Guest-Marcotte v. Life Ins. Co. of N. Am.
| Decision Date | 17 February 2016 |
| Docket Number | CASE NO. 15-CV-10738 |
| Parties | KIMBERLY J. GUEST-MARCOTTE, Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA, METALDYNE SALARY CONTINUATION PLAN, and METALDYNE POWERTRAIN COMPONENTS INC., Defendants. |
| Court | U.S. District Court — Eastern District of Michigan |
(Docs. 27, 35)
For the reasons stated below, it is recommended that the standard of review in this case is ARBITRARY AND CAPRICIOUS, Plaintiff's statement of procedural challenge (Doc. 27) be DENIED, and Plaintiff's motion to amend (Doc. 35) be GRANTED IN PART AND DENIED IN PART.
Plaintiff commenced this action on February 27, 2015, based on a denial of her claim for short-term disability ("STDs") under the Employee Retirement Income Security Act ("ERISA"). (Pl's Compl. Doc. 1.) Plaintiff's alleged disability that gives rise to her claim is based on her diagnosis of Ehlers-Danlos syndrome, a condition that affects the body's connective tissues. (Id. at ID 5.)
Plaintiff was employed at Defendant Metaldyne Powertrain Company ("Metaldyne") from July 2005 until November 22, 2013, as a Senior Risk Analysist. (Id. at ID 4.) Plaintiff's original complaint alleges that she was a participant in Metaldyne's Salary Continuation Plan ("Continuation Plan") governed by ERISA. (Id.) Plaintiff also alleges that Defendant Life Insurance Company of North America ("LICNA/CIGNA") was the plan administrator and fiduciary. (Id.) Plaintiff alleges that she became unable to continue her normal workload in June of 2013, due to her Ehlers-Danlos syndrome. Plaintiff applied for STDs under the Plan, relying on the testimony of Doctors Kadaj (primary) and Tinkle (expert in Ehlers-Danlos syndrome). (Id. at ID 5.) Plaintiff's claim was denied by Defendant LICNA/CIGNA in August of 2013, and her appeal was denied in November of 2013. (Id. at ID 6-7.) On November 22, 2013, Defendant Metaldyne terminated Plaintiff's employment based on documentation from Dr. Kadaj "which indicated that [she] remained unable to perform the essential functions of [her] position with or without a reasonable accommodation[,]" that she was "unlikely to recover fully/sufficiently to perform the functions of [her] position[,]" and that "the length of any leave would be indefinite in nature and a return to work was uncertain[.]" (Id. at ID 8.) Plaintiff notes the irony in the situation: (Doc. 1 at ID 7.)
Plaintiff filed her first complaint on February 27, 2015. (Doc. 1.) Pursuant to 28 U.S.C. § 636(b)(1)(A), (B) this matter was referred to the undersigned magistrate judge on April 1, 2015. (Doc. 9.) On August 5, 2015, this Court granted Defendant's motion to dismiss Count II of Plaintiff's original complaint, which alleged a violation of Michigan's Persons with Disabilities Civil Rights Act ("PWDCRA"). (Doc. 28.) Plaintiff filed a statement of procedural challenge on August 5, 2015. (Doc. 27.) Defendants filed a response on August 7, 2015. (Doc. 29.) The undersigned magistrate judge issued an order for supplemental briefing on October 7, 2015. Each party filed a supplemental brief (Docs. 31, 32) on October 22, 2015, and a response on October 29, 2015. (Docs. 33, 34.) On November 20, 2015, Plaintiff filed a motion for leave to file a First Amended Complaint. (Doc. 35.) Defendants filed a response on December 4, 2015. (Doc. 36.) Plaintiff filed a reply on December 11, 2015, (Doc. 37) and Defendants filed a sur reply on December 29, 2015. (Doc. 39.) The statement of procedural challenge and motion to amend are ready for report and recommendation without oral argument. See E.D. Mich. L.R. 7.1(f)(2). I will address Plaintiff's motion to amend before her statement of procedural challenge.
On January 22, 2015, Plaintiff requested "a copy of all plan documents related to her Short Term Disability plan and a copy of the entire claim file in this matter." (Doc. 35, at ID 768 (citing Doc 35 Exs. D, E).) Plaintiff's requests were specifically addressedto the "Metaldyne Salary Continuation Plan" and "CIGNA Group Insurance" and identified Plaintiff's incident number, plan number, the claim fiduciary, and the plan holder. (Id.) On February 20, 2015, LICNA/CIGNA responded to Plaintiff's request by disclosing 674 pages of material described as "copies of the policy information and copy of the claim file . . . ." (Id. at ID 769 (citing Doc. 35 Ex. F, at 837).) The Continuation Plan, upon which Plaintiff's original complaint relies, was included in that disclosure. (Doc. 35, Ex. F, at ID 838-63; Doc. 1, Ex. 3 at ID 23-48.) The footer and cover page of the Continuation Plan record an effective date of January 1, 2012. (Doc. 35, Ex. F, at ID 838-63.)
