |
OPINION & ORDER
This matter is before the Court on Defendant Huntington BancShares Inc.'s Motion for Judgment on the Pleadings (ECF No. 18) and Defendant Sun Life Assurance Company of Canada's Motion for Judgment on the Pleadings (ECF No. 23). For the reasons set forth below, both Motions are GRANTED.
This case arises from a complaint filed by Plaintiff Kelley A. O'Dell on April 24, 2020 against Sun Life Assurance Company of Canada ("Sun Life") and Huntington BancShares Inc. Group Health and Welfare Plan ("Huntington"),1 in which Plaintiff brought claims under ERISA concerning her claim for disability benefits. (ECF No. 1). On July 8, 2020, Plaintiff filed her amended complaint, pleading three claims related to the denial of her long-term disability benefits claim and subsequent non-disclosure of requested documents by the Defendants. (ECF No. 10). Ms. O'Dell worked as a Relationship Banker III for Huntington and was eligible for long-term disability benefits under the company's employee welfare benefit plan ("the Plan"). (Id. ¶¶ 1, 12-13). Under the Plan, Defendant Huntington is designated as the Plan Administrator and Defendant Sun Life administered the plan, making the determinations as to whether individuals qualified for benefits. (Id. ¶¶ 2-4). During the course of her employment, Ms. O'Dell alleges she took both short-term disability and Family and Medical Leave Act ("FMLA") leave related to symptoms of undiagnosed Hashimoto's Encephalopathy. (Id. ¶¶ 15-18). On or about March 14, 2019, Ms. O'Dell stopped working completely because of her disability and applied for long-term disability benefits with Sun Life, the insurer of her Plan's disability benefits. (Id. ¶¶ 2, 19-20). Because she had not yet met her Elimination Period under the Plan, Sun Life began this period on March 15, 2019. (Id. ¶¶ 21-22). On or about October 9, 2019, Sun Life denied the Plaintiff's claim for long-term disability benefits because she had not sufficiently demonstrated that she was "totally disabled" within the meaning of the policy. (Id. ¶ 23; see also ECF No. 10-1). After receiving the claim denial, Ms. O'Dell, through counsel, made three separate requests to Sun Life for her administrative claim file on October 25, 2019, November 14, 2019, and December 29, 2019. (Id. ¶¶ 24-25). On February 24, 2020, Ms. O'Dell "submitted a request for her administrative claim file to Huntington." (Id. ¶ 27). Ms. O'Dell alleges that she received no response from either Sun Life or Huntington to any of these requests. (Id. ¶¶ 25-26).
Ms. O'Dell then filed this lawsuit on April 24, 2020. Counts I and II concern Sun Life's consideration and eventual denial of Plaintiff's disability benefits claim. (Id. ¶¶ 31-52). In Count III, Ms. O'Dell brings a claim under 29 U.S.C. § 1132 for statutory penalties in the amount of $110 per day for a refusal to supply requested information in accordance with federal law. (Id. ¶¶ 53-59). Ms. O'Dell seeks the imposition of these penalties against both Sun Life and Huntington, in relation to her requests for her complete administrative claim file. (Id.). Both Defendants filed answers to her Amended Complaint. (ECF Nos. 12, 14).
On September 24, 2020, Defendant Huntington filed a Motion for Judgment on the Pleadings as to Count III pursuant to Federal Rule of Civil Procedure 12(c). (ECF No. 18). Huntington argues that, as the Plan Administrator, it is only subject to a statutory penalty under the narrow circumstances indicated in 29 U.S.C. § 1024(b)(4). Huntington contends that, under Section 1024(b)(4), it is only obligated to provide the Plaintiff with a limited set of plan documents, which do not include claim documents or any documents "used in the ministerial day-to-day processing of individual claims." (Id. at 6). Huntington argues that Ms. O'Dell's request for her "complete administrative claim file" was not a request for any of the specified plan documents and so it was under no duty to provide any documents to her. (Id. at 7). Huntington attached a copy of Ms. O'Dell's February 2020 request as an exhibit to its Motion and argues that consideration of the letter is proper because the document is referred to in Ms. O'Dell's pleadings and is integral to the Plaintiff's claim. (Id. at 5; see also ECF No. 18-1). Huntington also claims that Ms. O'Dell's letter did not provide "clear-notice" that she was seeking plan documents and that the plan document cannot be considered a "key document" at the center of the claim denial decision. (ECF No. 18 at 8-11). Because the documents requested do not fall within the ambit of 29 U.S.C. § 1024(b)(4), Huntington argues that its failure to disclose these documents cannot give rise to statutory penalties.
