Mohammed v. The Prudential Insurance Company of America

CourtDistrict Court, N.D. Illinois
DecidedAugust 7, 2020
Docket1:19-cv-03258
StatusUnknown

This text of Mohammed v. The Prudential Insurance Company of America (Mohammed v. The Prudential Insurance Company of America) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mohammed v. The Prudential Insurance Company of America, (N.D. Ill. 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION

HARES MOHAMMED, ) ) Plaintiff, ) ) v. ) 19 C 3258 ) ) THE PRUDENTIAL INSURANCE ) COMPANY OF AMERICA, ) Judge John Z. Lee ) Defendant. )

MEMORANDUM OPINION AND ORDER Hares Mohammed has sued The Prudential Insurance Company of America (“Prudential”), alleging that Prudential improperly denied his claim for disability benefits and breached its fiduciary duty in violation of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B), (a)(3). Prudential has moved to dismiss the action pursuant to Federal Rule of Civil P. 12(b)(6) and to quash Mohammed’s subpoenas to third-party claims administrators. For the reasons below, Prudential’s motion to dismiss is granted in part and denied in part, and its motion to quash is denied. I. Background1 Mohammed suffers from Parkinson’s disease, an incurable degenerative condition that has “caused tremors and loss of motor functioning in his hands.” Am.

1 On a motion to dismiss, the court “accept[s] as true all well-pleaded factual allegations and draw all reasonable inferences in favor of the plaintiff.” Heredia v. Capital Mgmt. Servs., L.P., 942 F.3d 811, 814 (7th Cir. 2019). Compl. ¶¶ 14–15, ECF No. 34. As a result of his condition, Mohammed stopped working for his employer, Capgemini America, Inc., in February 2017. Id. ¶ 16. Mohammed worked for Capgemini as a Network Engineer, a position that entailed

typing work he could no longer perform due to his condition. Id. As a Capgemini employee, Mohammed was a participant in Capgemini’s short-term disability (“STD”) and long-term disability (“LTD”) plans, both of which are insured by Prudential. Id. ¶ 9. Prudential both determines participants’ eligibility and pays benefits under these plans. Id. ¶ 10. After Mohammed stopped working for Capgemini, Prudential approved his claim for STD benefits. Id. ¶ 18. But Prudential refused to extend these benefits

beyond May 25, 2017, citing purported statements from Mohammed’s “treating physician” that he was able to work. Id. ¶ 19. Several months later, in November 2017, Mohammed appealed the denial of his STD benefits, claiming Prudential had mischaracterized his doctor’s statements and supplying “more recent notes from another doctor demonstrating his inability to perform his occupation.” Id. ¶ 21. About three weeks later, Prudential upheld its denial. Id. ¶ 22.

The following month, in January 2018, Mohammed hired counsel in preparation for a second administrative appeal. Id. ¶ 24. Before appealing, however, Mohammed took a job at Transunion as a Network Engineer, allegedly out of financial desperation caused by Prudential’s delay in approving his STD claim. Id. ¶ 26. Mohammed filed his second appeal in June 2018. Id. ¶ 25. This time, Mohammed succeeded, and in July 2018, Prudential paid him the remainder of the STD benefits he was due under the plan. Id. ¶ 29. Around the same time, Mohammed stopped working for Transunion because

his condition “severely limited” his ability to work and caused him to miss deadlines. Id. ¶ 28. He then sought and received STD benefits under a plan insured by Transunion. Id. Transunion’s plan administrator, unlike Prudential, immediately approved Mohammed’s STD claim. Id. Prudential also approved Mohammed’s claim for LTD benefits and paid him up until the time he began working with Transunion. Id. ¶ 31. But Prudential denied LTD benefits thereafter, reasoning that Mohammed’s income from

Transunion constituted “disability earnings” that “exceeded 80% of his indexed monthly earnings” with Capgemini. Id., Ex. 5, 11/27/18 Letter from B. Bartosz to M. Bartolic (“Denial Letter”), at 4, ECF No. 34-6.2 Under Capgemini’s LTD plan, “[d]isability earnings . . . include earnings from other employment that you receive for work which began after you became disabled. This would be, based on your restrictions and limitations . . . the work you are able to do . . . .” Id., Ex. 3, Long

Term Disability Plan (“LTD Plan”), at 15, ECF No. 34-4. Claims under the LTD plan terminate when a claimant’s disability earnings exceed 80% of his indexed monthly earnings with Capgemini. Id. For his part, Mohammed claims his earnings with Transunion are not “disability earnings” under the plan because he was not “able to do” the work of a Transunion Network Engineer. Id. ¶ 41.

2 Specifically, Mohammed’s monthly earnings with Transunion totaled $10,833.33, while his monthly earnings with Capgemini were only $10,262.83. Denial Letter at 4. Mohammed appealed Prudential’s denial of LTD benefits in February 2019. Id. ¶ 35. The next month, Prudential upheld the denial based on its prior interpretation of the plan’s “disability earnings” provisions, though it

“acknowledge[d] . . . Mohammed’s medical condition and reported continuing disability from his Regular Occupation.” Id., Ex. 6, 3/6/19 Letter from A. Billines to M. Bartolic (“Appeal Decision”), at 3, ECF No. 34-7. In its letter upholding the denial, Prudential raised for the first time an alternative argument that Mohammed was not “disabled” under the plan because, in light of his income with Transunion, “he no longer experienced a 20% or more loss in his monthly earnings.” Id.3

Rather than file a second appeal, Mohammed sued Prudential under two subsections of ERISA. Under 29 U.S.C. § 1132(a)(1)(B), Mohammed claims Prudential wrongly denied him LTD benefits based on an incorrect interpretation of the LTD plan. Am. Compl. ¶ 49. In the alternative, under 29 U.S.C. § 1132(a)(3), Mohammed argues Prudential breached its fiduciary duty in improperly delaying approval of his claim for STD benefits. Id. ¶ 54. Mohammed alleges this delay

forced him to seek alternative employment that, in Prudential’s view, disqualified him from receiving LTD benefits. Id. ¶¶ 55–56. In litigating this action, Mohammed has also subpoenaed two third-party claims administrators who paid

3 The plan’s definition of “disability” requires that a claimant experience a loss of 20% or more in his monthly earnings. LTD Plan at 11. “[M]onthly earnings” are defined as “your gross monthly income from your Employer in effect just prior to your date of disability.” Id. at 12. The plan further defines “Employer” as “the Contract Holder” (in this case, Capgemini). Id. at 5. his claims for STD benefits “without any denials or terminations.” Pl.’s Resp. Opp’n Mot. Quash at 4, ECF No. 50. II. Legal Standard

To survive a Rule 12(b)(6) motion to dismiss, a complaint must “state a claim to relief that is plausible on its face.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). That said, when considering motions to dismiss, the Court accepts “all well- pleaded factual allegations as true and view[s] them in the light most favorable to

the plaintiff.” Lavalais v. Vill. of Melrose Park, 734 F.3d 629, 632 (7th Cir. 2013). At the same time, “allegations in the form of legal conclusions are insufficient to survive a Rule 12(b)(6) motion.” McReynolds v.

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Mohammed v. The Prudential Insurance Company of America, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mohammed-v-the-prudential-insurance-company-of-america-ilnd-2020.