James v. American General Assurance Co.

816 F. Supp. 2d 471, 191 L.R.R.M. (BNA) 3033, 2011 U.S. Dist. LEXIS 101388, 2011 WL 3957651
CourtDistrict Court, E.D. Michigan
DecidedSeptember 8, 2011
DocketCivil Action No. 10-CV-12083
StatusPublished

This text of 816 F. Supp. 2d 471 (James v. American General Assurance Co.) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
James v. American General Assurance Co., 816 F. Supp. 2d 471, 191 L.R.R.M. (BNA) 3033, 2011 U.S. Dist. LEXIS 101388, 2011 WL 3957651 (E.D. Mich. 2011).

Opinion

OPINION AND ORDER GRANTING DEFENDANTS’ MOTION TO DISMISS FOR LACK OF SUBJECT MATTER JURISDICTION and GRANTING PLAINTIFF LEAVE TO FILE AMENDED COMPLAINT

MARK A. GOLDSMITH, District Judge.

I. INTRODUCTION

This case is filed pursuant to the Employee Retirement Income Security Act, 29 U.S.C. § 1001, et seq. (“ERISA”). Plaintiff Dennis G. James, a former employee of Northwest Airlines, Inc. (“NWA”), suffered injuries as a result of a car accident in 2002. Defendants Northwest Airlines Pension Plan for Contract Employees (“Pension Plan”) and Northwest Airlines Long Term Disability Plan (“LTD Plan”) denied Plaintiffs separate claims for disability-pension benefits and long-term disability benefits, respectively. Plaintiff challenges both denials, asserting that they were improper.1

Now before the Court is the Plan Defendants’ motion to dismiss for lack of subject matter jurisdiction.2 The Plan Defendants argue that the case must be dismissed in its entirety for lack of subject matter jurisdiction pursuant to the mandatory arbitration provision of the Railway Labor Act (“RLA”), 45 U.S.C. § 151 et seq. The matter is fully briefed and oral argument was heard on April 28, 2011. After oral argument, the Court requested, and the parties submitted, two rounds of supplemental briefing relating to two discrete issues. For the reasons that follow, the Court concludes that it lacks jurisdiction over this matter. Thus, the motion to dismiss of the Plan Defendants will be granted; Plaintiff will be granted leave to file an amended complaint within 14 days of today’s date, if he so chooses.

II. BACKGROUND3

Plaintiff is a former NWA reservation sales agent. Def. Ex. C, NWDP_JAMES 0225. In December 2002, Plaintiff suffered physical injuries, including a tom right rotator cuff, resulting from a car accident. Id. Plaintiff briefly returned to work after the accident but on March 26, 2000, ceased working and never returned.4 [476]*476On December 19, 2005, Plaintiff was awarded social security disability benefits on the finding that he was unable to engage in any substantial gainful employment. Def. Ex. C, NWDP_JAMES 0225-0226.

Plaintiff is a participant of, and filed claims under, two separate ERISA-governed employee benefit plans: the Pension Plan and the LTD Plan. Plaintiffs claims under both plans were denied; his claim for disability-pension benefits was denied by the Pension Plan, and his claim for long-term disability benefits was denied by the LTD Plan and its administrator, Defendant American General Assurance Company (“AGA”).5 In this lawsuit, Plaintiff challenges both denials.

The Pension Plan is a tax-qualified defined benefit pension plan for the benefit of eligible union-represented employees of NWA. Def. Ex. A, NWPPCE 0006. The plan provides eligible employees with disability-pension benefits. Employees are eligible to participate in the Pension Plan only if their collective bargaining agreement (“CBA”) authorizes it. Id. at 0019. There is no dispute that Plaintiff is eligible to participate in the Pension Plan because it has been adopted by the CBA between NWA and Plaintiffs union, the International Association of Machinists and Aerospace Workers (“IAM”). Def. Ex. B, IA1VLCBA 0266.

