House-Forshee v. Benefits Committee of Western & Southern Financial Group Company Flexible Benefits Plan

CourtDistrict Court, S.D. Ohio
DecidedApril 29, 2025
Docket1:24-cv-00110
StatusUnknown

This text of House-Forshee v. Benefits Committee of Western & Southern Financial Group Company Flexible Benefits Plan (House-Forshee v. Benefits Committee of Western & Southern Financial Group Company Flexible Benefits Plan) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
House-Forshee v. Benefits Committee of Western & Southern Financial Group Company Flexible Benefits Plan, (S.D. Ohio 2025).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO WESTERN DIVISION

ROBERTA HOUSE-FORSHEE, Case No. 1:24-cv-110 Plaintiff, McFarland, J. V. Bowman, M.J.

BENEFITS COMMITTEE OF WESTERN & SOUTHERN FINANCIAL GROUP CO. FLEXIBLE BENEFITS PLAN, et al., Defendants.

REPORT AND RECOMMENDATION On March 4, 2024, Plaintiff Roberta House-Forshee filed this civil action against the Benefits Committee of Western & Southern Financial Group Co. Flexible Benefits Plan and Western & Southern Financial Group, Inc. (collectively “W&S”) under the Employee Retirement Income Security Act of 1974 (“ERISA”). In her complaint, Plaintiff alleges that W&S wrongfully denied her short-term disability benefits under an Employee Welfare Benefit Plan that provided group disability benefits to W&S employees. (Doc. 1). This case has been referred to the undersigned magistrate judge for initial review of all pretrial motions other than motions for summary judgment. (Doc. 2). On January 30, 2025, Defendants filed a motion to dismiss. For the reasons stated, the motion to dismiss should be GRANTED, but without prejudice to Plaintiffs ability to move for a post- judgment award of attorney’s fees if appropriate. I. Background Plaintiff was previously employed as a customer service representative at the Gerber Life Insurance Company, a subsidiary of Western & Southern Financial Group. On June 12, 2023, Plaintiff submitted a claim for short-term disability benefits to the

Western & Southern Financial Group Flexible Benefits Plan (“Plan”). After initially approving Plaintiffs claim for benefits starting June 12, W&S terminated Plaintiffs short- term benefits on July 7, 2023. Plaintiff appealed, but W&S denied Plaintiffs appeal of the adverse short-term disability claim on September 8, 2023. (/d., Jf] 25-27, Doc. 17-1, PagelD 71).’ In its denial, W&S cited alleged inadequacies in the documentation submitted by Plaintiff in support of her claim. Following exhaustion of her administrative appeal on the short-term benefits claim, on March 5, 2024, Plaintiff filed this lawsuit. in her federal complaint, Plaintiff asserts that the W&S denial was arbitrary and capricious and in violation of ERISA and Defendants’ fiduciary obligations. (Doc. 1). Specifically, Plaintiff alleges that W&S “failed to exercise the statutorily required duty of care and prudence, failing to administer the Plan solely in the interests of the participants and beneficiaries as required under 28 U.S.C. §1104(a)(1)”; “by denying benefits to the Plaintiff contrary to the law and terms of the Plan” and because W&S “arbitrarily ignored and selectively reviewed documents Plaintiff has submitted and has failed to provide a full and fair review.” (Doc. 1, J 32). In support of her claims, Plaintiff alleges in part that W&S sent an incomplete claim file to the Appeals Committee for review of the denial of her claim for short-term benefits, and took no action after they became aware of omissions. (Doc. 1, [J 25-27; Doc. 17-1, PagelD 83-116). On or about January 10, 2024, Plaintiff filed an additional claim seeking long term disability (“LTD”) benefits under the Plan. (Doc. 17, 3). W&S denied that claim by letter

iPlaintiffs counsel has submitted a Declaration under penalty of perjury in support of her opposition to Defendants’ motion to dismiss, as well as excerpts from the Administrative Record and an invoice reflecting her attorney’s fees through October 31, 2024. (Docs. 17, 17-1, 17-2). As discussed below, the undersigned considers both parties’ evidentiary submissions in the context of Defendants’ factual attack on this Court's subject matter jurisdiction.

