Ford v. Freemen
This text of 388 F. Supp. 3d 692 (Ford v. Freemen) is published on Counsel Stack Legal Research, covering District Court, N.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
Opinion
JANE J. BOYLE, UNITED STATES DISTRICT JUDGE
Before the Court are: (1) Defendant Bank of America Corporation's (BoA) Motion to Dismiss (Doc. 32); and (2) Defendant Prudential Insurance Company of America's (Prudential) Motion to Dismiss (Doc. 36). Both Motions were filed under Federal Rule of Civil Procedure 12(b)(6)
*696and seek dismissal of the respective claims brought against BoA and Prudential in Plaintiff's Fourth Amended Complaint (Doc. 26). For the reasons stated below, the Court GRANTS in part and DENIES in part BoA's Motion to Dismiss (Doc. 32) and DISMISSES Plaintiff's state-law negligent-misrepresentation claim as preempted by ERISA. However, the Court GRANTS Plaintiff leave to amend his Complaint against BoA and to assert the dismissed state-law claim under ERISA. Furthermore, the Court GRANTS Prudential's Motion to Dismiss (Doc. 36) and DISMISSES with prejudice Plaintiff's ERISA claim against Prudential.
I.
BACKGROUND1
A. Factual Background
This case involves a dispute over Prudential's payment of the life-insurance benefits of David Freemen (hereinafter the "Decedent") to Defendant Otis Norman Freemen.2 Plaintiff alleges that he was the common-law spouse of the Decedent until the Decedent unfortunately passed away on October 23, 2016. Doc. 26, Pl.'s Fourth Am. Compl. (FAC), ¶ 11. The life-insurance policy (the "Policy") at issue was obtained in 1996 by the Decedent from his employer at the time, MBNA.3 Id. ¶ 12. On December 30, 1996, Plaintiff alleges that the Decedent executed a beneficiary form designating the Plaintiff as the 100% beneficiary on the Policy. Id. ¶ 12. The Decedent worked for MBNA until 2005, when he left active employment and was placed on long-term disability. Id. ¶ 13.
From 2005 to 2016, Plaintiff alleges that MBNA, BoA, and/or Prudential periodically sent the Decedent information confirming his status, the existence and amount of the Policy, and that Plaintiff was the sole beneficiary. Id. ¶ 15. However, Plaintiff does not currently have access to these documents because prior to the Decedent's death, Decedent "cleaned out" these documents, and thus, Plaintiff does not specifically allege which entity purportedly sent these documents. See id. After the Decedent's death, Plaintiff contacted Prudential and BoA to make claims for various survivor benefits, including a claim as the beneficiary under the Policy. Id. ¶ 16. Prudential told Plaintiff that there was no beneficiary designation on the Policy and advised Plaintiff to contact BoA to obtain the original records of the Policy since BoA had succeeded to MBNA's records. Id. ¶ 17.
Plaintiff then called BoA and spoke to a BoA employee, Kecia Atkins, requesting that she check the records to see if she could locate the form naming Plaintiff as the beneficiary on the Policy. Id. In response, Atkins allegedly confirmed that she "found [Plaintiff's] name, but could not (and would not) certify that the beneficiary designation applied to the Policy." Id. Atkins also allegedly "stated unequivocally that there was no beneficiary form showing [Plaintiff] as beneficiary of the Policy." Id. However, in October of 2018, in response *697to a subpoena Plaintiff served on BoA, BoA turned over records it had regarding the Policy, which allegedly showed Plaintiff as the sole 100% beneficiary of the Policy based on the 1996 designation. Id. ¶¶ 27-28.
Relying on the representations BoA made in 2016, Plaintiff proceeded to discuss with Prudential how the Policy proceeds would be paid without a beneficiary designee. Id. ¶¶ 17-18. Prudential allegedly stated that the proceeds would go to the Decedent's spouse, and if none existed, to his "heirs." Id. ¶ 18. Although Plaintiff alleges that he and the Decedent were common-law married, they never registered their marriage or applied for a marriage certificate after the Supreme Court's decision in Obergefell v. Hodges , --- U.S. ----,
Plaintiff then called Freemen expressing his concern that BoA and Prudential did not have record of his beneficiary designation and with having to go through the process of proving his marital status with the Decedent. Id. ¶ 19. Based on this concern, Freemen and Plaintiff allegedly agreed that Plaintiff was entitled to the Policy's proceeds and that instead of going through the "time consuming" process of proving up Plaintiff's marriage, Freemen would accept the proceeds as the Decedent's father and then send the money to Plaintiff. Id. Based on this alleged agreement, Plaintiff stopped pursuing his own claim for the funds with Prudential and allowed Freemen to complete the necessary paperwork to pay out the Policy's proceeds. Id. ¶ 20. Prudential paid Freemen the Policy proceeds, which at the time totaled $ 726,299.18. Id. ¶ 21. Despite their agreement, Freemen did not pay the Policy proceeds to Plaintiff, but instead allegedly used the money to pay off the title to his house and other third parties. Id. ¶ 24.
