Klecher v. Metropolitan Life Insurance

331 F. Supp. 2d 279, 2004 U.S. Dist. LEXIS 17405, 2004 WL 1925160
CourtDistrict Court, S.D. New York
DecidedAugust 27, 2004
Docket01 CIV. 9566(PKL)
StatusPublished
Cited by6 cases

This text of 331 F. Supp. 2d 279 (Klecher v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Klecher v. Metropolitan Life Insurance, 331 F. Supp. 2d 279, 2004 U.S. Dist. LEXIS 17405, 2004 WL 1925160 (S.D.N.Y. 2004).

Opinion

OPINION AND ORDER

LEISURE, District Judge.

Plaintiff in this ERISA action, Sharon Klecher, challenges the termination of Long-Term Disability (“LTD”) benefits under her employer’s benefit plan. Plaintiff originally brought a complaint against her employer’s insurance plan, defendant Oxford Health Plans, Inc. Employee Welfare Plan (“the Plan”), and the Plan’s insurer and claims administrator, defendant Metropolitan Life Insurance Company (“MetLife”). Klecher, the Plan and Met-Life cross-moved for summary judgment, and this Court ruled on these cross-motions in an opinion and order dated June 6, 2003. Klecher v. Metropolitan Life, 2003 WL 21314033 (S.D.N.Y. June 6, 2003). In light of the Court’s summary judgment ruling, plaintiff now moves for leave to amend her complaint under Rule 15 of the Federal Rules of Civil Procedure. Defendants oppose plaintiffs motion. For the reasons set forth below, the Court denies plaintiffs request for leave to file her proposed amended complaint, but grants plaintiff leave to file an amended complaint with limited changes to her original complaint.

Background

This action arises from the denial of LTD benefits to plaintiff. 1 Plaintiff worked for Oxford Health Plans Inc. (“Oxford”) as a Director of Provider Operations, and was a participant in, and beneficiary of, their group long-term disability plan. The plan is governed by ERISA. Oxford established and maintains the Plan, and pays the premiums for coverage on behalf of the participating employees. Benefits under the Plan are funded through a group insurance policy issued by MetLife, which fully insures the disability plan and is the claims administrator.

Klecher stopped working on October 20, 1998, and following her receipt of Short Term Disability benefits for a period, under the Terms of the Plan, began to receive LTD benefits on April 21, 1999. By letter dated October 4, 1999, MetLife terminated Klecher’s LTD benefits, informing her that MetLife had reviewed her claim file and the additional medical updates regarding her disability, and that MetLife determined that plaintiff was not “disabled” under the terms of the Plan. Plaintiff disputes this determination, and the actions taken by defendants to reach this determination.

I. Plaintiffs Original Complaint

Plaintiff brought a complaint for her ordinary denial of benefits dispute, setting forth in the complaint four distinct claims based upon four sets of allegations. Plaintiff brought her first claim against MetLife and the Plan for penalties for failure to provide plan documents under 29 U.S.C. 1132(c)(1). Plaintiff alleged in this claim that MetLife and the Plan failed to send requested documents to plaintiff. The Court granted summary judgment to Met-Life on this claim because it is not the plan administrator, and claims for payment of penalties only can be brought against plan administrators. See Klecher, 2003 WL 21314033, at *8. The Court denied summary judgment to the Plan on this claim, finding that it is the plan administrator. *281 The Court found that it could not determine whether the Plan met its obligations to send requested documents because defendants had not addressed in this litigation plaintiffs request for the applicable 1999 policy. Id. at *9. Issues about whether the Plan acted in bad faith, whether the Plan delayed or otherwise acted with prejudice in response to plaintiff’s requests for documents remained open, thus the Court denied summary judgment. Id. at *9 n. 14.

Plaintiffs original complaint set forth a second claim against the Plan for miscalculation of benefits. Plaintiff alleged in this claim that the Plan miscalculated her salary and denied her benefits due based on this miscalculation. The Court construed this claim as one brought for denial of benefits under 29 U.S.C. § 1132(a)(1)(B). The Court dismissed the claim because plaintiff had not exhausted her administrative remedies. Klecher, 2003 ■ WL 21314033, at *10.

Plaintiffs original complaint set forth a third claim against the Plan for breach of fiduciary duty. Plaintiff alleged in this claim that Oxford gave incorrect information to MetLife. Plaintiff alleged in particular that Oxford did not use the 1999 Plan although the terms of that Plan should have applied, and that Oxford described plaintiffs job to MetLife as “sedentary” rather than “light.” The Court noted that plaintiff had named and served the Plan, not Oxford, and thus reviewed the third claim as if brought against the Plan. The Court construed the claim as one brought for breach of fiduciary duty under 29 U.S.C. § 1132(a)(2). The Court then dismissed the claim because plaintiff sought individual relief, but § 1132(a)(2) only permits relief sought on behalf of the Plan. Klecher, 2003 WL 21314033, at *9.

Plaintiffs original complaint set forth a fourth and final claim against MetLife for incorrect determination of benefits. Plaintiff titled the claim as one for “breach of fiduciary duty,” and alleged that MetLife operated under a “conflict of interest,” and also that it acted arbitrarily and capriciously in determining that plaintiff was not entitled to LTD benefits. The Court noted that this claim would fail if brought as a breach of fiduciary duty claim under § 1132(a)(2) because plaintiff sought individual relief, id. at *7 n. 9, then construed the claim as one brought for denial of benefits under § 1132(a)(1)(B). Id. The Court denied summary judgment to defendants on this claim, finding that a genuine issue of material fact remains in dispute about which plan document controlled the determination of plaintiffs benefits. Id. at *7.

In sum, the Court’s summary judgment decision upon plaintiffs original complaint included three key rulings. First, the identity of the plan that governs plaintiffs benefits is not yet clear. Klecher, 2003 WL 21314033, at *7. Second, plaintiff has not exhausted her administrative remedies. Klecher, 2003 WL 21314033, at *10. And third, plaintiff seeks to recover damages on her own behalf, not on behalf of the Plan. Klecher, 2003 WL 21314033, at *9. Upon these rulings the Court upheld claim one against the Plan and claim four against MetLife and dismissed the rest of the claims.

II. Plaintiff’s Proposed Amended Complaint

Plaintiff now moves for leave to amend her complaint and submits her proposed amended complaint with her notice of motion. Plaintiffs amended complaint includes three claims.

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Cite This Page — Counsel Stack

Bluebook (online)
331 F. Supp. 2d 279, 2004 U.S. Dist. LEXIS 17405, 2004 WL 1925160, Counsel Stack Legal Research, https://law.counselstack.com/opinion/klecher-v-metropolitan-life-insurance-nysd-2004.