Haase v. Metropolitan Life Insurance Co.

198 F. Supp. 3d 412, 2016 WL 4076418, 2016 U.S. Dist. LEXIS 100113
CourtDistrict Court, E.D. Pennsylvania
DecidedAugust 1, 2016
DocketCIVIL ACTION NO. 15-2864
StatusPublished
Cited by3 cases

This text of 198 F. Supp. 3d 412 (Haase v. Metropolitan Life Insurance Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Haase v. Metropolitan Life Insurance Co., 198 F. Supp. 3d 412, 2016 WL 4076418, 2016 U.S. Dist. LEXIS 100113 (E.D. Pa. 2016).

Opinion

MEMORANDUM

EDUARDO C. ROBRENO, District Judge.

Table of Contents

I. FACTUAL BACKGROUND... 416

A. Relevant Plan Terms... 417

B. Plaintiffs Benefits Claim... 418

II. PROCEDURAL HISTORY... 422

III. Standard of Review... 422

IV. DISCUSSION... 423

A. ERISA Preemption of State Law Claims... 423

1. Claims Expressly Preempted by ERISA... 423
2. Claims Completely Preempted by ERISA... 424
3. Leave to Amend the Complaint... 425

B. Plaintiffs Action is Time-Barred... 427

1. Limitations Period and Accrual Date Provided by the Plan... 427
2. Default Limitations Period and Accrual Date... 429

V. CONCLUSION... 433

Plaintiff William F. Haase (“Plaintiff’ or “Haase”), a former employee of Nason Construction, Inc. (“Nason”), was seriously injured in a fall at work on or about May 5, 1997. Plaintiff was a participant in Nason’s long-term disability plan (the “Plan”), which was funded by a group insurance policy issued by Defendant Metropolitan Life Insurance Company (“Defendant” or “MetLife”). As a result of his injuries, Plaintiff applied for and ultimately received long-term disability benefits under the Plan. This ease concerns MetLife’s administration of Plaintiffs benefits claim during the period beginning in April 2003 and ending in April 2015, when Plaintiff initiated the instant litigation.

In this action, Plaintiff claims that Met-Life failed to make the appropriate benefit and interest payments due to him under the Plan and to timely issue benefit and interest payments. Plaintiff also alleges that MetLife failed to provide him with other pertinent information, including a W-2 form reflecting his accurate income, in a timely manner. Based on this conduct, Plaintiff brings five counts under Pennsylvania state law: breach of contract (Count I); bad faith, in violation of 42 Pa. Cons. Stat. § 8371 (Count II); fraud and deceit (Count III); violation of Pennsylvania’s Unfair Trade Practices and Consumer Protection Law (“UTPCPL”), 73 Pa. Cons. Stat. §§ 201-1 to 201-9 (Count VI); and breach of an implied covenant of good faith and fair dealing (Count V).

Defendant MetLife now moves for summary judgment. As is explained more fully below, Plaintiffs state law claims are preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001-1461. Although a plaintiff faced with ERISA preemption of his state law claims ordinarily is permitted leave to amend his complaint to state a claim for relief under ERISA, amendment in this case would be futile, because Plaintiffs cognizable ERISA claims are time-barred. Accordingly, the Court will grant Defendant’s motion for summary judgment and enter judgment in favor of Defendant and against Plaintiff.

I. FACTUAL BACKGROUND

The relevant factual history is lengthy, given that MetLife’s claim administration process at issue in this case spans over twelve years. The Court begins by setting forth the pertinent provisions of the Plan.

[417]*417A. Relevant Plan Terms
The Plan defines disability as follows: “Disabled” or “Disability” means that, due to sickness, pregnancy or accidental injury, you are receiving Appropriate Care and Treatment from a Doctor on a continuing basis; and
1. during your Elimination Period and the next 24 month period, you are unable to earn more than 80% of your Predisability Earnings or Indexed Predisability Earnings at your Own Occupation for any employer in your Local Economy; or
2. after the 24 month period, you are unable to earn more than 80% of your Indexed Predisability Earnings from any employer in your Local Economy at any gainful occupation for which you are reasonably qualified taking into account your training, education, experience and Predisability Earnings.

Def.’s Mot. Summ. J. Ex. A at 17,1 ECF No. 10-1. The Plan provides a maximum benefit period through age sixty-five. Id. at 13. Beneficiaries are required to provide proof of disability to be eligible for benefits. Id. at 14-16.

The Plan sets forth how benefits are to be calculated in the event that a beneficiary continues to work (e.g., on a part-time basis) while disabled. Id, at 17. The Plan also provides for the reduction of benefits where the beneficiary earns income from other sources, such as through Social Security disability benefits, workers’ compensation benefits, or third-party recoveries (e.g., a settlement or legal judgment). Id. at 20-23. The Plan provides as follows with respect to income received in a lump-sum payment:

If you receive Other Income Benefits in a lump sum instead of in monthly payments, you must provide to us satisfactory proof of the breakdown of: (i) the amount attributable to lost income; and (ii) the time period for which the lump sum is applicable. If you do not provide this information to us, we may reduce your Monthly Benefit by an amount equal to the Monthly Benefit otherwise payable. We will reduce the Monthly Benefit each month until the lump sum has been exhausted. However, if we are given proof of the time period and amount attributable to lost income, we will make a retroactive adjustment.

Id. at 20. The Plan also provides MetLife with the right to recover overpayments of benefits. Id. at 29-30.

Further, the Plan sets forth a three-year period of limitations to file any legal action:

No legal action of any kind may be filed against us:
***
2. more than three years after proof of Disability must be filed. This will not apply if the law in the area where you live allows a longer period of time to file proof of Disability.

Id. at 30.

Finally, the Plan provides discretionary authority to MetLife and its other fiduciaries:

Discretionary Authority of Plan Administrator and Other Plan Fiduciaries
In carrying out their respective responsibilities under the Plan, the Plan administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the Plan and to determine [418]*418eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determination made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.

Id. at 40.

B. Plaintiffs Benefits Claim

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Bluebook (online)
198 F. Supp. 3d 412, 2016 WL 4076418, 2016 U.S. Dist. LEXIS 100113, Counsel Stack Legal Research, https://law.counselstack.com/opinion/haase-v-metropolitan-life-insurance-co-paed-2016.