Eschler v. Lincoln National Life Insurance Company, The

CourtDistrict Court, D. Utah
DecidedNovember 3, 2020
Docket2:20-cv-00467
StatusUnknown

This text of Eschler v. Lincoln National Life Insurance Company, The (Eschler v. Lincoln National Life Insurance Company, The) is published on Counsel Stack Legal Research, covering District Court, D. Utah primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Eschler v. Lincoln National Life Insurance Company, The, (D. Utah 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UTAH

KARI ESCHLER,

Plaintiff,

v. MEMORANDUM DECIISON

AND ORDER THE LINCOLN NATIONAL LIFE

INSURANCE COMPANY, an Indiana Civil No. 2:20-CV-467 DB corporation; and MEDICAL PRIORITY

CONSULTANTS, INC., a Utah corporation,

dba PRIORITY DISPATCH, INC., Judge Dee Benson

Defendants.

Before the court is Defendant Medical Priority Consultants, Inc. dba Priority Dispatch, Inc.’s (“Priority Dispatch”) Motion to Dismiss pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure. The motion has been fully briefed by the parties, and the court has considered the facts and arguments set forth in those filings. Pursuant to civil rule 7-1(f) of the United States District Court for the District of Utah Rules of Practice, the court elects to determine the motion on the basis of the written memoranda and finds that oral argument would not be helpful or necessary. DUCivR 7-1(f). LEGAL STANDARD “The court’s function on a Rule 12(b)(6) motion is not to weigh potential evidence that the parties might present at trial, but to assess whether the plaintiff’s complaint alone is legally sufficient to state a claim for which relief may be granted.” Tal v. Hogan, 453 F.3d 1244, 1252 (10th Cir. 2006). The court must construe the complaint in the light most favorable to the Plaintiff, accept all well-pleaded factual allegations as true, and draw all reasonable inferences in favor of the Plaintiff. However, the court need not accept as true legal conclusions or unwarranted inferences. See Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009); Khalik v. United Air

Lines, 671 F.3d 1188, 1191 (10th Cir. 2012). Plaintiff must provide “enough facts to state a claim to relief that is plausible on its face.” Bell Atlantic Corp. v. Twombly, 550 U.S. 544 (2007). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). The plausibility standard is not a “probability requirement,” but it does require “more than a sheer possibility that a defendant has acted unlawfully.” Id. In considering the adequacy of a plaintiff’s allegations in a complaint subject to a motion to dismiss, a district court not only considers the complaint, but may also “consider documents

referred to in the complaint if the documents are central to the plaintiff’s claim and the parties do not dispute the documents’ authenticity.” Alvarado v. KOB-TV, LLC, 493 F.3d 1210, 1215 (10th Cir. 2007); see Tellabs, Inc. v. Makor Issues & Rights, Ltd., 551 U.S. 308, 322 (2007) (district court may consider “documents incorporated into the complaint by reference and matters of which a court may take judicial notice”). BACKGROUND For purposes of ruling on Defendant’s motion to dismiss, the court accepts the following as true. Plaintiff Kari Eschler initiated this action seeking to collect benefits under Defendant Priority Dispatch’s employee life insurance plan. Plaintiff is the mother of Shaela Savage (“Shaela”), a former employee of Defendant Priority Dispatch. (Dkt. 2, Pl.’s Compl. ¶ 2.) Shaela began working at Priority Dispatch in November 2016 and continued her employment until her death on October 29, 2019. (Id., ¶¶ 10, 19.)

Defendant Priority Dispatch offers a variety of benefit plans for eligible employees. Basic Life insurance and Voluntary Life insurance benefits are provided through “Group Life and Dependent Life Insurance for Employees of Priority Dispatch, Inc.” (the “Plan”). (Id. ¶ 4.) The Plan was established pursuant to 29 U.S.C § 1001 et seq. of the Employee Retirement Income Security Act of 1974 (“ERISA”). Defendant Priority Dispatch is the Sponsor and Plan Administrator. Defendant Lincoln National Life Insurance Company (“Lincoln National”) is responsible for administering claims under the plan. Lincoln National “has the sole discretionary authority to determine eligibility and to administer claims in accord with the interpretation of policy provisions, on the Plan