On October 10, 2020, Ms. O'Dell filed her Response in Opposition to Huntington's Motion. (ECF No. 22). In her response, she urged this Court to deny the Rule 12(c) Motion or, alternatively, to convert it to a partial motion for summary judgment under Rule 12(d) to be granted in her favor. (Id.). Plaintiff argues that Huntington is liable for the statutory penalty under Section 1132(c) because it wholly failed to respond to her inquiry and was required to produce documents within the scope of 29 U.S.C. § 1024(b)(4) after her request. (Id. at 8-9). Ms. O'Dell contends thatthe disability insurance policy was the key document surrounding her disability insurance claim and her request satisfied the clear-notice test. (Id. at 9).
On October 26, 2020, Huntington filed its Reply, reiterating that the letter may be considered under Rule 12(c) without converting the Motion to one for partial summary judgment, that the letter did not meet the clear-notice standard, and that it cannot be liable for statutory penalties as a result. (ECF No. 22). Huntington also suggests that the proper vehicle for the Plaintiff's claims about her ignored requests is her Section 502(a)(1)(B) claim for benefits, which is not the subject of its Motion for Judgment on the Pleadings. (Id. at 10).
Defendant Sun Life also filed a Motion for Judgment on the Pleadings under Rule 12(c) pertaining to Count III on October 13, 2020. (ECF No. 23). Sun Life's argument concerning Section 1132(c) statutory penalties is two-fold. First, Defendant Sun Life argues that only plan administrators are liable for per diem penalties, and because it is an insurance company, there is no statutory authority to impose these penalties against it. (Id. at 5-6). Second, Sun Life raises a similar argument to Defendant Huntington: the request for the "administrative claim file" does not fall into any of the document types required to be produced under Section 1024(b)(4). (Id. at 6). Sun Life included in its filing the three requests that it received from Ms. O'Dell and argues that this Court may consider these items because the documents were referenced in Ms. O'Dell's pleadings and are integral to the Plaintiff's claim. (Id. at 4 n.4; see also ECF No. 23-1). Defendant Sun Life also notes that Ms. O'Dell has other avenues to litigate the issue of Sun Life's delayed response, namely, her Section 502(a)(1)(B) claim for benefits. (Id. at 7-8).
On November 2, 2020, Plaintiff O'Dell filed a response in opposition to Sun Life's Motion. (ECF No. 25). Ms. O'Dell argues that it is not "absolute" under Sixth Circuit case law that only a plan administrator can be assessed penalties under 29 U.S.C. § 1132(c). (Id. at 3). In support ofthis argument, Plaintiff suggests that two leading cases for the proposition that only plan administrators are subject to per diem penalties, VanderKlok v. Provident Life & Accident Insurance Co., 956 F.2d 610 (6th Cir. 1992), and Hiney Printing Co. v. Branter, 243 F.3d 956 (6th Cir. 2001), are distinguishable from the case sub judice. (Id.). Finally, Plaintiff suggests that Sun Life can be treated as a de facto plan administrator under a theory of equitable estoppel. (Id. at 6).
On November 13, 2020, Sun Life filed a Reply in support of its Motion. (ECF No. 26). In its Reply, Defendant Sun Life notes that all parties agree that Defendant Huntington is the plan administrator. (Id. at 3). Sun Life then emphasizes that the Sixth Circuit has consistently held that only plan administrators can be subject to statutory penalties under Section 1132(c). (Id.). Sun Life further argues that Plaintiff's theory of a de facto plan administrator has been dismissed by the Sixth Circuit and insurance companies cannot be subject to statutory penalties for failures to comply with information requests. (Id. at 3-5). Defendant Sun Life concludes its Reply by noting that Plaintiff has not asserted a claim for promissory estoppel in her Complaint, and that one would fail as a matter of law if it had been raised. (Id. at 7-8).
When a motion for judgment on the pleadings under Federal Rule of Civil Procedure 12(c) is based on the argument that the complaint fails to state a claim upon which relief may be granted, the Court employs the same legal standard as a Rule 12(b)(6) motion. Morgan v. Church's Fried Chicken, 829 F.2d 10, 11 (6th Cir. 1987) (). The Court will grant the Rule 12(c) motion "when no material issue of fact exists and the party making the motion is entitled to judgment as a matter of law." JPMorgan Chase Bank, N.A. v. Winget, 510 F.3d 577, 582 (6th Cir. 2007) (quoting Paskvan v. City of Cleveland Civil Serv.Comm'n, 946 F.2d 1233, 1235 (6th Cir. 1991)). When a party moves for judgment on the pleadings, the Court must construe "all well-pleaded material allegations of the pleadings of the...
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