B. Procedural Background
On February 22, 2017, Plaintiff filed his Original Petition in state court bringing only state-law claims against Freemen based on his breach of the agreement. See generally Doc. 1-2, Ex. A-2, Original Pet. After almost two years of litigation in state court, Plaintiff filed a Third Amended Petition, adding state-law claims against Defendants BoA and Prudential. See generally Doc. 1-4, Ex. A-49, Third Am. Pet. On November 20, 2018, Defendants removed the state-court action to this Court invoking federal-question jurisdiction. See Doc. 1, Notice of Removal. Defendants argued that the Policy at issue was provided under an employee welfare benefit plan controlled by the Employee Retirement Income Security Act (ERISA), and thus, Plaintiff's state-law claims were preempted. Id. ¶ 4. Plaintiff did not dispute Defendants' removal on any grounds.
Then, on January 2, 2019, Plaintiff filed his now-operative Fourth Amended Complaint. Doc. 26, FAC. In this Complaint, Plaintiff brings a state-law claim against BoA for negligent misrepresentation based on its allegedly negligent handling of and communications regarding the Policy documents. Id. ¶¶ 43-46.
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JANE J. BOYLE, UNITED STATES DISTRICT JUDGE
Before the Court are: (1) Defendant Bank of America Corporation's (BoA) Motion to Dismiss (Doc. 32); and (2) Defendant Prudential Insurance Company of America's (Prudential) Motion to Dismiss (Doc. 36). Both Motions were filed under Federal Rule of Civil Procedure 12(b)(6)
*696and seek dismissal of the respective claims brought against BoA and Prudential in Plaintiff's Fourth Amended Complaint (Doc. 26). For the reasons stated below, the Court GRANTS in part and DENIES in part BoA's Motion to Dismiss (Doc. 32) and DISMISSES Plaintiff's state-law negligent-misrepresentation claim as preempted by ERISA. However, the Court GRANTS Plaintiff leave to amend his Complaint against BoA and to assert the dismissed state-law claim under ERISA. Furthermore, the Court GRANTS Prudential's Motion to Dismiss (Doc. 36) and DISMISSES with prejudice Plaintiff's ERISA claim against Prudential.
I.
BACKGROUND1
A. Factual Background
This case involves a dispute over Prudential's payment of the life-insurance benefits of David Freemen (hereinafter the "Decedent") to Defendant Otis Norman Freemen.2 Plaintiff alleges that he was the common-law spouse of the Decedent until the Decedent unfortunately passed away on October 23, 2016. Doc. 26, Pl.'s Fourth Am. Compl. (FAC), ¶ 11. The life-insurance policy (the "Policy") at issue was obtained in 1996 by the Decedent from his employer at the time, MBNA.3 Id. ¶ 12. On December 30, 1996, Plaintiff alleges that the Decedent executed a beneficiary form designating the Plaintiff as the 100% beneficiary on the Policy. Id. ¶ 12. The Decedent worked for MBNA until 2005, when he left active employment and was placed on long-term disability. Id. ¶ 13.
From 2005 to 2016, Plaintiff alleges that MBNA, BoA, and/or Prudential periodically sent the Decedent information confirming his status, the existence and amount of the Policy, and that Plaintiff was the sole beneficiary. Id. ¶ 15. However, Plaintiff does not currently have access to these documents because prior to the Decedent's death, Decedent "cleaned out" these documents, and thus, Plaintiff does not specifically allege which entity purportedly sent these documents. See id. After the Decedent's death, Plaintiff contacted Prudential and BoA to make claims for various survivor benefits, including a claim as the beneficiary under the Policy. Id. ¶ 16. Prudential told Plaintiff that there was no beneficiary designation on the Policy and advised Plaintiff to contact BoA to obtain the original records of the Policy since BoA had succeeded to MBNA's records. Id. ¶ 17.
