Stinson v. Prudential Insurance

857 F. Supp. 2d 681, 2012 WL 748626, 2012 U.S. Dist. LEXIS 30665
CourtDistrict Court, S.D. Ohio
DecidedMarch 8, 2012
DocketCase No. 2:11-CV-651
StatusPublished

This text of 857 F. Supp. 2d 681 (Stinson v. Prudential Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Stinson v. Prudential Insurance, 857 F. Supp. 2d 681, 2012 WL 748626, 2012 U.S. Dist. LEXIS 30665 (S.D. Ohio 2012).

Opinion

OPINION & ORDER

ALGENON L. MARBLEY, District Judge.

I. INTRODUCTION

This matter is before the Court on Defendant The Prudential Insurance Company of America’s (“Defendant” or “Prudential”) Motion to Dismiss the Complaint filed by Plaintiff Troy L. Stinson (“Plaintiff’ or “Stinson”). (Doc. 3, 7.) For the reasons stated herein, this Court GRANTS Defendant’s Motion to Dismiss.

II. BACKGROUND

A. Factual Background

Plaintiff is a resident of Piketon, Ohio, and his deceased wife, Gretchen Y. Stinson (“Decedent”), was also a resident of Pike-ton. Prudential is a life insurance company authorized to transact business in the State of Ohio, with its principal place of business in Newark, New Jersey. Decedent was a teacher in the Scioto Valley Local School District and licensed by the Ohio Department of Education. Decedent was also a member of the National Education Association (“NEA”), which is a labor union for educators.

Plaintiff alleges that “Prudential underwrote the Accidental Death and Dismemberment Plan held by the NEA Member Insurance Trust, policy GC 31490,” and that Decedent was a primary insured under that plan. (Compl. at ¶ 3.) Plaintiff explains in his Complaint, however, that he failed to attach a copy of the relevant plan because “Plaintiff has not been able to timely procure a verifiably accurate copy of it prior to the commencement of this action.” Id. Defendant attaches a copy of a document, entitled ‘Your NEA Insurance Booklet and Certificate,” (“Booklet”) to its Motion to Dismiss which Defendant states contains information about the plan at issue in this lawsuit; the “NEA Members Insurance Plan.” (Doc. 7, 7-1.) Plaintiff concedes in his Memorandum Contra to Defendant’s Motion to Dismiss (“Memorandum Contra”) that the NEA Members Insurance Plan (“Plan”) is the plan at issue in this lawsuit.1 While as a general rule, [683]*683courts are not to consider matters outside of the pleading when deciding a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), Tackett v. M & G Polymers, USA LLC, 561 F.3d 478, 488 (6th Cir. 2009), an exception arises when a plaintiff fails to introduce pertinent documents as part of his or her pleading, and the defendant may then introduce those documents in exhibits as part of a Rule 12(b)(6) motion, Thomas v. Publishers Clearing House, Inc., 29 Fed.Appx. 319, 322 (6th Cir.2002).2 As the Sixth Circuit has explained, “[o]therwise, a plaintiff with a legally deficient claim could survive a motion to dismiss simply by failing to attach a dispositive document upon which it relied.” Weiner v. Klais & Co., 108 F.3d 86, 89 (6th Cir.1997). Therefore, when deciding Defendant’s Motion to Dismiss, this Court may properly consider the Booklet containing information about the Plan that was incorporated by reference in the Plaintiffs Complaint.

Pages 24 through 28 of the Booklet contain a “Summary Plan Description.” (Doc. 7-1 at 24-28.) NEA sponsors the Plan, which provides “NEA members with group insurance benefits in the event of death, accident, sickness, disability, or other occurrences affecting members and families.” Id. at 25. The benefits are funded by one or more group insurance policies acquired and maintained by the trustees of the NEA Members Insurance Trust. The Life and Accidental Death & Dismemberment Insurance3 is open to NEA members on a voluntary basis. Participants select the type of coverage they want, pay the entire cost themselves, and NEA does not contribute to the cost of coverage, except during total disability waiver. The Booklet explicitly states that the purpose of the Summary Plan Description is to “inform [the participant] about the Plan’s structure,” and “is being furnished to [the participant] in compliance with the Employee Retirement Income Security Act of 1974 (ERISA).” Id.

[684]*684Participants in the Plan “are entitled to certain rights and protections under ERISA.” Id. at 27. Those right are summarized in the Summary Plan Description and include: the right to examine documents and contracts associated with the Plan, the right to copy those documents, and the right to obtain a summary financial report. The Summary Plan Description also explains that ERISA imposes duties on NEA, the trustees who operate the Life and Accidental Death & Dismemberment Insurance, and Prudential. These entities are fiduciaries, and specifically, Prudential is the “appropriate named fiduciary for purposes of the enrollment process, claim settlement, and review of denied claims.” Id. Moreover, the processes by which a participant can contest a claim for a benefit that has been denied are described, and a participant is told that if his or her claim is denied or ignored, he or she “may file suit in a state or federal court.” Id.

During all relevant times, Plaintiff alleges that he was a beneficiary of the Life and Accidental Death & Dismemberment Insurance under the Plan. On or about November 12, 2008, Decedent died as a result of accidental bodily injuries that she sustained on October 28, 2008. As a result, Plaintiff became eligible for benefits under the Life and Accidental Death & Dismemberment Insurance, making Prudential liable to Plaintiff in a total amount of $60,000. Plaintiff alleges that he has given Prudential notice and proof of his claim, performed all necessary conditions of the Plan, filled out all of the requested proof of losses, acted in good faith, and exhausted all administrative remedies under the Plan. Nevertheless, Prudential rejected his claim for benefits in its entirety.

Prudential disputes the facts related to Plaintiffs claim, and contends that Plaintiffs claim was denied in a letter dated December 14, 2009 4 on the basis that Decedent died “as the result of medical treatment of a sickness, which is expressly stated as a non-covered loss under the terms of the Plan.” (Doc. 7.) Prudential also contends that Plaintiff never appealed Prudential’s decision, despite the fact that the Plan provides Plaintiff with an opportunity to do so.

B. Procedural Background

On or around June 15, 2011, Plaintiff filed his Complaint in the Court of Common Pleas for Pike County, Ohio. Prudential removed this case in late July, pursuant to 28 U.S.C. § 1332, on the grounds that there is complete diversity jurisdiction, and also pursuant to 28 U.S.C. § 1331, on the grounds that there is federal question jurisdiction because this Court must determine whether Plaintiffs claims are preempted in whole or part by ERISA. Stinson did not file a motion for remand. [685]*685Shortly thereafter, Prudential filed this Motion to Dismiss, which is ripe for review.

III. STANDARD OF REVIEW

Federal Rule of Civil Procedure

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Bluebook (online)
857 F. Supp. 2d 681, 2012 WL 748626, 2012 U.S. Dist. LEXIS 30665, Counsel Stack Legal Research, https://law.counselstack.com/opinion/stinson-v-prudential-insurance-ohsd-2012.