Ouellette v. Prudential Financial, Inc.

CourtDistrict Court, District of Columbia
DecidedSeptember 21, 2011
DocketCivil Action No. 2011-0454
StatusPublished

This text of Ouellette v. Prudential Financial, Inc. (Ouellette v. Prudential Financial, Inc.) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ouellette v. Prudential Financial, Inc., (D.D.C. 2011).

Opinion

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

COLEMAN SCOTT MOFFETT on his own behalf and on behalf of all other persons similarly situated,

Plaintiffs, Civil Action No. 9‐cv‐1915 (RLW) v.

PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA; HILDA L. SOLIS, in her official capacity as Secretary of the United States Department of Labor

Defendants.

CHRISTOPHER C. OUELLETTE, on his own behalf and on behalf of all other persons similarly situated,

Plaintiffs, Civil Action No. 11‐cv‐00454 (RLW) v.

PRUDENTIAL FINANCIAL, INC. (d/b/a PRUDENTIAL INSURANCE COMPANY OF AMERICA; and HILDA L. SOLIS (Secretary of the Department of Labor)

MEMORANDUM OPINION1

This is an as-yet uncertified class action in which plaintiffs Coleman Scott Moffett

(“Moffett”) and Christopher C. Ouellette (“Ouellette”) (collectively, “Plaintiffs”) bring an action

1 This is a summary opinion intended for the parties and those persons familiar with the facts and arguments set forth in the pleadings; not intended for publication. against Prudential Life Insurance Company of America (“Prudential”) and Hilda L. Solis in her

official capacity as Secretary of the United States Department of Labor (“Secretary Solis” or “the

Secretary”) (collectively, “Defendants”), alleging Fifth Amendment due process violations against

Prudential, and challenging the Employee Retirement Income Security Act of 1974 (“ERISA”), 29

U.S.C. §§ 1001-1461, and the United States Department of Labor’s (“DOL”) Rules and Regulations

as unconstitutional under the due process clause.

This matter is before the Court on Defendants' Motions to Dismiss (Docket. Nos. 10 & 12)

for lack of subject matter jurisdiction pursuant to Rule 12(b)(1) and failure to state a claim for which

relief can be granted pursuant to Rule 12(b)(6). See Fed. R. Civ. P. 12(b)(1); 12(b)(6). Having

considered the full briefing on these motions, and for the reasons set forth below, Defendants’

motions are GRANTED and Plaintiffs’ complaints in this consolidated action are dismissed with

prejudice.

I. BACKGROUND

A. Statutory Background

Congress enacted ERISA to “protect ... the interests of participants in employee benefit plans

and their beneficiaries” by setting out substantive regulatory requirements for employee benefit

plans and “providing for appropriate remedies, sanctions, and ready access to the Federal courts.” 29

U.S.C. § 1001(b). The purpose of ERISA is to provide a uniform regulatory regime over employee

benefit plans. Aetna Health, Inc. v. Davila, 542 U.S. 200, 208 (2004).

2 Section 503 of ERISA, 29 U.S.C. § 1133, requires companies to provide a claims procedure

available following the denial of benefits to a plan participant. Specifically, section 503 provides

that every employee benefit plan shall:

(1) provide adequate notice in writing to any participant or beneficiary whose claim for benefits under the plan has been denied, setting forth the specific reasons for such denial, written in a manner calculated to be understood by the participant, and

(2) afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim.

29 U.S.C. § 1133. ERISA further provides that “the Secretary may prescribe such regulation as

he finds necessary or appropriate to carry out the provisions of this subchapter.” Id. § 1135.

Pursuant to this authority, the Secretary promulgated regulations which set forth minimum

procedural requirements for “full and fair review” of adverse benefit determinations. In addition

to providing claimants with the opportunity to submit and obtain additional information related

to their claim for benefits, see 29 C.F.R. § 2560.503-1(h)(2)(ii)-(iv), the regulations also require

that every employee benefit plan

[p]rovide for a review that does not afford deference to the initial adverse benefit determination and that is conducted by an appropriate named fiduciary of the plan who is neither the individual who made the adverse benefit determination that is the subject of the appeal, nor the subordinate of such individual.

29 C.F.R. § 2560.503-1(h)(3)(ii).

3 B. Factual Background

Moffett and Ouellette were each insured under a group disability insurance policy issued by

Prudential to their respective employers. The facts pertaining to each Plaintiff are as follows.

Moffett is a former employee of a corporation known as PEP-Direct. (Compl. ¶ 6). In January

2007, PEP-Direct concluded that Moffett’s disability rendered him unable to perform his

occupational duties and terminated his active employment with the company. (Compl. ¶ 9).

Prudential initially paid Moffett short-term benefits for a period of twelve weeks, but later

terminated short-term disability benefits, and denied long-term disability benefits, when it concluded

that Moffett was not disabled from his occupation. (Compl. ¶ 13). Moffett, although allowed two

appeals under his employer’s plan, was denied on both appeals. (Compl. ¶¶ 27-32).

Ouellette was insured through his employer, H.P. Hood, under a Prudential policy for both

short and long-term disability. (Compl. ¶ 7). Ouellette, like Moffett, was initially paid short-term

disability benefits by Prudential, but was later denied his long-term disability claim because

Prudential concluded that Ouellette’s disability did not prevent him from performing the material

and substantive duties of his occupation. (Compl. ¶ 11). Ouellette exercised his right to two appeals

under his employer’s plan, but both appeals were denied. (Compl. ¶ 20).

C. Procedural History

On October 7, 2009, Moffett filed a complaint against Prudential and the Secretary

challenging the constitutionality of the appeals process set forth in ERISA and the DOL’s

regulations implementing ERISA, and alleging that Prudential’s denials of administrative appeals

4 violate the due process clause of the Fifth Amendment and, therefore, should be deemed unlawful

and void.

Moffett’s complaint alleges three counts. Count I is directed to Prudential only and alleges

that Prudential’s denials of administrative appeals are unlawful and void because its appeals process,

which involves a financially interested decision-maker, violates the due process clause of the Fifth

Amendment. Count II is directed to the Secretary and alleges that the Department of Labor has

failed to meet its obligations under ERISA to ensure that section 503(2) is interpreted, applied, and

exercised in a manner consistent with due process.2 In Count III, Moffett pleads in the alternative

and claims that if section 503(2) is not interpreted as guaranteeing plan participants’ rights to a

financially neutral adjudicator, then section 503(2) “must be declared unconstitutional as an overly

broad delegation of adjudicatory authority.” (Compl. ¶ 65).

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