Plaintiff then called BoA and spoke to a BoA employee, Kecia Atkins, requesting that she check the records to see if she could locate the form naming Plaintiff as the beneficiary on the Policy. Id. In response, Atkins allegedly confirmed that she "found [Plaintiff's] name, but could not (and would not) certify that the beneficiary designation applied to the Policy." Id. Atkins also allegedly "stated unequivocally that there was no beneficiary form showing [Plaintiff] as beneficiary of the Policy." Id. However, in October of 2018, in response *697to a subpoena Plaintiff served on BoA, BoA turned over records it had regarding the Policy, which allegedly showed Plaintiff as the sole 100% beneficiary of the Policy based on the 1996 designation. Id. ¶¶ 27-28.
Relying on the representations BoA made in 2016, Plaintiff proceeded to discuss with Prudential how the Policy proceeds would be paid without a beneficiary designee. Id. ¶¶ 17-18. Prudential allegedly stated that the proceeds would go to the Decedent's spouse, and if none existed, to his "heirs." Id. ¶ 18. Although Plaintiff alleges that he and the Decedent were common-law married, they never registered their marriage or applied for a marriage certificate after the Supreme Court's decision in Obergefell v. Hodges , --- U.S. ----,
Plaintiff then called Freemen expressing his concern that BoA and Prudential did not have record of his beneficiary designation and with having to go through the process of proving his marital status with the Decedent. Id. ¶ 19. Based on this concern, Freemen and Plaintiff allegedly agreed that Plaintiff was entitled to the Policy's proceeds and that instead of going through the "time consuming" process of proving up Plaintiff's marriage, Freemen would accept the proceeds as the Decedent's father and then send the money to Plaintiff. Id. Based on this alleged agreement, Plaintiff stopped pursuing his own claim for the funds with Prudential and allowed Freemen to complete the necessary paperwork to pay out the Policy's proceeds. Id. ¶ 20. Prudential paid Freemen the Policy proceeds, which at the time totaled $ 726,299.18. Id. ¶ 21. Despite their agreement, Freemen did not pay the Policy proceeds to Plaintiff, but instead allegedly used the money to pay off the title to his house and other third parties. Id. ¶ 24.
B. Procedural Background
On February 22, 2017, Plaintiff filed his Original Petition in state court bringing only state-law claims against Freemen based on his breach of the agreement. See generally Doc. 1-2, Ex. A-2, Original Pet. After almost two years of litigation in state court, Plaintiff filed a Third Amended Petition, adding state-law claims against Defendants BoA and Prudential. See generally Doc. 1-4, Ex. A-49, Third Am. Pet. On November 20, 2018, Defendants removed the state-court action to this Court invoking federal-question jurisdiction. See Doc. 1, Notice of Removal. Defendants argued that the Policy at issue was provided under an employee welfare benefit plan controlled by the Employee Retirement Income Security Act (ERISA), and thus, Plaintiff's state-law claims were preempted. Id. ¶ 4. Plaintiff did not dispute Defendants' removal on any grounds.
Then, on January 2, 2019, Plaintiff filed his now-operative Fourth Amended Complaint. Doc. 26, FAC. In this Complaint, Plaintiff brings a state-law claim against BoA for negligent misrepresentation based on its allegedly negligent handling of and communications regarding the Policy documents. Id. ¶¶ 43-46. Against Prudential, Plaintiff brings a federal claim under ERISA alleging that he was entitled to the Policy's proceeds, but was denied the proceeds in violation of ERISA § 502(a)(1)(B), codified at
On January 16, 2019, BoA filed its Motion to Dismiss arguing inter alia that Plaintiff's state law negligent-misrepresentation claim is preempted by ERISA and that Plaintiff's claim for benefits should *698otherwise be dismissed with prejudice for failure to exhaust administrative remedies. Doc. 33, BoA Mot. to Dismiss, 4-5, 10-11. Shortly thereafter, on January 22, 2019, Prudential filed its Motion to Dismiss making the same exhaustion argument and arguing that in any case, Prudential appropriately paid Freemen according to the Policy's terms, and thus, cannot be liable under ERISA. Doc. 36, Prudential's Mot. to Dismiss, 5-8. Having been fully briefed on both Motions, the Court now addresses the sufficiency of Plaintiff's claims as to both Defendants.
II.
LEGAL STANDARD
Under Rule 8(a)(2) of the Federal Rules of Civil Procedure, a complaint must contain "a short and plain statement of the claim showing that the pleader is entitled to relief." Fed. R. Civ. P. 8(a)(2). Rule 12(b)(6) authorizes a court to dismiss a plaintiff's complaint for "failure to state a claim upon which relief can be granted."
