Presnal v. Dearborn National Life Insurance Company

CourtDistrict Court, N.D. Indiana
DecidedJanuary 11, 2024
Docket3:23-cv-00290
StatusUnknown

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

Bluebook
Presnal v. Dearborn National Life Insurance Company, (N.D. Ind. 2024).

Opinion

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF INDIANA FORT WAYNE DIVISION

ESTATE OF MARIBETH PRESNAL, ) and EDWIN M. PRESNAL JR., Individually ) and as the Personal Representative of the ) Estate of Maribeth Presnal, ) ) Plaintiff, ) ) v. ) CASE NO.: 3:23-cv-0290-HAB ) DEARBORN NATIONAL LIFE ) INSURANCE COMPANY and ) BEACON HEALTH SYSTEM, INC. ) ) Defendants. ) ) )

OPINION AND ORDER

Maribeth Presnal (“Maribeth”) was a nurse and employee of Defendant, Beacon Health System Inc. (“Beacon”), who qualified for an Employee Welfare Benefit Plan. Under the Plan, Maribeth enrolled in basic life insurance. When Maribeth began experiencing cognitive impairments, she terminated her employment with Beacon. Beacon did not conduct an exit interview. When her husband and sole beneficiary, Plaintiff Edwin J. Presnal Jr. (“Edwin”), applied for the life insurance benefits after his wife’s passing, his claim was denied because Maribeth never converted her basic life insurance policy to a personal policy. Thus, Beacon informed Edwin that Maribeth’s coverage had terminated. Edwin sued Defendants, Beacon and Dearborn National Life Insurance Company (“Dearborn”), under the Employee Retirement Income Security Act (“ERISA”) alleging that Beacon breached its fiduciary duty by not conducting an exit interview and failing to inform Maribeth or Edwin of their rights under the Plan. (ECF No. 2). Beacon moved to dismiss Plaintiffs’ claims against it based on three grounds. (ECF No. 13). Beacon’s motion is fully briefed (ECF Nos. 13, 15, 16, 19) and ripe for ruling.

I. Standard of Review

Federal Rule of Civil Procedure 12(b)(6) provides for the dismissal of a complaint, or any portion of a complaint, for failure to state a claim upon which relief can be granted. Fed. R. Civ. P. 12(b)(6). “To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citations and internal quotation marks omitted); see also Ray v. City of Chi., 629 F.3d 660, 662-63 (7th Cir. 2011). “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.” Id. When analyzing a motion to dismiss a claim under Rule 12(b)(6), the factual allegations in the complaint must be accepted as true and viewed in the light most favorable to the plaintiff. Brokaw v. Mercer Cnty., 235 F.3d 1000, 1006 (7th Cir. 2000). That said, the Court is not “obliged to accept as true legal conclusions or unsupported conclusions of fact.” Bielanski v. Cty. Of Kane, 550 F.3d 632 Cir. 2008). And “[t]hreadbare recitals of the elements of a cause of action, supported by merely conclusory statements do not suffice.” Iqbal, 556 U.S. at 678. II. Well-Pleaded Facts

Beacon is an Indiana corporation which owns and operates hospitals in South Bend, Indiana. (ECF No. 2, ¶ 4). Beacon employed Maribeth as a full-time registered nurse and Director of Nursing in the Cardiovascular Services Department. (Id. at ¶¶ 8-9). Thus, she was eligible for and participated in an Employee Welfare Benefit Plan (“Policy”) offered by Beacon. (Id. at ¶ 9). Under the Policy, Maribeth enrolled in basic term life insurance in the amount of $145,000. (Id. at ¶ 18). She named her husband, Edwin, as the sole beneficiary. (Id. at ¶¶ 2, 25). Dearborn and Beacon were administrators and fiduciaries of the Policy. (Id. at ¶ 10). At some point, Maribeth began displaying cognitive impairments for which she was demoted because of her inability to multi-function, overall disorganization, and forgetfulness. (Id. at ¶ 12). Maribeth noticed the problems herself and confided in fellow Beacon employees that she

was struggling because of such impairments. (Id. at ¶ 13). An employee of Beacon’s human resources department told Edwin that she knew of Maribeth’s cognitive problems. (Id. at ¶ 15). And the same employee pleaded with Maribeth to get help rather than resign. (Id.). Still Maribeth terminated her employment with Beacon on December 31, 2016. (Id. at ¶ 11). Beacon performs exit interviews when employees terminate their employment in which Beacon’s Human Resources Department routinely discusses and advises the employees of their benefit rights, including health and life insurance benefits. (Id. at ¶ 10). Yet Beacon’s Human Resources Department did not conduct an exit interview with Maribeth. (Id. at ¶ 23). Nor did they advise Maribeth of her rights under the Policy after termination. (Id.).

The Policy gave Maribeth the option of converting her basic life insurance coverage to a personal policy within thirty days of her termination. (Id. at ¶ 21). Maribeth never converted the Policy. (Id. at ¶ 22). But the Policy did contain a disability clause which continues coverage if the insured becomes disabled: For Basic Life:

If you are disabled September 1, 1996, or after and are disabled due to illness or injury then your coverage will continue for 60 months, provided all premiums are paid when due, the policy is in force, and your coverage is not replaced with group life insurance provided by a new carrier.

(Id. at ¶ 19). Yet Maribeth failed to make her premium payments necessary to continue coverage under the clause. (Id. at ¶ 25). As a result, her basic life insurance coverage terminated. (Id. at ¶ 26). Months after Maribeth’s termination, she was diagnosed with Frontotemporal Dementia (“FTD”) by a neurologist at the Mayo Clinic. (Id. at ¶¶ 16-17). FTD is a “progressive neurodegenerative disease [which] causes executive dysfunction and impairs a patient’s judgment, insight, and decision-making abilities.” (Id. at ¶ 17). Maribeth’s neurologist opined that, at the time

of her termination, Maribeth could not understand the benefits and consequences of converting her life insurance coverage under the Policy. (Id. at ¶ 22). Three years after Maribeth’s resignation, Edwin applied to Dearborn for the life insurance benefits under the Policy. (Id. at ¶ 29). Dearborn denied the claim because Maribeth never converted her basic life insurance policy to a personal policy. (Id. at ¶ 30). Edwin then made a claim against Beacon. (Id. at ¶ 32). Beacon denied the claim too. (Id.) Maribeth died from complications with FTD on December 4, 2021—five years after her resignation. (Id. at ¶ 29). Plaintiffs now allege that Beacon breached its fiduciary duty to Maribeth and Edwin under ERISA by failing to inform Edwin or Maribeth of her rights under the Policy.

(Id. at ¶ 41). III. Discussion Plaintiffs’ claim for breach of fiduciary duty is based on Beacon’s alleged failure to “conduct an exit interview and inform Maribeth of her rights under the policy and/or explain to [Edwin] Maribeth’s rights under the policy at the time of her termination.” (Id.). And Plaintiffs claim that the Policy’s time limitations to convert the policy and make premium payments should be equitably tolled because of Maribeth’s mental incapacity. (Id. ¶ 39).

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Bluebook (online)
Presnal v. Dearborn National Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/presnal-v-dearborn-national-life-insurance-company-innd-2024.