Peterson v. The Lincoln National Life Insurance Company

CourtDistrict Court, D. Massachusetts
DecidedMarch 31, 2025
Docket4:23-cv-40097
StatusUnknown

This text of Peterson v. The Lincoln National Life Insurance Company (Peterson v. The Lincoln National Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Peterson v. The Lincoln National Life Insurance Company, (D. Mass. 2025).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS

DEBORAH PETERSON,

Plaintiff,

v.

THE LINCOLN NATIONAL LIFE Case No. 4:23-CV-40097-MRG INSURANCE COMPANY,

Defendant.

GUZMAN, D.J. MEMORANDUM & ORDER ON PLAINTIFF’S MOTION FOR PARTIAL SUMMARY JUDGMENT [ECF No. 29] AND DEFENDANT’S MOTION FOR SUMMARY JUDGMENT [ECF No. 32]

I. INTRODUCTION This is a long-term disability (“LTD”) insurance benefits denial case. Plaintiff- plan participant Deborah Peterson has sued Defendant-insurance carrier The Lincoln National Life Insurance Company alleging various state-law claims arising from a failure to pay LTD benefits under an employee welfare benefits plan administered by her employer, non-party Notre Dame Health Care Center, Inc. (“NDHCCI”). Before the Court are the parties’ cross-motions for summary judgment. [ECF No. 29; ECF No. 32]. At the moment, the heart of the dispute is whether NDHCCI’s benefits plan is governed by ERISA1 or if, conversely, it is a “church plan” and thus exempt from the statute’s requirements. After a careful review of the facts and an exercise in statutory interpretation,

the Court ultimately concludes that NDHCCI’s benefits plan is not a church plan because it was neither (a) established or maintained by a church or association of churches nor (b) is it maintained by a principal-purpose organization. Therefore, Roberts’ state law claims are preempted by ERISA. Accordingly, Plaintiff’s claims are DISMISSED WITHOUT PREJUDICE to Plaintiff’s ability to file a new action asserting claims under ERISA.

II. BACKGROUND a. The Facts2 i. NDHCCI

Plaintiff served as a Coordinator of Rehabilitation Services at non-party NDHCCI until October 20, 2020, when a disability allegedly required her to cease working. [ECF No. 10 at 4–5]. NDHCCI is a civil organization organized in the Commonwealth of Massachusetts in 1990. [ECF No. 35-1]. According to its Articles of Organization, its purpose is to: To establish, maintain, own and operate health care facilities, including nursing homes, to provide and render, and to employ others to provide

1 “ERISA” refers to the Employee Retirement Income Security Act of 1974, a federal statute. As a general matter, ERISA “obligates private employers offering pension plans to adhere to an array of rules designed to ensure plan solvency and protect plan participants.” Advocate Health Care Network v. Stapleton, 581 U.S. 468, 472 (2017) (citations omitted).

2 The following facts are undisputed unless otherwise noted. and render, medical, minor surgical, custodial and other health—related services as permitted by the law of the Commonwealth of Massachusetts; (b) to do any and all other acts which are necessary, incidental or useful to the establishment and operation of an organization for the foregoing purposes and related to the maintenance and delivery of high-quality health care services; and (c) to engage in the foregoing activities while adhering to applicable philosophy and tenets of the Roman Catholic Church and the Sisters of Notre Dame De Namur.

[Id.]

