Struve v. Electrolux Home Products, Inc. Life Insurance Plan

CourtDistrict Court, N.D. Illinois
DecidedFebruary 25, 2019
Docket1:17-cv-08158
StatusUnknown

This text of Struve v. Electrolux Home Products, Inc. Life Insurance Plan (Struve v. Electrolux Home Products, Inc. Life Insurance Plan) 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
Struve v. Electrolux Home Products, Inc. Life Insurance Plan, (N.D. Ill. 2019).

Opinion

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

GERALD A. STRUVE, ) ) Case No. 17-cv-8158 Plaintiff, ) ) Judge Robert M. Dow, Jr. v. ) ) ELECTROLUX HOME PRODUCTS, INC. ) LIFE INSURANCE PLAN, et. al., ) ) Defendants. ) )

MEMORANDUM OPINION AND ORDER

Before the Court are the motion to dismiss filed by Defendants Electrolux Home Products, Inc. Life Insurance Plan and Electrolux Home Products, Inc. [30], and Plaintiff’s motion to strike certain affirmative defenses asserted by Defendant Prudential Insurance Company of America [36]. For the reasons set forth below, the motion to dismiss [30] is granted, and the motion to strike [36] is granted. Further status hearing set for March 19, 2019 at 9:30 a.m. I. Background At all relevant times, Decedent Jeffrey Struve (“Decedent”)—an employee of Electrolux Home Products, Inc. (“Electrolux”)—was a participant in the Electrolux Home Products, Inc. Life Insurance Plan (the “Plan”), an employee welfare benefit plan. [Id. at ¶ 21.] Electrolux was the Plan sponsor, administrator, and a fiduciary of the Plan. [Id. at ¶ 22.] The Plan retained Defendant the Prudential Insurance Company of America (“Prudential”) to provide life insurance for the Plan’s participants and their beneficiaries under a Group Insurance Contract. [Id. at ¶ 23.] The Plan is fully insured by Prudential, so Prudential pays benefits from its own assets. [Id. at ¶ 25.] All claims determinations are made by Prudential as the claims administrator. [Id.] Prudential “has the sole discretion to interpret the terms of the Group Contract, to make factual findings, and to determine eligibility for benefits.” [1-4, at 3.] As an employee of Electrolux, Decedent was provided Group Term Life Insurance (also called Basic Life Insurance) by Prudential for $240,000 effective March 1, 2011. [1 at ¶ 28.] On or about March 9, 2013, Decedent requested and was provided $160,000.00 in “Employee

Supplemental Life Insurance” (also called “Optional Life Insurance”) with Prudential. [Id. at ¶ 29.] On or about February 28, 2013, Decedent requested an increase in “Employee Supplement Life Insurance” coverage to two times his salary ($320,000). [Id. at ¶ 29.]1 Under the terms of the Plan, Decedent was entitled to the requested increase in coverage without proof of insurability. [Id. at ¶ 31.] However, even though Decedent enrolled and agreed to pay the required contributions, Defendants refused to provide the requested increase in coverage without proof of insurability. [Id. at ¶ 32.] Specifically, Defendants required Decedent to complete a Short Form Health Statement Questionnaire, which he did. [Id.] The requested increase in coverage to two times Decedent’s salary went into effect on January 1, 2014. [Id. at ¶ 33.]

Decedent passed away on August 13, 2014 from metastatic soft tissue sarcoma myxofibrosarcoma. [Id. at ¶ 34; 1-1, at 2.] He paid all contributions up to the month during which he passed away. [1, at ¶ 34.] Decedent properly designated his son Gerald Struve (the “Beneficiary” or “Plaintiff”) as the beneficiary of any death benefits. [Id. at ¶ 36.] The Beneficiary made a claim to the Plan and Prudential for payment of the Basic Life Insurance and the Optional Life Insurance benefits. [Id. at ¶ 37.] The Basic Life Insurance benefits were paid. [Id. at ¶ 38.] However, Prudential denied the Beneficiary’s claim for Optional Life Insurance benefits because

