Poisson v. Aetna Life Ins. Co.
| Decision Date | 21 September 2020 |
| Docket Number | Case No. SACV 20-1030JVS(DFMx) |
| Citation | 488 F.Supp.3d 942 |
| Parties | Joyce POISSON v. AETNA LIFE INSURANCE COMPANY |
| Court | U.S. District Court — Central District of California |
Sarah J. Demers, Glenn R. Kantor, Kantor and Kantor LLP, Northridge, CA, for Joyce Poisson.
Cindy Mekari Rucker, Maynard Cooper and Gale LLP, Los Angeles, CA, for Aetna Life Insurance Company.
Proceedings: [IN CHAMBERS] Order Regarding Motion to Dismiss
Defendant Aetna Life Insurance Company ("Aetna") filed a motion to dismiss the complaint of Plaintiff Joyce Poisson ("Poisson"). MTD, ECF No. 12. Poisson filed an opposition. Opp'n, ECF No. 19. Aetna filed a reply. Reply, ECF No. 20. With leave of Court, ECF No. 26, Poisson filed a sur-reply. Sur-reply, ECF No. 28.
For the following reasons, the Court DENIES the motion.
This cases arises from a tragic motorcycle accident on March 4, 2011. Compl., ECF No. 1, ¶ 5. In that accident, Walter Jones ("Jones") suffered severe trauma to his head
and face, resulting in serious, permanent brain damage. Id. Jones was an employee of Qlogic, and covered by Qlogic's employee benefits plan with Aetna (the "Plan"). Id. at ¶ 2. Following his accident, he applied for and received long-term disability benefits from June 3, 2011, until July 25, 2011. Id. at ¶ 6.
On July 24, 2011, Jones returned to work at Qlogic. Id. at 7. Despite returning to work, however, Jones was never able to fully resume the job responsibilities that he had prior to the accident. Id. at ¶ 9. Then, on March 9, 2014, Jones was informed that his employment was being terminated. Id. at 11.
Jones proceeded to initiate a long-term disability claim with Aetna on April 30, 2014. Id. at ¶ 12. Aetna then received an attending physician statement from Dr. Lawrence Chang stating that he was "uncertain about [Jones'] level of disability" in part because he was not Jones' treating physician prior to March 2014. Id. at ¶ 14. Aetna later denied Jones' long-term disability claim in a letter dated July 29, 2014. Id. at 19.
As the complaint recounts, Jones:
Id. at ¶ 20. Jones filed for Social Security Disability Insurance ("SSDI") on October 29, 2015, and underwent a psychological examination by Dr. Halimah McGee on January 12, 2016, which found that "Jones was not competent to manage funds on his own behalf and would require 24-hour care and supervision for the rest of his life." Id. at ¶¶ 21-22. From 2015 to 2019, Poisson, Jones' wife, "attempted to resolve her husband's benefit dispute with Aetna, but she was not legally authorized to act on his behalf." Id. at ¶ 24.
Finding no success, Poisson sought legal counsel starting in 2018. Id. at ¶ 25. Lawyers advised Poisson that she should seek a court order naming her as appointed conservator for Jones, a petition for which she filed on August 16, 2019. Id. at ¶ 26. Then, on March 19, 2020, Jones underwent a neurological consultation with Dr. Arthur Kowell, who concluded that "it is medically probable that the patient would not have been reliably competent in managing his legal and financial affairs since" the time of his motorcycle accident. Id. at ¶¶ 27, 28.
On June 8, 2020, Poisson filed the instant lawsuit. See generally id. Poisson has filed a claim under 29 U.S.C. § 1132(a)(1)(B) of the Employment Retirement Income Security Act of 1974 ("ERISA") for Jones' long-term disability benefits, enforcement and clarification of Jones' rights under the Plan, and clarification of Jones' rights. Id. at ¶¶ 31-36. Poisson also seeks in the alternative equitable relief requiring Aetna to "reopen its claim investigation and consider all relevant information" under 29 U.S.C. § 1132(a)(3). Id. at ¶¶ 37-43.
Under Rule 12(b)(6), a defendant may move to dismiss for failure to state a claim upon which relief can be granted. A plaintiff must state "enough facts to state a claim to relief that is plausible on its face." Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007). A claim has "facial plausibility" if the plaintiff pleads facts that "allow[ ] the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009).