Under the Pension Plan, employees are eligible for disability-pension benefits if the employee suffers a “total and permanent disability which renders the Participant incapable of any employment with the Employer.” Def. Ex. A, NWPPCE 0011. In order to receive disability-pension benefits, the claimant must be deemed “disabled” as of the employee’s “disability retirement date,” which is the date on which the employee exhausts all vacation and sick leave benefits, and any other incapacity benefits. Id. at 0012.

The process governing the adjudication of disability-pension benefit claims is outlined in the Pension Plan and the CBA. At the initial step, the Pension Plan determines whether the claimant qualifies for benefits. Id. If the claimant disagrees with the Plan’s determination, then the matter proceeds to step two. At step two, the matter is referred to a mutually-agreeable independent physician, who conducts an independent medical examination and renders a binding opinion as to whether the claimant is disabled under the terms of the Pension Plan. Id. If the claimant disagrees with the independent physician’s disability determination, the claimant may pursue a step three appeal through the system board of adjustment (“SBA”). Def. Ex. B, IAMLCBA 187-189.

Plaintiff submitted his claim under the Pension Plan on or about July 13, 2006. The claim was denied at step one on a finding that Plaintiff was not totally and permanently disabled as of March 26, 2003, his purported disability retirement date. Def. Ex. C, NWDP_JAMES 0222-0227. Plaintiff appealed the initial denial and, pursuant to the terms of the Pension Plan, selected Dr. Mitchell Z. Poliak, M.D. as an independent physician. Def. Ex. D, NWDP_JAMES 0277.

[477]*477Dr. Poliak reviewed Plaintiffs medical records and performed a physical examination in order to determine whether Plaintiff was totally and permanently disabled as of March 26, 2003. Dr. Poliak concluded that although Plaintiff was totally disabled as of March 26, 2003, he was not also permanently disabled on that date. According to Dr. Poliak, Plaintiff was not permanently disabled until later — sometime between his first shoulder surgery on March 27, 2003 and his second shoulder surgery on April 29, 2003. Plaintiff was informed of the denial of his claim at step two by letters dated September 6 and 18, 2007. Id. at 0277-0288.

On November 26, 2007, Plaintiff wrote to the Pension Plan challenging the disability retirement date (March 26, 2003) used to determine whether he was entitled to disability-pension benefits. Plaintiff argued that a later date applied because he had not yet exhausted all his unpaid sick time as of March 26, 2003. The Pension Plan agreed with Plaintiff and determined that his correct disability retirement date was one day later, March 27, 2003. Accordingly, the Pension Plan sustained Plaintiffs challenge, re-opened his claims file, and instructed Dr. Poliak to reevaluate his opinion in light of the one-day change in the disability retirement date. Def. Ex. F, NWDP_JAMES 0147-0150. Dr. Poliak re-evaluated Plaintiffs claim, but ultimately reached the same conclusion as before. Def. Ex. G, NWDP_JAMES 0116-0119; Def. Ex. H, NWDP_JAMES 0120.6

Plaintiff was notified of Dr. Poliak’s decision by letter dated April 8, 2008. Def. Ex. I, NWDP-JAMES 0114. On April 14, 2008, Plaintiff spoke to Christine Wolff, the Pension Plan’s administration manager, inquiring how to proceed. NWDP_JAME S 0522 (docket entry 22-5). He was advised by Wolff “to file a request for system board review through his union.” Id.

The next month, on June 10, 2008, Plaintiff wrote a letter to Jerry Cross, an IAM representative, advising that the Pension Plan had denied his claim for disability-pension benefits.

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816 F. Supp. 2d 471, 191 L.R.R.M. (BNA) 3033, 2011 U.S. Dist. LEXIS 101388, 2011 WL 3957651, Counsel Stack Legal Research, https://law.counselstack.com/opinion/james-v-american-general-assurance-co-mied-2011.