In practice, NDHCCI has repeatedly stated in annual Internal Revenue Service (“IRS”) filings that its mission and/or most significant activity is to “provide quality nursing and hospice care for the elderly and poor residents of the community.” [ECF No. 35-2 at 2–5]. According to its by-laws, the “Members” of the organization are, ex officio, the moderator and the leadership team of the Sisters of Notre Dame de Namur’s East-West Province. [ECF No. 30-5 at 5]. Further, there must be between six and eighteen “Directors,” at least six of whom must be Sisters of Notre Dame de Namur. [Id. at 7]. In terms of “Officers,” the organization must have a president, a treasurer, and a clerk. [Id. at 10]. NDHCCI is a 501(c)(3) not-for-profit corporation, and it is included in The Official Catholic Directory, which lists Roman Catholic institutions in the United States. [ECF No. 10 at 3–4]. ii. The Plan and the Group Policy NDHCCI maintains a suite of employee benefits plans, including health and dental benefits, long-term disability (“LTD”) benefits, short-term disability benefits, accidental death and dismemberment benefits, as well as life insurance benefits. E.g., [ECF No. 43 at 2]. According to its by-laws, NDHCCI established its LTD benefits plan (the “Plan”) “to assist employees in their efforts to financially take care of themselves and their families if rendered temporarily disabled.” [Id.] To fund the Plan, NDHCCI purchased a group insurance policy from

Defendant -- specifically Policy No. 10226010 (the “Group Policy”). [ECF No. 35-6; ECF No. 35-7]. The Group Policy’s formal name is “Group Long Term Disability Insurance For Employees of Notre Dame Health Care Center, Inc.” [See ECF No. 43 at 3–4]. Under the Group Policy, NDHCCI is the policyholder and pays the premium for its employees’ LTD benefits coverage. [See id.] Notably, the policy application that NDHCCI submitted to Defendant in December 2012 shows that NDHCCI

checked boxes indicating its understanding that the Plan was subject to ERISA and that it was responsible for providing summary plan descriptions to its employees. [ECF No. 35-3 at 5].3 Defendant contends that NDHCCI requested descriptions of the Plan that it could provide to its employees, which it later did provide. [E.g., ECF No. 35-7].4 Further, NDHCCI designated itself as the Plan Administrator of the Plan. [Id.]5

The Group Policy defined “Total Disability” or “Totally Disabled” as follows:

3 Plaintiff admits that this document speaks for itself but notes that she does not know what NDHCCI understood this form to mean when it completed it and further stated that this fact should not have any bearing on the dispute. [ECF No. 43 at 3].

4 Plaintiff states that she is unaware of any requests that NDHCCI might have made of Defendant but does acknowledges that Defendant did issue a description of the Group Policy. [Id.]

5 Specifically, the description that Defendant provided to NDHCCI explained that “[t]he [Group] Plan is administered directly by the Plan Administrator with benefits provided in accordance with provisions of the group insurance policy issued by [Defendant].” [Id. at 4]. 1.) During the Elimination Period and Own Occupation Period, it means that due to an Injury or Sickness the Insured Employee is unable to perform each of the Main Duties of his or her Own Occupation.

2.) After the Own Occupation Period, it means that due to an injury or Sickness the Insured Employee is unable to perform each of the Main Duties of any Gainful Occupation.

[ECF No. 10 at 4–5].

iii. Plaintiff and Her Claim Plaintiff has a significant medical history of scoliosis and kyphosis dating back to her childhood. [Id. at 5]. In September 2014, Plaintiff underwent a 13-level spinal fusion. [Id.] Complications from that surgery required a revision surgery in October 2015. [Id.] Plaintiff was hired by NDHCCI on or about July 17, 2017, [ECF No. 35- 8 at 2], and she participated in the Plan while she was an employee, [ECF No. 43 at 4]. Her disease allegedly progressed during her employment, and this required short stints of disability leave. [ECF No. 10 at 5]. Over time, however, Plaintiff allegedly became unable to fulfill the “Main Duties” of her occupation and she ceased work on October 20, 2020. [Id.] Plaintiff timely submitted a claim to Defendant; alleging that she was “Totally Disabled” for purposes of the Group Policy. [ECF No. 43 at 4–5]. iv. Defendant Denies the Claim; Plaintiff Pursues Internal Appeals On July 12, 2021, Defendant notified Plaintiff that it had finished its claim review and had determined that no LTD benefits were payable since she was not Totally Disabled under the Group Plan’s definition. [ECF No. 10 at 6]. On January 3, 2022, Plaintiff appealed the claim denial.

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