Dunnigan v. Metropolitan Life Insurance

214 F.R.D. 125, 30 Employee Benefits Cas. (BNA) 1079, 2003 U.S. Dist. LEXIS 2, 2003 WL 23109
CourtDistrict Court, S.D. New York
DecidedJanuary 2, 2003
DocketNo. 99 Civ. 4059(SAS)
StatusPublished
Cited by49 cases

This text of 214 F.R.D. 125 (Dunnigan v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dunnigan v. Metropolitan Life Insurance, 214 F.R.D. 125, 30 Employee Benefits Cas. (BNA) 1079, 2003 U.S. Dist. LEXIS 2, 2003 WL 23109 (S.D.N.Y. 2003).

Opinion

OPINION AND ORDER

SCHEINDLIN, District Judge.

I. INTRODUCTION

Helen Dunnigan is a beneficiary of a long-term disability (“LTD”) insurance policy issued by Metropolitan Life Insurance Company (“MetLife”). Dunnigan brings this action [128]*128on behalf of herself and all other similarly situated participants of a MetLife disability policy, pursuant to the Employment Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., to recover interest on disability benefit payments received retroactively from MetLife. Dunni-gan claims that MetLife’s delay in payment of those benefits' deprived recipients of the time value of their money.

In November 1999, MetLife moved to dismiss the complaint, arguing that claims for interest on delayed benefits cannot be maintained under ERISA. On March 8, 2000, this Court held that interest on delayed plan payments may be sought under section 502(a)(3)(b) of ERISA, which permits beneficiaries to seek equitable relief for plan violations, but that Dunnigan had not alleged an essential element of a claim under that section — bad faith — and therefore failed to assert a claim upon which relief could be granted. See Dunnigan v. Metropolitan Life Ins. Co., 99 F.Supp.2d 307, 323 (S.D.N.Y.2000), vacated, 277 F.3d 223 (2d Cir.2002). This Court further held that any such action requires an individualized assessment of the facts and equities surrounding each claim and thus cannot be maintained on behalf of a class of plaintiffs. See id. at 325-26.

The Second Circuit affirmed this Court’s ruling that claims for recovery of interest may be brought under section 502(a)(3)(b), but held that plaintiff need only allege that her payments were “unreasonably delayed” — not that the insurer acted in “bad faith” — to state a claim for equitable relief under this section. See Dunnigan, 277 F.3d at 229-30. As a result, the Second Circuit vacated this Court’s dismissal of Dunnigan’s claims and denial of class certification, and remanded for reconsideration of the issue of class certification, to which it “intimate[d] no view.” Id. at 231-32.

In response to the Circuit’s decision, Dun-nigan amended her class action complaint and now moves to certify, pursuant to Rule 23(b)(3) of the Federal Rules of Civil Procedure, a class consisting of all beneficiaries of an LTD plan- insured by MetLife, whose claims for benefits were approved more than ninety days after they were submitted and who did not receive written notice of “special circumstances” requiring an extension of time to render a determination. Dunnigan makes several creative arguments, drawing on other areas of the law, to convince this Court that the claims of the putative class members present a common theory of liability that outweighs individual issues.

For the reasons set forth below, the assessment of the reasonableness of MetLife’s delay, like the analysis of whether MetLife acted in bad faith, cannot be adjudicated on a class-wide basis, without evaluation of the unique facts and circumstances of each class member’s individual claim. Accordingly, Dunnigan’s motion for class certification is again denied.

II. FACTUAL BACKGROUND

A. LTD Plan Provisions

Deloitte & Touche (“Deloitte”) provides its employees with LTD benefits through a plan issued by MetLife (the “Deloitte Plan” or the “Plan”). See Second Amended Class Action Complaint (“SAC”), Ex. A to Affirmation of Scott M. Riemer, plaintiffs attorney (“Riemer Aff.”), ¶ 4. The Deloitte Plan is an employee welfare benefit plan within the meaning of section 3(1) of ERISA, 29 U.S.C. § 1002(1). See id. ¶ 4. With respect to the Deloitte Plan, MetLife is a “fiduciary” within the meaning of section 3(21)(A) of ERISA, 29 U.S.C. § 1002(21)(A). See id. ¶ 7.

All of the terms and conditions of Met-Life’s coverage of the Plan, including the time-frames for adjudicating claims specified in the Department of Labor (“DOL”) regulations,1 are set forth in a Certificate of Insur-[129]*129anee (“Certificate” or “Ins. Cert.”).2 See Ins. Cert., Ex. B to Affidavit of Laura Sullivan, business consultant for MetLife (“Sullivan Aff.”). The Certificate identifies Deloitte as the plan administrator. See Ins. Cert. at 14. As the plan administrator, Deloitte is responsible for preparing a summary plan description (“SPD”) and distributing it to plan participants. See Sullivan Aff. ¶ 17.

MetLife has produced two documents that it claims are Deloitte’s SPD. See Long Term Disability Benefits: Choices to Balance Your Disability Needs, revised July 1994 (“7/94 SPD”), Ex. C to Sullivan Aff;3 Long Term Disability Benefits, March 1998 Edition (“3/98 SPD”), Ex. A to Riemer Rep. Aff. Only one of the two documents — the July 1994 version — provides notice of the time-frames specified in the DOL regulations.4 See 7/94 SPD at 8.3 (providing “In the event your claim has been denied in whole or in part, you or your authorized representative should receive, within 90 days, a written notice stating the basis of the denial (or 180 days if there exist circumstances beyond the Plan Administrator’s control).”). The time limits are not described in the acknowledgment letters sent to claimants after they submit a notice of claim or proof of claim. See Acknowledgment Letter 1: Initial Claim Acknowledgment; Ex. J to Riemer Aff.; Acknowledgment Letter 2: Predetermination Letter, Ex. K to Riemer Aff.

Under the Deloitte Plan, payment of LTD benefits commences upon completion of a ninety day “elimination period” following the onset of an employee’s disability. See Ins. Cert, at 2, 5. The Plan specifically provides that: (i) “When we receive proof that you are Disabled, we will pay a Monthly Benefit in accordance with the Schedule of Benefits.” Id. at 6; (2) “[Written p]roof [of a claim] must describe the event, the nature and extent of the cause for which a claim is made; it must be satisfactory to us.” Id. at 9; (3) “If the written proof of a claim: (a) has been made on time; and (b) is satisfactory to us; we will pay the accrued benefits monthly at the end of the period for which they are due.” Id.

A claim is considered timely if received not later than ninety days following the end of the elimination period. See id. The Plan makes no express provision for the payment of interest on delayed or retroactive awards of benefits. See Sullivan Aff. ¶ 15.

B. MetLife’s Claim Procedures

MetLife maintains a number of procedures designed to assure that LTD benefit determinations are made in a timely fashion, in advance of the ninety and sixty day time periods set forth in the regulations. See Deposition of Laura Sullivan (“Sullivan Dep.”), Ex. A to Affidavit of Allan M.

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Bluebook (online)
214 F.R.D. 125, 30 Employee Benefits Cas. (BNA) 1079, 2003 U.S. Dist. LEXIS 2, 2003 WL 23109, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dunnigan-v-metropolitan-life-insurance-nysd-2003.