To survive a motion to dismiss, a plaintiff must plead "enough facts to state a claim to relief that is plausible on its face." Bell Atl. Corp. v. Twombly ,
III.
ANALYSIS
In analyzing these Motions to Dismiss, the Court will first address BoA's argument that Plaintiff's state-law negligent-misrepresentation claim is preempted by ERISA; then second address the sufficiency of Plaintiff's ERISA § 502(a)(1)(B) claim against Prudential; and then finally address the failure-to-exhaust-administrative-remedies argument raised by BoA and Prudential.
A. ERISA Preemption
First, the Court addresses BoA's argument that ERISA preempts Plaintiff's state-law claim for negligent misrepresentation. Doc. 33, BoA's Mot. to Dismiss, 4-10.
"[T]here are two types of preemption under ERISA": complete and conflict. Giles v. NYLCare Health Plans, Inc. ,
1. Complete Preemption
Complete preemption is an exception to the well-pleaded complaint rule. Aetna Health Inc. v. Davila ,
Complete preemption under ERISA stems from § 502(a), codified at 29 U.S.C. 1132(a), which sets forth a comprehensive civil enforcement scheme. Davila ,
In Davila , the Supreme Court articulated a two-prong test for complete preemption which provides that an individual's cause of action is completely preempted by ERISA: (1) "if an individual, at some point in time, could have brought his claim under ERISA § 502(a)(1)(B), and [ (2) ] ... there is no other independent legal duty that is implicated by a defendant's actions."
Plaintiff does not challenge Davila 's first prong-that he could have brought his claims under the civil-enforcement provisions set forth in § 502(a)-and instead, focuses his analysis on arguing that BoA's conduct arises from an "other independent legal duty." See Doc. 40, Pl.'s Resp. to BoA's Mot., 3-5. However, as discussed in more detail below, the Court finds that the remedy Plaintiff seeks from BoA could have been brought as a claim under § 502(a)(1)(B) or § 502(a)(3), and thus, the Court considers the more "crucial question ... [of] whether [Plaintiff] is in fact seeking benefits under the terms of the plan, or rights that derive from" an independent legal duty. See Lone Star OB/GYN Assocs. v. Aetna Health Inc. ,
A legal duty is not independent of ERISA if it "derives entirely from the particular rights and obligations established by [ERISA] benefit plans." Davila ,
To summarize, Plaintiff's negligent-misrepresentation claim alleges that BoA was negligent in its handling of the Policy documents-namely, the beneficiary form that the Decedent completed in 1996 listing Plaintiff as the sole beneficiary-and misrepresented to him that there was no beneficiary listed on the Policy. Doc. 26, FAC, ¶¶ 43-45. Plaintiff argues that the "negligence is demonstrated by the production of the beneficiary form in subsequent discovery-which was an obvious part of the MBNA records maintained by Bank of America." Doc. 40, Pl.'s Resp. to BoA's Mot., 2; see also Doc. 26, FAC, ¶¶ 27-29, 45. Plaintiff alleges that relying on this misinformation, he entered into the agreement with Freemen, which ultimately resulted in his inability to recover any of the Policy's proceeds. Doc. 26, FAC, ¶ 46. Plaintiff thus argues that his negligent-misrepresentation claim is not subject to complete preemption because his claim against BoA does not require interpretation of the Plan, and arises from BoA's alleged breach of "an independent legal duty" not to negligently provide false or misleading information in its business. Doc. 40, Pl.'s Resp. to BoA's Mot., 1.