Administrator’s behalf.” (Dkt. 15-1, Certificate of Group Insurance, Summary Plan Description.) Shaela was an “eligible employee” and had Basic Life insurance under the Plan. The death benefit on the Basic Life insurance policy was approximately equal to Shaela’s annual income. Shaela did not elect Voluntary Life insurance at the time of her initial hiring in November 2016. (Dkt. 17-1, Lincoln National Letter dated Jan. 9, 2020 at 3.) In early 2019 Shaela became pregnant. (Compl. ¶18.) On April 8, 2019, Shaela applied for Voluntary Life insurance benefits1 under the Plan. (Compl. ¶ 13; Dkt. 15-2 at 1.) Shaela’s

1 Referred to as “Personal Life insurance” in Plan documents. requested death benefit for the Voluntary Life insurance was $150,000. (Compl. ¶ 15.) Because Shaela did not elect coverage for Voluntary Life insurance during her initial eligibility period (when hired) or during the Open Enrollment period, in order to complete the enrollment process she was required to submit “evidence of insurability.” (Dkt. 15-3 at 3.) Shaela authorized Defendant Priority Dispatch to deduct the life insurance premiums

from her payroll, and Defendant Priority Dispatch did, in fact, deduct from Shaela’s paychecks the corresponding premiums for both the Basic Life and Voluntary life insurance policies. (Compl. ¶ 52-53.) Defendant Priority Dispatch “failed to alert[] Shaela that the routine evidence of insurability form needed to be completed.” (Compl. ¶ 54.) This lack of notice combined with the withholding of premiums caused Shaela to believe she was insured with a $150,000 Voluntary Life insurance benefit. (Compl. ¶¶ 52, 54-57.) Plaintiff was the named beneficiary on Shaela’s Basic Life insurance policy and Voluntary Life insurance policy.

On October 29, 2019, Shaela died from complications arising during or shortly after childbirth. (Compl. ¶ 19.) Shaela’s child survived and is being raised by Plaintiff, the child’s legal guardian and grandmother. Shortly after Shaela’s death, Plaintiff sent Lincoln National a claim for life insurance proceeds under both the Basic Life and Voluntary Life insurance policies. Lincoln National paid to Plaintiff the Basic Life insurance claim in the amount of $38,292.80 plus interest. However, Lincoln National denied Plaintiff’s Voluntary Life insurance claim. In a letter dated November 20, 2019, Lincoln National stated that because Shaela enrolled in Voluntary Life outside of the Open Enrollment period, her enrollment was subject to “evidence of insurability” which was never received by Lincoln National. The November 20, 2019 denial of Plaintiff’s claim states, in pertinent part: [Shaela] enrolled in voluntary life insurance [on] 4/8/19 outside the approved open enrollment period of May 1st-May 31st. Therefore, her benefit enrollment was subject to evidence of insurability in which non[e] [sic] was ever received. Therefore, no benefits are payable at this time for voluntary life insurance.

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Related

Tellabs, Inc. v. Makor Issues & Rights, Ltd.
551 U.S. 308 (Supreme Court, 2007)
Bell Atlantic Corp. v. Twombly
550 U.S. 544 (Supreme Court, 2007)
Ashcroft v. Iqbal
556 U.S. 662 (Supreme Court, 2009)
Whitehead v. Oklahoma Gas & Electric Co.
187 F.3d 1184 (Tenth Circuit, 1999)
Tal v. Hogan
453 F.3d 1244 (Tenth Circuit, 2006)
Alvarado v. KOB-TV, L.L.C.
493 F.3d 1210 (Tenth Circuit, 2007)
CIGNA Corp. v. Amara
131 S. Ct. 1866 (Supreme Court, 2011)
Jack D. Denton v. First National Bank of Waco, Texas
765 F.2d 1295 (First Circuit, 1985)
Khalik v. United Air Lines
671 F.3d 1188 (Tenth Circuit, 2012)
Coleman v. Pension Benefit Guaranty Corp.
94 F. Supp. 2d 18 (District of Columbia, 2000)
Smith v. Sydnor
184 F.3d 356 (Fourth Circuit, 1999)
Silva v. Metropolitan Life Insurance
762 F.3d 711 (Eighth Circuit, 2014)

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