1 The Court assumes that the complaint contains an error regarding the dates of the Decedent’s requests for supplemental life insurance, as the complaint indicates that the request for increase in such coverage came after the Decedent initially requested such coverage. Regardless, the Court does not rely on these dates in ruling on the pending motions. the Decedent purportedly made misrepresentations regarding his medical history on the Short Form Health Statement Questionnaire. [1-1.] Specifically, Prudential contended that the Decedent should have answered “yes” to the last question on the form, which asked: Within the last five years, have you been diagnosed with, or treated by a member of the medical profession for, Acquired Immune Deficiency Syndrome (AIDS) or AIDS-Related Complex (ARC), or have you been treated for or had any trouble with any of the following: heart, chest pain, high blood pressure, cancer or tumors, diabetes, lungs, kidneys, liver?

[1, at ¶¶ 3-5.] Prudential contended that the Decedent’s response was misleading “because he was diagnosed with Diabetes” within the relevant time frame. [Id. at ¶ 4.] Plaintiff brings this lawsuit against the Plan, Electrolux, and Prudential to recover benefits he contends are due under the Plan and related life insurance policies under Sections 502(a)(1)(B) and 502(a)(3) of the Employee Retirement Income Security Act of 1974 (“ERISA”). The Plan and Electrolux (hereinafter, the “Defendants”)2 moved to dismiss Plaintiff’s claims against them. Prudential answered the complaint and asserted numerous affirmative defenses. Plaintiff moved to strike certain of those of affirmative defenses. Before the Court are the motion to dismiss filed by Defendants and the motion to strike filed by Plaintiff. II. Motion to Dismiss A. Legal Standard To survive a Rule 12(b)(6) motion to dismiss for failure to state a claim upon which relief can be granted, the complaint first must comply with Rule 8(a) by providing “a short and plain statement of the claim showing that the pleader is entitled to relief,” Fed. R. Civ. P. 8(a)(2), such that the defendant is given “fair notice of what the * * * claim is and the grounds upon which it

2 Although Prudential also is a Defendant, Prudential did not move to dismiss Plaintiff’s complaint. Unless otherwise noted, references to “Defendants” hereinafter are to the two moving Defendants, the Plan and Electrolux. rests.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47 (1957)) (alteration in original). Second, the factual allegations in the complaint must be sufficient to raise the possibility of relief above the “speculative level.” E.E.O.C. v. Concentra Health Servs., Inc., 496 F.3d 773, 776 (7th Cir. 2007) (quoting Twombly, 550 U.S. at 555). “A pleading that offers ‘labels and conclusions’ or a ‘formulaic recitation of the elements of a cause

of action will not do.’” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Twombly, 550 U.S. at 555). Dismissal for failure to state a claim under Rule 12(b)(6) is proper “when the allegations in a complaint, however true, could not raise a claim of entitlement to relief.” Twombly, 550 U.S. at 558. In reviewing a motion to dismiss pursuant to Rule 12(b)(6), the Court accepts as true all of Plaintiff’s well-pleaded factual allegations and draws all reasonable inferences in Plaintiff’s favor. Killingsworth v. HSBC Bank Nevada, N.A., 507 F.3d 614, 618 (7th Cir. 2007). B. Analysis 1. Section 502(a)(1)(B) Claims Defendants Elextrolux and the Plan argue that they are not the proper Defendants to this

ERISA benefits action because they had no role in the benefits decision at the heart of this case. To the extent that Plaintiff seeks to bring claims to recover benefits due under Section 502(a)(1)(B), the Court agrees that Defendants are not proper Defendants.

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Struve v. Electrolux Home Products, Inc. Life Insurance Plan, Counsel Stack Legal Research, https://law.counselstack.com/opinion/struve-v-electrolux-home-products-inc-life-insurance-plan-ilnd-2019.