Ultimately, the Court disagrees with Plaintiff and finds that his claim is subject to complete preemption because his attempt to recoup the Policy proceeds based on BoA's false and/or misleading information regarding his coverage status is encompassed within ERISA's civil-enforcement scheme. See , e.g., Gearlds v. Entergy Servs., Inc. ,
The Fifth Circuit considered a similar case in McGowin v. ManPower International, Inc. ,
Like the plaintiff in McGowin , Plaintiff bases his negligent-misrepresentation claim on BoA allegedly misinforming him that he was not a beneficiary, when he alleges he was. See Doc. 26, FAC, ¶¶ 43-44. And Plaintiff is seeking damages-albeit couched in the terms of "reliance damages"-in the amount of the proceeds he was unable to recover under the Policy. See id. ¶ 46. Thus, like in McGowin , in order to determine whether BoA made negligent misrepresentations, the Court will have to interpret, at least in part, his purported beneficiary status under the Policy. Therefore, Plaintiff may characterize his cause of action as arising under negligent misrepresentation, but he seeks a determination of his eligibility for benefits under an ERISA-governed plan, and he prays for relief specifically provided by § 502(a)(1)(B) or § 502(a)(3). See McGowin ,
2. Conflict Preemption
Although the Court finds that complete preemption applies to Plaintiff's state-law claim, the Court will also briefly discuss conflict preemption since it applies as well. Conflict preemption does not provide grounds for removal but instead functions solely as an "affirmative federal defense to a state-law claim." Westfall v. Bevan ,
The Court concludes that both factors lean in favor of finding that Plaintiff's negligent-misrepresentation claim is subject to conflict preemption. First, as discussed above, Plaintiff alleges that he is a beneficiary to the ERISA Policy and is seeking to obtain the proceeds he believes he was entitled to based on his beneficiary status. The Fifth Circuit has held that when the "facts underlying a state law claim bear some relationship to an employee benefit plan, we evaluate the nexus between ERISA and state law in the framework of ERISA's statutory objectives." Mayeaux v. La. Health Serv. & Indem. Co. ,
The Court's task in the case will ultimately be to determine whether BoA-as the alleged contract holder of the ERISA Policy and successor to MBNA's duties and obligations-is liable under ERISA for allegedly providing false or misleading information as to Plaintiff's beneficiary status and presumably failing to give the beneficiary form to Prudential. These allegations, although framed in terms of negligent misrepresentation, go to the core of ERISA's safeguarding objectives.
Second, this claim for relief directly affects the relationship between two of the most traditional ERISA entities-a plan sponsor/employer and a beneficiary-which weighs heavily in favor of finding that the claim is subject to conflict preemption. See Memorial Hosp. Sys. v. Northbrook Life Ins. Co. ,
Plaintiff claims he is a Policy beneficiary, which is a traditional ERISA entity. See
In reaching this determination, the Court finds that the various cases Plaintiff cites to support his position are not applicable to this case. See Doc. 40, Pl.'s Resp. to BoA's Mot., 7-9. In fact, the cases cited by Plaintiff are distinguishable and refute his own argument. Specifically, the cases Plaintiff cites in which courts found that ERISA preemption did not apply either: (1) involved at least one nontraditional ERISA entity-e.g. , a third-party medical service provider-and/or (2) involved duties and obligations based on separate oral or written contractual obligations between the parties and were not solely based on the interpretation and coverage of the ERISA plan at issue. See , e.g. , Lone Star OB/GYN Assocs. ,
3. Repleading Under ERISA
Though the Fifth Circuit has not clearly indicated "the appropriate course of action for claims found to be completely preempted,"
*704it has outlined two possible approaches:
District courts in this circuit are split. Most hold that complete preemption results in dismissal of the state-law claim, even though they typically allow plaintiffs to replead and assert the dismissed state law claims as federal claims. Defendants, as well as the Second Circuit, urge this approach. But at least one of our district courts does not dismiss the claim, instead treating it as having become a properly asserted federal claim and proceeding to adjudicate it on the merits.
Spear Mktg., Inc. v. BancorpSouth Bank ,
B. Sufficiency of Plaintiff's ERISA § 502(a)(1)(B) Claim Against Prudential
Next, the Court addresses the sufficiency of Plaintiff's ERISA § 502(a)(1)(B) claim against Prudential. Doc. 26, FAC, ¶¶ 47-50. Plaintiff argues that Prudential violated § 502(a)(1)(B) by denying his post-suit claim for benefits he made to Prudential despite the fact that he was noted as the beneficiary on the beneficiary designation form completed by the Decedent in 1996. Id. ¶¶ 47-48. Prudential argues that Plaintiff's claim fails because in paying the life-insurance proceeds to Freemen, it complied with the terms of the ERISA-governed plan and otherwise made the payment in good faith. Doc. 36, Prudential's Mot. to Dismiss, 1, 7-9.
"ERISA requires '[e]very employee benefit plan [to] be established and maintained pursuant to a written instrument,'
"[Plaintiff's] claim therefore stands or falls by 'the terms of the plan[.]' " Kennedy ,
As relevant to this issue, the Policy6 defines a "Beneficiary" as "a person chosen, on a form approved by Prudential, to receive the insurance benefits." Doc. 51-1, Ex. A, 4 (Beneficiary Rules). With regards to distribution of the Policy's benefits, the Policy states that:
If there is a Beneficiary for the insurance, it is payable to that Beneficiary. Any amount of insurance for which there is no Beneficiary at your death will be payable to the first of the following: Your (a) surviving spouse; (b) surviving child(ren) in equal shares; (c) surviving parents in equal shares; (d) surviving siblings in equal shares; (e) estate.