dated April 8, 2024, shortly after this lawsuit was filed. (Doc. 17, 94). On the same date, issued a letter allegedly approving short-term disability benefits for March 25-May 7, 2024, dates for which Plaintiff maintains that she should have been eligible for LTD benefits. (/d.) In order to administratively exhaust her separate LTD claim, Plaintiff filed a separate administrative appeal of the decision denying her LTD benefits on October 2, 2024. (Doc. 17, J 6). Plaintiffs counsel attests that also on October 2, in the course of settlement discussions for the above-captioned case, she notified defense counsel that a resolution of this case involving short-term benefits would require W&S to administratively reverse the prior denial in order to avoid prejudicing the resolution of her then still-pending LTD claim. While a separate claim, counsel represents that the outcome of the LTD claim depended in part on the existence of a short-term benefits award. (Doc. 17, J 8; Doc. 18, PagelD 121-122). Plaintiffs counsel's email to defense counsel stated: “I’m open to discussing the contours of this but to me the easiest thing seems to be an administrative decision by W&S that would essentially render the lawsuit moot as to her [short-term] benefit claim, and settlement as to (my limited) attorney fees and costs.” (Doc. 17, J 8). Approximately two weeks later on October 18, 2024, the Western & Southern Benefits Appeals Committee issued a letter to Plaintiffs counsel stating that, in connection of Plaintiffs October 2 appeal of the denial of LTD benefits under the Plan, it had “further considered” its prior administrative denial of her appeal for short-term benefits. (Doc. 15-1, PagelD 47). The letter concludes: “Based on additional information received by the Benefits Appeals Committee, the Benefits Appeals Committee has determined that Ms. House-Forshee was unable to perform the normal duties of her

regular occupation for any employer from July 8, 2023 through October 30, 2023.” (/d.) The October 18 letter does not identify what “additional information” was received by W&S, when it was received, or from whom. Plaintiff asserts that Defendants “had all potentially relevant information to ...change its mind for at feast 10 months,” dating to Plaintiffs submission of records with her LTD application on or about January 10, 2024. (Doc. 18, PagelD 131) (emphasis original). In other words, Plaintiff disputes that any “additional information” was received by W&S beyond the initiation of this lawsuit and counsel’s settlement demand. Following notice of the reversal of the adverse benefits decision, Plaintiff's counsel represents that she continued settlement discussions concerning her attorney’s fees, which totaled $4,108.50 as of October 31, 2024.2 At Defendants’ request, Plaintiff withdrew her outstanding discovery requests, and the parties jointly sought to extend the Court’s Calendar deadlines. (Doc. 16, J] 5, 7). The parties never consummated a written settlement. Instead, on January 30, 2025, Defendants moved to dismiss based on their post-litigation reversal of the decision denying Plaintiffs claim for short-term benefits. According to W&S, this federal case is now moot because Plaintiff has been paid all short-term benefits to which she is entitled. Il. Analysis A. Standard of Review and Burden of Proof under Rule 12(b)(1) Defendants assert that this Court no longer has subject matter jurisdiction under Rule 12(b)(1), Fed. R. Civ. P. The standard of review for a motion to dismiss filed under

2Doc. 17-2 (Attorney Fee Invoice). Curiously, counsel's time records suggest that she was notified of the reversal of the benefits decision not on October 18, 2024, the date of the letter, but on October 2, 2024. (Doc. 17-2, PagelD 117).

Rule 12(b)(1) depends on the type of motion that has been filed. Rule 12(b)(1) motions to dismiss for lack of subject-matter jurisdiction generally come in two varieties: a facial attack or a factual attack. Ohio Nat'l Life Ins. Co. v. United States, 922 F.2d 320

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House-Forshee v. Benefits Committee of Western & Southern Financial Group Company Flexible Benefits Plan, Counsel Stack Legal Research, https://law.counselstack.com/opinion/house-forshee-v-benefits-committee-of-western-southern-financial-group-ohsd-2025.