Howard v. Hartford Life & Accident Ins. Co. A/K/A Hartford Life D/B/A the Hartford

• Decision Date: 31 March 2011
• Docket Number: Case No. 3:10–cv–192–J–34TEM.
• Citation: 765 F.Supp.2d 1341
• Parties: Kimberly HOWARD, an individual, Plaintiff,v.HARTFORD LIFE & ACCIDENT INSURANCE COMPANY a/k/a Hartford Life d/b/a The Hartford, a corporation, Defendant.
• Court: U.S. District Court — Middle District of Florida

765 F.Supp.2d 1341

Kimberly HOWARD, an individual, Plaintiff,

v.HARTFORD LIFE & ACCIDENT INSURANCE COMPANY a/k/a Hartford Life d/b/a The Hartford, a corporation, Defendant.

Case No. 3:10–cv–192–J–34TEM.

United States District Court, M.D. Florida,Jacksonville Division.

March 31, 2011.

Alicia Paulino–Grisham, Maggie M. Smith, DI Law Group, Hollywood, FL, for Plaintiff.Jerel C. Dawson, William J. Gallwey, III, Shutts & Bowen, LLP, Miami, FL, for Defendant.

ORDER

MARCIA MORALES HOWARD, District Judge.

THIS CAUSE is before the Court on Defendant's Motion to Dismiss Improper ERISA Claims with Memorandum of Law in Support Thereof (Doc. No. 6; Motion) filed by Defendant Hartford Life and Accident Insurance Company (Defendant) on April 15, 2010. Plaintiff Kimberly Howard (Plaintiff) filed a response in opposition to the Motion on May 14, 2010. See Response in Opposition to Defendant's Motion to Dismiss Improper ERISA Claims (Doc. No. 9; Response). In addition, Plaintiff filed a notice of supplemental authority on January 6, 2011. See Notice of Supplemental Authority in Opposition to Defendant's Motion to Dismiss Improper ERISA Claims (Doc. No. 35; Notice). With the Court's permission, Defendant filed a reply in support of its Motion on June 21, 2010. See Defendant's Court–Authorized Reply Memorandum in Support of Motion to Dismiss Improper ERISA Claims (Doc. No. 13; Reply). Accordingly, this matter is ripe for disposition.

I. Background Facts ¹

In April of 2005, Plaintiff was an employee of Fidelity National Financial, Inc., where she held the position of Business Strategy Manager I. See Complaint at ¶¶ 5, 12, 13. During her employment, Plaintiff was a participant in the Fidelity National Financial, Inc. Group Benefit Plan (Plan), which Defendant insured and underwrote. See id. at ¶ 6. As a Plan participant, Plaintiff “is entitled to receive disability benefits under the Plan if she meets the definition(s) of disability.” Id. at ¶ 9. Under the Plan,

Disability or Disabled means that during the Elimination Period and for the next 24 months you are prevented by:

1. accidental bodily injury;

2. sickness;

3. Mental Illness;

4. Substance Abuse; or

5. pregnancy,

from performing one or more of the Essential Duties of Your Occupation, and as a result your Current Monthly Earnings are no more than 80% of your Indexed Pre-disability Earnings.

After that, you must be so prevented from performing one or more of the Essential Duties of Any Occupation....

Any Occupation means an occupation for which you are qualified by education, training, or experience, and that has an earnings potential greater than an amount equal to the lesser of the product of your Indexed Pre-disability Earnings and the Benefit Percentage and the Maximum Monthly Benefit shown in the Schedule of Insurance....

Essential Duty means a duty that:

1. Is substantial, not incidental;

2. Is fundamental or inherent to the occupation; and

3. Cannot be reasonably omitted or changed.

To be at work for the number of hours in your regularly scheduled workweek is also an Essential Duty.

Id. at ¶ 10. Pursuant to the terms of the Plan, a participant who becomes disabled is entitled to gross disability benefits equal to 60% of his or her monthly income, which in Plaintiff's case “yields a gross monthly disability benefit of $5,512.03, prior to the deduction of other income benefits which may reduce a claimant's benefits during the pendency of the claim.” Id. at ¶ 11.

Plaintiff became disabled on April 29, 2005, “due her [sic] medical condition which includes: Systemic Lupus Erythematosus (“SLE”), Fibromyalgia, Scheuermann's Disease, Bilateral Carpal Tunnel Syndrome, Cervical Degenerative Disc Disease, Asthma, chronic and severe headaches, and Left Shoulder Rotator Cuff Tear....” Id. at ¶ 13. As a result, Plaintiff applied for short-term disability benefits under the Plan, which Defendant approved on May 22, 2005. See id. at ¶ 14. On September 16, 2005, however, Defendant denied Plaintiff's “short-term disability benefits retroactively to on or about September 5, 2005.” Id. at ¶ 15. After an appeal by Plaintiff, Defendant overturned the denial, reinstating Plaintiff's short-term disability benefits. See id. at ¶ 16.