On October 22, 2015, Defendants filed a supplemental brief (Doc. 31) on Plaintiff's Statement of Procedural Challenge. (Doc. 30.) Attached to this brief were two exhibits the "Short Term Disability Income Plan of Metaldyne, LLC" (Doc. 35, Ex. B, at ID 798-814) and the "Short Term Disability Income Plan for the Employees of Metaldyne LLC." (Collectively "STD Plans") (Doc. 35, Ex. C, at ID 815-34.) Both documents have a plan effective date of January 1, 2012. (Doc. 35, Ex. B, at ID 798; Doc. 35 Ex. C, at ID 815.) They also include the following notation in the footer of each page "Copyright © 2001-2003 . . . Revised 10/2003." (Doc. 35, Exs. B, C.) The STD Plans state, "The Employer adopted, on the effective date above, a short term disability income plan . . . ." (Doc. 35, Ex. B, at ID 798.)
As a result of this disclosure, Plaintiff seeks to file an amended complaint which adds the Short Term Disability Income Plan of Metaldyne, LLC as a new Defendant, adds five new exhibits, and cleans up the complaint by removing Count II. (Doc. 35, atID 771.) Plaintiff also seeks to add Count III, which alleges that Defendants violated ERISA Section 104(b)(4), 29 U.S.C. Section 1024(b)(4) by failing to provide the STD Plans within thirty days of her January 22 request. (Doc. 35, at ID 770.) Plaintiff asserts that Defendants "knew or should have known" that the STD Plans were requested on January 22, 2015 "as one of the documents supporting its decision to deny benefits in this case." (Doc. 35, at ID 769 (citing Cultrona v. Nationwide Life Ins. Co., 748 F.3d 698, 708 (6th Cir. 2014)).) She argues that Defendants had "clear notice" that the STD Plans had been requested because she specifically requested the disability plan and its summary plan description and identified her plan number, incident number, the plan holder, and the claims fiduciary. (Doc. 35, at ID 769-70.) Plaintiff seeks penalties pursuant to ERISA Section 502(c)(1)(B), 29 U.S.C. Section 1132(c)(1)(B) and 29 C.F.R. Section 2575.502c-1.
When a party wishes to amend a pleading after the opposing party's responsive pleading has been served, it may only do so by leave of court or by written consent of the adverse party. Fed. R. Civ. P. 15(a). When a motion for leave to amend is before the court, Rule 15(a) provides that "leave shall be freely given when justice so requires." Id. "Although Rule 15(a) indicates that leave to amend shall be freely granted, a party must act with due diligence if it intends to take advantage of the Rule's liberality," United States v. Midwest Suspension & Brake, 49 F.3d 1197, 1202 (6th Cir. 1995), because, despite the Rule's liberality, leave to amend "is by no means automatic." Little v. Liquid Air Corp., 952 F.2d 841, 845-46 (5th Cir. 1992). The decision to grant or deny a motionto amend is left to the sound discretion of the district court. Robinson v. Michigan Consol. Gas Co., 918 F.2d 579, 591 (6th Cir. 1990).
When determining whether to grant leave to amend, the court is to consider several factors:
Undue delay in filing, lack of notice to the opposing party, bad faith by the moving party, repeated failure to cure deficiencies by previous amendments, undue prejudice to the opposing party, and futility of amendment are all factors which may affect the decision. Delay by itself is not sufficient reason to deny a motion to amend. Notice and substantial prejudice to the opposing party are critical factors in determining whether an amendment should be granted.
Head v. Jellico Hous. Auth., 870 F.2d 1117, 1123 (6th Cir. 1989) (quoting Hageman v. Signal L.P. Gas, Inc., 486 F.2d 479, 484 (6th Cir. 1973)). Courts may also consider whether the matters contained in the proposed amended complaint are unrelated to claims in the original complaint. Hestep v. Warren, 27 F. App'x 308, 309 (6th Cir. 2001). A proposed amendment is futile if the amendment could not withstand a Federal Rule of Civil Procedure 12(b)(6) motion to dismiss. See Thiokol Corp. v. Dep't of Treasury, 987 F.2d 376, 382-83 (6th Cir. 1993).
A motion to dismiss under Fed. R. Civ. P. 12(b)(6) tests the sufficiency of the complaint and will be granted if the plaintiffs have failed "to state a claim upon which relief can be granted." "The court must construe the complaint in the light most favorable to the plaintiff, accept all the factual allegations as true, and determine whether the plaintiff can prove a set of facts in support of its claims that would entitle it to relief." Bovee v. Coopers & Lybrand C.P.A., 272 F.3d 356, 360 (6th Cir. 2001). But the plaintiff must plead "enough facts to state a claim to relief that is plausible on its face," otherwisethe complaint will be dismissed. Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 570 (2007). The plausibility standard requires the plaintiff to "raise a right to relief above the...
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