You may change the Beneficiary at any time without the consent of the present Beneficiary. The Beneficiary change form must be filed through the Contract Holder. The change will take effect on the date the form is signed. But it will not apply to any amount paid by Prudential before it receives the form.
Prudential thus argues that it acted in accordance with the terms of the Policy when it paid the Policy proceeds to Freemen because: (1) at that time it was not aware of the beneficiary designation form naming Plaintiff nor did it have the form in its possession; (2) Plaintiff never filed a claim as a surviving spouse (which Plaintiff *706concedes); and (3) Prudential acted in good faith because it was not aware of any competing claim. Doc. 36, Prudential's Mot. to Dismiss, 7-9. In response, Plaintiff argues that: (1) Prudential did not act in accordance with the terms of the Policy because there was no explicit requirement that the Decedent was required to send the 1996 original beneficiary designation form to Prudential, but only that he file it with the contract holder, which he did; and (2) Prudential's argument that it paid out the proceeds in good faith requires more evidence and is improper to determine at the motion-to-dismiss stage because Prudential did not contact BoA to determine what forms it had in its possession. Doc. 44, Pl.'s Resp. to Prudential's Mot., 7-11. The Court addresses Plaintiff's arguments, but concludes that the allegations in Plaintiff's Complaint are insufficient to state an ERISA § 502(a)(1)(B) claim against Prudential.
The Court finds that Prudential acted in accordance with the plan documents based on the information it had at the time when it paid out the Policy proceeds. First, there are no allegations in the Complaint that Prudential was aware there was a beneficiary designation form at the time it paid out the proceeds. Plaintiff alleges that when he first contacted Prudential, it told him that it did not have a beneficiary form on file for the Policy. Doc. 26, FAC, ¶ 17. In fact, Plaintiff acknowledges that even after subpoenaing Prudential's records there was no beneficiary designation form found in Prudential's records.
In reaching this conclusion, the Court is not persuaded by Plaintiff's argument that "[t]here is no evidence of any requirement [in the Policy] that the Decedent is required to send the form directly to Prudential[,]" and thus, by "[h]aving completed the form, and delivering it to the 'Contract Holder,' Prudential was required to pay Policy proceeds according to the beneficiary form in the hands of the Contract Holder." Doc. 44, Pl.'s Resp. to Prudential's Mot., 9. In essence, Plaintiff argues that the Policy "suggests that Prudential had a duty to inquire further about the plan documents and forms in the possession of its designated 'contract holder.' "
Even assuming the Policy did not require that Prudential receive the beneficiary designation form for it to be effective,7 *707and assuming that Prudential did not contact BoA, the Fifth Circuit has held that in the ERISA context "[t]here is no justifiable basis for placing the burden solely on the administrator to generate evidence relevant to deciding the claim, which may or may not be available to it, or which may be more readily available to the claimant." Vega v. Nat'l Life Ins. Servs., Inc. ,
In a case involving similar facts from the Eighth Circuit, the court found that a life insurance company properly paid out the death benefits according to a 1991 designation even though the life insurance company was aware that there was a later designation, was "on notice of 'a legitimate dispute between the beneficiaries,' " and failed to warn the plaintiffs that it would pay in accordance with the 1991 designation before doing so. Matschiner v. Hartford Life Ins. Co. ,
Although Matschiner was decided at summary judgment, the Court still finds it persuasive since the allegations in Plaintiff's Complaint establish that like the life insurance company in Matschiner , Prudential cannot be found liable under § 502(a)(1)(B): Prudential told Plaintiff that he would need to contact BoA and acquire the beneficiary designation form; Plaintiff never produced the form nor was it found in Prudential's records; and, Prudential advised Plaintiff how the Policy's proceeds would be paid out absent a designee. As discussed in more detail below, Plaintiff chose not to pursue a claim for benefits under the Policy with Prudential, but instead entered into an agreement with Freemen where he would receive the Policy's proceeds and then give the proceeds to Plaintiff. In Plaintiff choosing this path, Prudential did what it was required to do under the Policy-and what Plaintiff expected them to do-it paid the Policy's proceeds to Freemen since there was no beneficiary designee and no claim by the Decedent's spouse or children. Therefore, *708Plaintiff's Complaint has failed to allege a § 502(a)(1)(B) claim against Prudential.
