McLaughlin v. Unum Life Ins. Co. of America, No. 02-67-P-S.

• Decision Date: 08 October 2002
• Docket Number: No. 02-67-P-S.
• Citation: 224 F.Supp.2d 283
• Parties: Elizabeth A. MCLAUGHLIN, Plaintiff v. UNUM LIFE INSURANCE COMPANY OF AMERICA, Athena Neurosciences Inc. Long Term Disability Plan, Defendants
• Court: U.S. District Court — District of Maine

224 F.Supp.2d 283

Elizabeth A. MCLAUGHLIN, Plaintiff v. UNUM LIFE INSURANCE COMPANY OF AMERICA, Athena Neurosciences Inc. Long Term Disability Plan, Defendants

No. 02-67-P-S.

United States District Court, D. Maine.

October 8, 2002.

COPYRIGHT MATERIAL OMITTED

Charles W. March, Esq., Reben, Benjamin, & March, Portland, ME, Daniel Feinberg, Esq., Teresa S. Renaker, Esq., Lewis & Feinberg, PC, Oakland, CA, for Elizabeth A McLaughlin, plaintiff.

Geraldine G. Sanchez, Esq., Pierce, Atwood, Portland, ME, Mark A. Casciari, Esq., Seyfarth, Shaw, Fairweather & Geraldson, Chicago, IL, Melinda J. Caterine, Esq., Moon, Moss, McGill, Hayes & Shapiro, P.A., Portland, ME, Daniel B. Klein, Esq., Seyfarth Shaw, Boston, MA, for UNUM Life Insurance Company of America, Athena Neurosciences Inc Long Term Disability Plan, defendants.

ORDER GRANTING THE MOTION TO DISMISS

SINGAL, District Judge.

Plaintiff has brought an action against her employee welfare benefit plan and her long term disability insurer to: 1) recover benefits due to her under the plan, 2) enforce her rights under the plan, and 3) clarify her right to future benefits under the plan. Presently before the Court is Defendant UNUM Life Insurance Company of America's ("UNUM") Motion to Dismiss (Docket # 4). For the reasons discussed below, the Court GRANTS Defendant's Motion to Dismiss.

I. STANDARD OF REVIEW

When evaluating a motion to dismiss under Rule 12(b)(6), the court takes the well-pleaded facts as true and draws all reasonable inferences in the plaintiff's favor. Gorski v. N.H. Dep't of Corr., 290 F.3d 466, 473 (1st Cir.2002). A defendant is entitled to dismissal only if it appears to a certainty that the plaintiff would be unable to recover under any set of facts. Correa-Martinez v. Arrillaga-Belendez, 903 F.2d 49, 52 (1st Cir.1990). Nonetheless, granting a motion to dismiss based on a limitations defense is appropriate when the pleader's allegations leave no doubt that an asserted claim is time-barred. LaChapelle v. Berkshire Life Ins. Co., 142 F.3d 507, 509 (1st Cir.1998).

Ordinarily, a court may not consider any documents beyond the complaint, or not expressly incorporated therein when addressing a motion to dismiss, unless the motion is converted into one for summary judgment. Alternative Energy, Inc. v. St. Paul Fire and Marine Ins. Co., 267 F.3d 30, 33 (1st Cir.2001). Courts may, however, consider outside material when the complaint relies upon documents whose authenticity is not challenged. Id. Such documents "merge[] into the pleadings" and the court may properly consider them under a Rule 12(b)(6) motion to dismiss. Beddall v. State Street Bank and Trust, Comp., 137 F.3d 12, 17 (1st Cir.1998).

Here, Plaintiff's Complaint refers to the Policy at issue and relies, in part, on several letters exchanged by the parties to assert the date upon which the claim was officially denied. The Court considers these documents to have "merged" into the pleadings for the purposes of evaluating the Defendant's Motion to Dismiss.

II. BACKGROUND

Plaintiff, Elizabeth McLaughlin ("McLaughlin"), is a former employee of Athena Neurosciences, Inc. ("Athena") who suffers from Chronic Fatigue Syndrome ("CFS")¹ and Fibromyalgia.² As an employee of Athena, McLaughlin was a participant in Athena's long-term disability plan ("Plan"). UNUM issued and administered a long-term disability policy to the Plan ("Policy").

In or about May 1994, McLaughlin filed a claim for long term disability benefits with UNUM. By letter dated August 16, 1994, UNUM granted McLaughlin's request for long term disability benefits under the Plan effective July 13, 1994. UNUM decided, however, that McLaughlin's claim fell within the insurance policy's mental illness limitation, which provided that UNUM would pay no more than twenty-four months of benefits for any disability due to "mental illness."³

McLaughlin repeatedly challenged UNUM's classification of her disability as a mental illness by submitting records of her physical problems. UNUM, however, maintained its classification of McLaughlin's disability and, thereby, discontinued McLaughlin's long term disability benefits under the Plan effective July 13, 1996.

In response, McLaughlin, requested a review of this denial by letter dated August 5, 1996. In her letter, McLaughlin again explained that CFS and Fibromyalgia are physical disorders, but that her disabled condition caused her to suffer some secondary depression. By letter dated August 7, 1996, however, UNUM officially denied McLaughlin's claim.