Plaintiff subsequently filed a “claim for long-term disability benefits under the Plan.” Id. at ¶ 17. Defendant approved her claim and began paying Plaintiff long-term disability benefits under the Plan in early November 2005. See id. At Defendant's insistence, Plaintiff subsequently applied for and was awarded Social Security Disability Benefits. See id. at ¶¶ 20–21. Defendant thereafter asserted that Plaintiff's Social Security Disability Benefits were an offset to her Plan benefits. See id. at ¶ 22. Accordingly, Defendant contended that it had overpaid Plaintiff's benefits under the Plan and demanded that Plaintiff immediately relinquish to Defendant the Social Security Disability Benefits that she had received in a lump sum. See id. Then, “on or about November 14, 2006, [Defendant] terminated [Plaintiff's] total disability benefit payment.” Id. at ¶ 23. Despite her timely appeal of this decision Defendant upheld its denial and its refusal to pay Plaintiff long-term disability benefits under the Plan. See id. at ¶ 24. Defendant has refused, since November 15, 2006, to pay Plaintiff benefits to which she is entitled under the Plan. See id. at ¶ 25.

II. Procedural History

On March 3, 2010, Plaintiff initiated this action by filing the Complaint pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq. See id. at ¶ 1. In the Complaint, Plaintiff asserts a single claim entitled “Action to Recover Plan Benefits, Enforce Rights Under the Plan & Clarify Entitlement to Plan Benefits Pursuant to 29 U.S.C. § 1132(a)(1)(B)” against Defendant. Id. at 6. In addition to requesting an award of benefits due under the Plan with interest, Plaintiff seeks a declaratory judgment and order for “Disgorgement of any profits or gain Defendant, HARTFORD, has obtained as a result of the wrongful action alleged in this Complaint and equitable distribution of any profits or gain to Plaintiff, MS. HOWARD.” Id. at 9. As noted above, Defendant filed the instant Motion on April 15, 2010, seeking dismissal of the requests for relief for disgorgement and equitable distribution of profits.

III. Standard of Review

In ruling on a motion to dismiss, the Court must accept the factual allegations set forth in the complaint as true. See Ashcroft v. Iqbal, –––U.S. ––––, 129 S.Ct. 1937, 1949, 173 L.Ed.2d 868 (2009); Swierkiewicz v. Sorema N.A., 534 U.S. 506, 508 n. 1, 122 S.Ct. 992, 152 L.Ed.2d 1 (2002); see also Lotierzo v. Woman's World Med. Ctr., Inc., 278 F.3d 1180, 1182 (11th Cir.2002). In addition, all reasonable inferences should be drawn in favor of the plaintiff. See Omar ex. rel. Cannon v. Lindsey, 334 F.3d 1246, 1247 (11th Cir.2003) (per curiam). Nonetheless, the plaintiff must still meet some minimal pleading requirements. Jackson v. BellSouth Telecomm., 372 F.3d 1250, 1262–63 (11th Cir.2004) (citations omitted). Indeed, while “[s]pecific facts are not necessary[,]” the complaint should “ ‘give the defendant fair notice of what the ... claim is and the grounds upon which it rests.’ ” Erickson v. Pardus, 551 U.S. 89, 93, 127 S.Ct. 2197, 167 L.Ed.2d 1081 (2007) (per curiam) (quoting Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007)). Further, the plaintiff must allege “enough facts to state a claim that is plausible on its face.” Twombly, 550 U.S. at 570, 127 S.Ct. 1955. “A claim has facial plausibility when the pleaded factual content allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Iqbal, 129 S.Ct. at 1949 (citing Twombly, 550 U.S. at 556, 127 S.Ct. 1955). The “plaintiff's obligation to provide the grounds of his entitlement to relief requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Twombly, 550 U.S. at 555, 127 S.Ct. 1955 (internal quotations omitted); see also Jackson, 372 F.3d at 1262 (explaining that “conclusory allegations, unwarranted deductions of facts or legal conclusions masquerading as facts will not prevent dismissal”) (internal citation and quotations omitted). Indeed, “the tenet that a court must accept as true all of the allegations contained in a complaint is inapplicable to legal conclusions,” which simply “are not entitled to [an] assumption of truth.” See Iqbal, 129 S.Ct. at 1949, 1951. Thus, in ruling on a motion to dismiss, the Court must determine whether the complaint contains “sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’ ” Id. at 1949 (quoting Twombly, 550 U.S. at 570, 127 S.Ct. 1955).

IV. Discussion

In the Motion, Defendant argues that dismissal of Plaintiff's requests for disgorgement of profits and equitable distribution is appropriate because Plaintiff has failed to state a claim upon which such relief can be granted. See generally Motion. Defendant asserts that such remedies are not available under 29 U.S.C. § 1132(a)(1)(B) (hereinafter § 1132(a)(1)(B)). See id. at 3. Defendant further asserts that such relief is not available in this instance pursuant to another provision of ERISA—29 U.S.C. § 1132(a)(3) (hereinafter § 1132(a)(3))—because Plaintiff has an adequate remedy under § 1132(a)(1)(B). See id. at 4. For her part, Plaintiff maintains that disgorgement of profits and equitable distribution are appropriate remedies under § 1132(a)(1)(B). See generally Response. In addition, Plaintiff appears to contend that because such relief is available pursuant to § 1132(a)(3), it is equally available to her in this action. See id. at 3–5.

In the Complaint, Plaintiff alleges a single claim against Defendant as Plan administrator ² pursuant to § 1132(a)(1)(B). See Complaint at 6. Under ...