C. Failure to Exhaust Administrative Remedies
Finally, the Court takes up BoA and Prudential's argument that Plaintiff's claim for benefits should be dismissed because he failed to exhaust administrative remedies provided for in the Policy. Doc. 33, BoA's Mot. to Dismiss, 10-11; Doc. 36, Prudential's Mot. to Dismiss, 5-6. First the Court will address BoA' exhaustion argument, followed by Prudential's.
1. BoA's Exhaustion Argument
To start, the Court notes that Plaintiff does not currently have any ERISA claims against BoA, yet BoA still makes the argument that failure to exhaust plan remedies bars Plaintiff's ERISA claims. Thus, at first glance, ruling on this issue seems premature. In response, Plaintiff argues that BoA's failure-to-exhaust-administrative-remedies argument is misplaced because BoA has failed to show that the Policy required him to make a claim with BoA, as apposed to the plan-administrator, Prudential. Doc. 40, Pl.'s Resp. to BoA's Mot., 10. In its Reply, BoA does not respond to this argument or make additional exhaustion arguments.
"Generally, the Fifth Circuit requires that 'claimants seeking benefits from an ERISA plan must first exhaust available administrative remedies under the plan before bringing suit to recover benefits.' " N. Cypress Med. Ctr. Operating Co. v. CIGNA Healthcare ,
Even if exhaustion was appropriate to address at this stage, Plaintiff has pled facts indicating that an exception to the exhaustion requirement may apply. In Bourgeois v. Pension Plan for Employees of Santa Fe International Corporations , the Fifth Circuit addressed various possible exceptions to ERISA's exhaustion requirement, some of which may be applicable to this case. See
*709The Court stated that prior Fifth Circuit precedent "support[ed] the proposition that a court should not relinquish its jurisdiction because of a failure to exhaust administrative remedies when there was a valid reason for such failure."
In this case, Plaintiff's claim is based on the alleged misrepresentations made by a BoA employee, Kecia Atkins, stating that there was no beneficiary designation on the Policy. Doc. 26, FAC, ¶ 17. And Plaintiff relied on this information when he decided to enter an agreement with Freemen in lieu of making a claim for benefits with Prudential. Id. ¶ 19. Although discovery will be needed to determine the applicability of this and other potential exceptions to the exhaustion requirement, the Court finds that the allegations in Plaintiff's Complaint and the unique circumstances of this case are sufficient to infer that an exception to exhausting administrative remedies may be appropriate in this case. Thus, the Court declines to dismiss Plaintiff's claims against BoA on exhaustion grounds.
2. Prudential's Exhaustion Argument
Prudential also argues that Plaintiff's ERISA claim fails because he failed to exhausted administrative remedies. Doc. 36, Prudential's Mot. to Dismiss, 5-6. Plaintiff concedes that although granting a motion to dismiss for failure to exhaust administrative remedies is generally disfavored, "[i]f failure to exhaust administrative remedies is apparent from the face of the complaint ... a Rule 12(b)(6) motion is the proper vehicle." Doc. 44, Pl.'s Resp. to Prudential's Mot., 4 (citing Jefferson v. Loftin ,
Instead, Plaintiff made a claim with Prudential roughly two years later when he discovered BoA had the beneficiary form; however, this was after Prudential had already paid the Policy's proceeds to Freemen and after Plaintiff filed his suit in state court. See id. ¶ 30. Plaintiff argues that his post-lawsuit claim for benefits satisfies the exhaustion requirement because Prudential failed to respond on time, a violation of its own procedures. Id. ; Doc. 44, Pl.'s Resp. to Prudential's Mot., 5-6. However, the Fifth Circuit has found that absent an applicable exception, allowing a plaintiff to make his initial claim for benefits in a lawsuit undermines the policy considerations underlying the exhaustion requirement. See Meza , 908 F.2d at 1279 (quoting *710Denton v. First Nat'l Bank of Waco, Tex. ,
Plaintiff also argues that the exhaustion requirement on his claim against Prudential should be excused because exhausting administrative remedies in this case would be futile. Doc. 44, Pl.'s Resp. to Prudential's Mot., 5-6. Plaintiff argues that futility is met "if the plan administrator has indicated in the course of the litigation that it intends to refuse any further claim by Plaintiff, or that it has a longstanding policy concerning denial of certain types of claims." Id. at 5 (quoting Gastwirth v. Cigna Grp. Ins. ,
Plaintiff however misinterprets this exception. Based on the allegations in Plaintiff's Complaint, Prudential's position as to who is entitled to the Policy's proceeds has remained the same from the time Plaintiff called Prudential following the Decedent's death to present day-absent a beneficiary designee, the Policy's proceeds would be paid out to the Decedent's spouse, and if none, to the Decedent's heirs. See Doc. 26, FAC, ¶ 18. Prudential's current position is not that it would have refused any claim by Plaintiff, but that the time to make a claim was when it originally advised Plaintiff of the proper claim process after the Decedent's death and prior to filing suit.