McLaughlin maintains she remains physically disabled under the terms of the Plan. To date, UNUM has not paid McLaughlin's disability benefits for any period after July 1996. McLaughlin, therefore, brings this single count complaint against UNUM and the Plan alleging that UNUM violated her rights under 29 U.S.C. § 1132(a)(1)(B). In response, UNUM moves to dismiss asserting that McLaughlin's ERISA claim for long-term disability benefits is time-barred.

III. DISCUSSION

A. The Employee Retirement Security Act of 1974

The Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 et seq. (1999), was enacted because Congress intended employee benefit plans to be an exclusively federal concern. Lugo v. AIG Life Ins. Co., 852 F.Supp. 187, 190 (S.D.N.Y.1994). ERISA comprehensively regulates, among other things, employee welfare benefit plans that "provide medical, surgical, or hospital care, or benefits in the event of sickness, accident, disability, or death." § 1002(1); Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 44, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987). The goal of ERISA is "to provide uniform, national regulation of benefit plans." Aetna Life Ins. Co. v. Borges, 869 F.2d 142, 147 (2d Cir.1989).

ERISA has six civil enforcement provisions. Mass. Mut. Ins. Co. v. Russell, 473 U.S. 134, 146, 105 S.Ct. 3085, 87 L.Ed.2d 96 (1985). Plaintiff's cause of action arises under 29 U.S.C. § 1132(a)(1)(B).⁴ ERISA does not contain a statute of limitations for suits brought under this provision. Nazario Martinez v. Johnson & Johnson Baby Prod., 184 F.Supp.2d 157, 159 (D.P.R.2002) (citing Harrison v. Digital Health Plan, 183 F.3d 1235, 1238 (11th Cir.1999)). In such a situation, a federal court generally applies the "most analogous" statute of limitations from the jurisdiction where it sits, as long as the limitations period is not inconsistent with federal law or policy. Id. (citing Wilson v. Garcia, 471 U.S. 261, 266, 105 S.Ct. 1938, 85 L.Ed.2d 254 (1985)); see also Wang Labs., Inc. v. Kagan, 990 F.2d 1126, 1128 (9th Cir.1993) (stating that in an ERISA action, federal courts ordinarily borrow the forum state's statute of limitations so long as application of the state statute's time period does not impede the effectuation of federal policy).

B. Statute of Limitations

The parties agree that Maine's six-year statute of limitations for all civil actions applies to this case.⁵ Maine's six-year statute of limitations provides, in relevant part, that "[a]ll civil actions shall be commenced within six years after the cause of action accrues and not afterwards." 14 M.R.S.A. § 752 (1996).

Despite looking to state law to determine the applicable time period, federal courts look to federal law to determine the time at which a plaintiff's federal claim accrues. Bolduc v. Nat'l Semiconductor Corp., 35 F.Supp.2d 106, 118-119 (D.Me.1998) (citing Maggio v. Gerard Freezer & Ice Co., 824 F.2d 123, 127 (1st Cir.1987)). In an ERISA case, federal courts apply the "discovery rule" to determine when a plaintiff's ERISA claim accrues. Union Pac. R.R. Co. v. Beckham, 138 F.3d 325, 330 (8th Cir.1998). Consistent with the "discovery rule," the general rule in an ERISA action is that a cause of action accrues after a claim for benefits has been made and formally decided. Id. An exception exists, however, when there has been a clear and unequivocal repudiation of the employee's claim for benefits, which has been made known to the beneficiary. Id. at 330-331. In such cases, a claim under ERISA accrues before a formal denial has been issued and even before a claim for benefits is filed. Id.

In light of Bolduc and Beckham, Defendant argues Plaintiff's cause of action accrued in August 1994, when Defendant approved Plaintiff's claim for benefits and also informed her that her claim was classified as a mental illness subject to a maximum of twenty-four months of benefits. It was at this point, Defendant argues, that Plaintiff first "discovered" that her disability benefits were going to be denied after twenty four months.

In response, Plaintiff argues the statute of limitations did not begin to run until UNUM officially denied Plaintiff's claim in August 1996. Plaintiff argues Defendant's August 1994, letter cannot be construed as a claim denial letter because it does not contain the information required under the Department of Labor regulations issued pursuant to ERISA Section 1133.⁶

Furthermore, Plaintiff argues this case is distinguishable from cases like Bolduc and Beckham. Plaintiff argues the courts in both Bolduc and Beckham used the date of unequivocal repudiation as the accrual date for the statute of limitations because the claimant in each of those cases never filed a claim for employee benefits, and therefore, no formal denial date could be used as the start of the limitations period. Here, because Plaintiff made a formal claim, Plaintiff argues it would be inappropriate to apply the "narrow exception" discussed in Bolduc and Beckham.

As Defendant states, however, Plaintiff's argument points to a "distinction without a difference." (See Def.'s Reply Mem. in Supp. of Mot. to Dismiss at 13 (Docket # 8).). Regardless of whether the Bolduc and Beckham plaintiffs actually filed a claim for benefits, the significance of the court's holding in those cases is that a cause of action is deemed to have accrued whenever the claimant first learned of her...