In resolving a 12(b)(6) motion under Twombly, the Court must follow a two-pronged approach. First, the Court must accept all well-pleaded factual allegations as true, but "[t]hreadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice." Iqbal, 556 U.S. at 678, 129 S.Ct. 1937. Nor must the Court " ‘accept as true a legal conclusion couched as a factual allegation.’ " Id. at 678-80, 129 S.Ct. 1937 (quoting Twombly, 550 U.S. at 555, 127 S.Ct. 1955 ). Second, assuming the veracity of well-pleaded factual allegations, the Court must "determine whether they plausibly give rise to an entitlement to relief." Id. at 679, 129 S.Ct. 1937. This determination is context-specific, requiring the Court to draw on its experience and common sense, but there is no plausibility "where the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct." Id.
Before considering Aetna's arguments to dismiss, the Court first addresses whether it can take judicial notice of the Plan attached to the Montgomery declaration, see Plan, ECF No. 13, 6-41, and the letter from the California Department of Insurance attached to the Montgomery supplemental declaration. See DoI Letter, ECF No. 20-1, 6-7.
Because factual challenges have no bearing under Rule 12(b)(6), generally, the Court may not consider material beyond the pleadings in ruling on a motion to dismiss. Lee v. City of Los Angeles, 250 F.3d 668, 688 (9th Cir. 2001), overruled on other grounds, Galbraith v. Cnty. of Santa Clara, 307 F. 3d 1119, 1125 (9th Cir. 2002). There are, however, three exceptions to this rule that do not demand converting the motion to dismiss into one for summary judgment. Lee, 250 F.3d at 688. First, pursuant to Federal Rule of Evidence 201, the Court may take judicial notice of matters of public record, but it "cannot take judicial notice of disputed facts contained in such public records."
Khoja v. Orexigen Therapeutics, Inc., 899 F.3d 988, 999 (9th Cir. 2018), cert. denied sub nom. Hagan v. Khoja, ––– U.S. ––––, 139 S. Ct. 2615, 204 L. Ed. 2d 264 (2019) (citing Lee, 250 F.3d at 689 ); see Fed. R. Evid. 201(b). Second, the Court also may take judicial notice of documents attached to or "properly submitted as part of the complaint." Lee, 250 F.3d at 688. Third, if the documents are "not physically attached to the complaint," they may still be considered if the documents' "authenticity ... is not contested" and the documents are necessarily relied upon by the complaint. Id.; United States v. Corinthian Colleges, 655 F.3d 984, 998–99 (9th Cir. 2011). "However, if the document merely creates a defense to the well-pled allegations in the complaint, then that document did not necessarily form the basis of the complaint" and cannot be incorporated by reference. Khoja, 899 F.3d at 1002.
Poisson does not object to the court taking judicial notice of the Plan. Further, Plaintiffs refer to the Plan throughout the FAC. See FAC, ¶¶ 2, 6, 32-42. The Court therefore takes judicial notice of the Plan. The letter from the California Department of Insurance is not a matter of public record, nor is it attached to or relied upon in the complaint. Consequently, the Court declines to take judicial notice of the letter.
Aetna argues that Poisson's claim under 29 U.S.C. § 1132(a)(1)(B) is barred by a three-year limitations period in the Plan. MTD at 3-4. Courts will enforce a limitations period prescribed by an ERISA plan so long as the limitations period is reasonable. Heimeshoff v. Hartford Life & Acc. Life Ins., 571 U.S. 99, 105-06, 134 S.Ct. 604, 187 L.Ed.2d 529 (2013). The Supreme Court has held a three-year limitations period to be reasonable. Id. at 109, 134 S.Ct. 604. Under the terms of the Plan, "[n]o legal action can be brought to recover under any benefit after three years from the deadline for filing claims." Plan at 27. Under Heimeshoff, the Plan's limitations period is therefore valid.
The Plan further states that "[t]he deadline for filing a claim for benefits is 90 days after the end of the elimination period." Plan at 26. The elimination period, in turn, is defined as "[t]he first 90 days of a period of total disability." Plan at 9. Finally, "[a] period of total disability starts on the first day you are totally disabled as a direct result of a significant change in your physical or mental condition occurring while you are insured under this Policy." Plan at 19. Aetna deemed Jones' period of total disability as beginning on March 17, 2014, the date of Jones' visit to Dr. Chang following his end of employment with Qlogic. Compl. Ex. A at 14. Ninety days following March 17, 2014, was June 15, 2014. This means that the limitations period would have ended up on June 15, 2017, before the complaint in this lawsuit was filed on June 8, 2020. See Compl.
Poisson responds that the limitations period was equitably tolled because Jones has been mentally incompetent for the entire relevant period, and therefore the limitations period could not have started until Poisson was named as legal conservator on August 29, 2019. Opp'n at 10-11; see Compl. ¶ 30...
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