Furthermore, Plaintiff has failed to allege any hostility or bias on Prudential's part. For example, Plaintiff has not alleged that Prudential's policy was to consider only heterosexual spouses as beneficiaries under the Policy or that even if Plaintiff proved up his common-law marriage Prudential would not have consider him a spouse subject to beneficiary status. In fact, Plaintiff alleges that Prudential advised him that he would need to prove up his marriage status to take under the Policy. Although Plaintiff has arguably alleged bias and/or hostility as to BoA's employee, see Doc. 26, FAC, ¶ 29 (alleging that once he told BoA's employee that he was Decedent's spouse she "became less than helpful"), there are no allegations that Prudential was hostile or biased against Plaintiff's attempt to collect the Policy's proceeds.
To be clear, although the Court finds that Plaintiff potentially has an exception to exhausting administrative remedies with respect to ERISA claims against BoA-and thus, Rule 12(b)(6) dismissal is improper as to BoA's claims-the Court does not find that the same reasoning applies to Prudential. This is because Plaintiff admits in his Complaint that even after subpoenaing Prudential's records, "it appeared that Prudential did not have copies of the beneficiary designation." Id. ¶ 26. Thus, unlike BoA-who allegedly had the form in it possession, but failed to produce it when requested-Prudential was appropriately operating under the belief that there was no beneficiary designation form. And while *711operating under that belief, Prudential advised Plaintiff that according to the Policy's terms, absent a beneficiary designee, the Policy's proceeds would be paid out to the Decedent's spouse, and if none, to Decedent's heirs. Id. ¶ 18. Prudential also advised Plaintiff that as Decedent's common-law spouse he would have to make a claim and prove up the elements of common-law marriage to seek benefits under the Policy. Id.
Thus, the allegations in the Complaint show that Prudential properly advised Plaintiff of his rights under the Policy based on the information known to it at the time. In other words, Plaintiff has not alleged any failure on the part of Prudential to provide him with plan information or how any of its actions prejudiced his ability to obtain the Policy's proceeds. See Meza , 908 F.2d at 1279 (citing Curry , 891 F.2d at 846 ). Although the Court recognizes that the claim process Prudential outlined would likely take significant time and effort, the fact remains that Plaintiff chose to "stop[ ] pursuing his own claim to the funds," and thus on the face of the Complaint it is clear that Plaintiff failed to exhaust his administrative remedies prior to filing suit. See Doc. 26, FAC, ¶ 20.
IV.
CONCLUSION
For the above-stated reasons, the Court GRANTS in part and DENIES in part BoA's Motion to Dismiss (Doc. 32) and GRANTS Prudential's Motion to Dismiss (Doc. 36). Specifically, as to BoA's Motion, the Court DENIES the Motion as to its exhaustion argument, but GRANTS the Motion as to its preemption argument, and therefore, DISMISSES Plaintiff's state-law negligent-misrepresentation claim as preempted by ERISA. However, the Court GRANTS Plaintiff leave to amend his Complaint to assert the dismissed state-law claim under ERISA and in a manner consistent with this Order. Plaintiff must file an amended complaint within thirty days of this Order.
As to Prudential's Motion, the Court GRANTS its Motion and finds that the allegations in Plaintiff's Complaint fail to state a claim under ERISA § 502(a)(1)(B) because the Complaint shows that Prudential paid the Policy proceeds according to the Policy's terms and Plaintiff failed to exhaust his administrative remedies prior to filing suit. The Court finds that allowing Plaintiff the opportunity to replead against Prudential would be futile because Plaintiff would in essence have to contradict many of the allegations and arguments he currently asserts against Prudential in order to state a viable § 502(a)(1)(B) claim. Therefore, the Court DISMISSES with prejudice Plaintiff's § 502(a)(1)(B) claim against Prudential. As this is the only remaining claim against Prudential, the Clerk of Court is directed to terminate Prudential from this case.
SO ORDERED.
Related
Cite This Page — Counsel Stack
388 F. Supp. 3d 692, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ford-v-freemen-txnd-2019.