D'Iorio v. Winebow, Inc.

920 F. Supp. 2d 313, 55 Employee Benefits Cas. (BNA) 1418, 2013 WL 416313, 2013 U.S. Dist. LEXIS 15207
CourtDistrict Court, E.D. New York
DecidedJanuary 18, 2013
DocketNo. 12-CV-1205 (ADS)(ARL)
StatusPublished
Cited by4 cases

This text of 920 F. Supp. 2d 313 (D'Iorio v. Winebow, Inc.) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
D'Iorio v. Winebow, Inc., 920 F. Supp. 2d 313, 55 Employee Benefits Cas. (BNA) 1418, 2013 WL 416313, 2013 U.S. Dist. LEXIS 15207 (E.D.N.Y. 2013).

Opinion

MEMORANDUM OF DECISION AND ORDER

SPATT, District Judge.

On March 12, 2012, the Plaintiff Janet D’lorio (“the Plaintiff’) commenced this action by filing a Complaint against the Defendant Winebow, Inc. (“the Defendant”). The action seeks statutory, injunctive and equitable relief relating to the Defendant’s alleged breach of fiduciary duty for its failure to disclose plan documents and its affirmative and/or negligent misrepresentation of benefits under its long-term disability and life insurance plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). Specifically, the Plaintiff brings (1) a cause of action under ERISA § 502(c)(1), 29 U.S.C. § 1132(c)(1), for the Defendant’s alleged failure to provide or comply with a request for information by a participant or beneficiary, which a plan administrator is required to furnish and (2) a cause of action under ERISA § 502(a)(3), 29 U.S.C. § 1132(a)(3), to redress alleged violations by the Defendant of duties under ERISA.

Presently before the Court is a motion by the Defendant to dismiss the Plaintiffs Complaint in its entirety pursuant to Federal Rule of Civil Procedure (“Fed. R. Civ.P.”) 12(b)(6). For the reasons set forth below, the motion is denied in part and granted in part.

J. BACKGROUND

The following facts are derived from the Plaintiffs Amended Complaint, filed on March 12, 2012. In the resolution of this motion, the facts are construed in the light most favorable to the Plaintiff.

In 1997, the Plaintiff, a New York State resident, began working as a sales representative for the Defendant. The Complaint does not provide details as to the nature of the Defendant’s business, except to indicate that the Defendant is a corporation registered under New Jersey State law and has its primary place of business is located in New Jersey.

According to the Complaint, the Plaintiffs pay while working for the Defendant was based on 100% of the sales commissions she earned. In this regard, the Plaintiff received “a minimum draw amount” regardless of the amount of sales commissions she earned in a given pay period. (PI. Compl., ¶ 7.) However, in the event that the Plaintiffs sales commission did not meet this minimum draw amount, the difference was then subtracted from future sales commission earnings that were above the minimum draw amount.

In December 2008, the Defendant gave a PowerPoint presentation of the various welfare benefit plans offered by the Defendant to the Plaintiff and her co-workers. Included in this PowerPoint presentation was the Defendant’s long-term and life insurance plan through its new carrier, UNUM, effective as of January 1, 2009. In the PowerPoint presentation, the Defendant described the long-term disability policy benefits as “66 2/3% of monthly earnings to a maximum of $15,000 per month” and that “long-term disability benefits were to be ‘paid by [the Defendant] at no cost you [sic].” (PI Compl., ¶¶ 10, 11, internal alteration omitted.) In addition, the PowerPoint presentation represented that the Defendant’s life insurance policy [316]*316benefits were “ ‘lx annual earnings up to a maximum of $150,000’ and was ‘paid by [the Defendant] at no cost you [sic].” (PI. CompL, ¶ 12, internal alteration omitted.) Further, the Plaintiff alleges that the Defendant failed to furnish her with a copy of the required summary plan descriptions within 90 days after she became a participant in the plan.

In January 2010, the Plaintiff was seriously injured in a fall, which exacerbated her other medical conditions. The Complaint does not provide any further details about the Plaintiffs medical condition. In February 2010, she spoke with Erin McGinness (“McGinness”), a human resources representative for the Defendant, about disability leave and her benefits. McGinness advised the Plaintiff that she would have to first take a six-month short-term disability leave in order to become eligible for long-term disability. McGinness also advised the Plaintiff that her long-term disability benefits would be 66.66% of her income.

In mid-March 2010, the Plaintiff contacted McGinness and informed her that her last day would be at the end of the month. Thereafter, on April 5, 2010, the Plaintiff began a short-term disability leave.

In the beginning of September 2010, the Plaintiff contacted the Defendant about filling out her application for long-term disability benefits. By this time, McGinness was no longer employed by the Defendant, so the Plaintiff instead spoke with Nancy Duca (“Duca”), another human resource representative for the Defendant. Duca told the Plaintiff that her benefits would be based on income.

Also in September 2010, the Plaintiff filled out her required section of the long-term disability application; had her doctor complete his required section; and sent the application to UNUM along with an empty section, which was designated to be filled out by the Defendant. The Plaintiff called Duca to inform her that she had mailed the application to UNUM. Duca advised the Plaintiff that she had submitted the Defendant’s part of the application to UNUM and included as the Plaintiffs earning the amount of her W2s for 2008 and 2009, along with a statement of earnings for her three months of work in 2010. These W2s indicate that the Plaintiff earned $108,654.13 in 2008, $110,793 in 2009 and $44,000 for the three months she worked in 2010. Duca told the Plaintiff that her long-term disability benefits would be based on these figures. In addition, during this call, the Plaintiff requested a copy of the long-term disability policy. Duca directed the Plaintiff to contact UNUM for a copy.

On or about September 28, 2010, UNUM sent the Plaintiff a letter in which it requested copies of her medical records from her treating providers and earning information from her employer. The letter was written by Lynn Patton (“Patton”), a disability benefits specialist with UNUM. The Plaintiff contacted Patton to ask about her benefits. Patton told the Plaintiff about aspects of the long-term disability plan as to which the Plaintiff was allegedly never previously informed. These aspects included (1) that approval was not automatic and there was thus a chance benefits could be denied; (2) that approval varied and it could not be determined when benefits would begin; and (3) that the Plaintiffs benefits would only be $3,333.34 a month, which was based on 66.67% of her $60,000 “salary.” (PL CompL, ¶ 28.)

Subsequently, the Plaintiff had a teleconference with Duca and Michele Edelstein (“Edelstein”), the Vice President of Human Resources. Although Edelstein confirmed that the Plaintiffs application did not indicate that she earned $60,000, Edelstein reasoned that UNUM must have relied on the Plaintiffs draw amount of [317]*317$60,000. Edelstein stated that only this amount is covered under the long-term disability policy. According to the Plaintiff, since she “earned over $60,000 a year for over the past eight years,” she “could have increased her draw amount, but did not do so because she relied on [the Defendant’s] statements that benefits were calculated based on ‘earnings.’ ” (PI. Compl., ¶ 30.)

In November 2010, the Plaintiffs long-term disability benefits were approved.

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920 F. Supp. 2d 313, 55 Employee Benefits Cas. (BNA) 1418, 2013 WL 416313, 2013 U.S. Dist. LEXIS 15207, Counsel Stack Legal Research, https://law.counselstack.com/opinion/diorio-v-winebow-inc-nyed-2013.