Wiener v. Unumprovident Corp.

202 F. Supp. 2d 116, 2002 U.S. Dist. LEXIS 3557, 2002 WL 334468
CourtDistrict Court, S.D. New York
DecidedFebruary 28, 2002
Docket00 CIV. 9315(NRB)
StatusPublished
Cited by23 cases

This text of 202 F. Supp. 2d 116 (Wiener v. Unumprovident Corp.) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wiener v. Unumprovident Corp., 202 F. Supp. 2d 116, 2002 U.S. Dist. LEXIS 3557, 2002 WL 334468 (S.D.N.Y. 2002).

Opinion

OPINION AND ORDER

BUCHWALD, District Judge.

Plaintiff, Ruth Wiener (“Wiener”), commenced this lawsuit in New York Supreme Court in November of 2000, alleging claims for breach of contract, violation of General Business Law (“GBL”) § 349, intentional infliction of emotional distress, and bad faith. Defendants Unumprovident Corporation (“Unum”), Paul Revere Life Insurance Company (“Paul Revere”), and New England Life Insurance Company (“New England”) removed pursuant to 28 U.S.C. § 1441 on diversity grounds. Presently before the Court is defendants’ motion to dismiss for failure to state a claim as a matter of law, pursuant to Federal Rule of Civil Procedure 12(b)(6). Defendants also argue that plaintiffs claims are preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. 1144(a). Plaintiff moves for leave to amend to rectify any deficiencies in the complaint should the Court find merit in defendants’ motion. For the following reasons, defendants’ motion to dismiss is granted in part and denied in part. Plaintiffs motion for leave to amend the complaint is granted.

BACKGROUND

In January of 1992, plaintiff became extremely ill and was unable to continue working as an accountant. From that time until August of 2000, plaintiff received monthly disability benefit payments from defendants Paul Revere and New England 1 , from which she had purchased individual disability insurance policies in 1988 and 1981 respectively. Wiener also received disability benefits under a group policy with Paul Revere. On August 21, 2000, Unum notified Wiener in writing that it no longer considered her to be totally disabled as defined in the group policy. Thereafter, defendants ceased making payments under both the individual and group policies. Plaintiff alleges that this decision was made by a customer care representative who is not a medical doctor based solely upon an incomplete review of her medical records.

In her complaint, plaintiff seeks declaratory judgment that she is totally disabled under the definition in the individual insurance policies, requiring defendants to continue to make such payments for as long as Wiener is so disabled, and awarding Wiener judgment in an amount equal to *119 the sum of the income disability payments under the individual policies for the period since termination. Wiener also seeks damages for breach of contract, violation of General Business Law § 349, intentional infliction of emotional distress, and bad faith denial of coverage. Subsequent to the filing of the complaint and in connection with an administrative proceeding governing the group policy, Unum reinstated Wiener’s disability benefits and paid her all past-due benefits. Currently pending before this Court is defendants’ motion to dismiss plaintiffs remaining claims under Rule 12(b)(6).

A. Legal Standard

In considering a motion to dismiss pursuant to Fed.R.Civ.P. 12(b)(6), we accept as true all material factual allegations in the complaint, Atlantic Mutual Ins. Co. v. Balfour Maclaine Int’l, Ltd., 968 F.2d 196, 198 (2d Cir.1992), and may grant the motion only where “it appears beyond doubt that the plaintiff can prove no set of facts in support of [her] claim which would entitle [her] to relief.” Still v. DeBuono, 101 F.3d 888, 891 (2d Cir.1996); see Conley v. Gibson, 355 U.S. 41, 48, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957). In addition to the facts set forth in the complaint, we may also consider documents attached thereto and incorporated by reference therein, Automated Salvage Transp., Inc. v. Wheelabrator Envtl. Sys., Inc., 155 F.3d 59, 67 (2d Cir.1998), as well as matters of public record, Pa ni v. Empire Blue Cross Blue Shield, 152 F.3d 67, 75 (2d Cir.1998).

B. Applicability of ERISA

In their motion, defendants argue that plaintiffs claims concerning termination of her insurance benefits under the two individual policies named in her complaint are preempted by ERISA. Defendants ground this assertion on the fact of plaintiffs coverage by a third policy with Paul Revere that is a group insurance policy provided by plaintiffs employer and governed by ERISA. Defendants conclude that ERISA preempts determination of the claims asserted in this lawsuit because the individual policies at issue here are related to the group policy. 2

By its terms, ERISA governs employee benefit plans established or maintained by an employer or an employee organization. See 29 U.S.C. § 1002(l)-(6); see Rombach v. Nestle USA Inc., 211 F.3d 190, 192-93 (2d Cir.2000) (reviewing the kinds of employee plans covered by ERISA). Defendants seem to concede that the individual policies themselves do not fall within this description, but argue that the individual policies are so related to the third plan that they are preempted. See Defs.’ Mot. to Dismiss at 19. However, without the benefit of any discovery, we are without the requisite knowledge to evaluate the inter-relationship, if any, between the individual policies purchased by plaintiff and the group policy. Cf. Agrawal v. Paul Revere Life Ins. Co., 205 F.3d 297, 299-302 (6th Cir.2000) (discussing the fact-based analysis of whether individual and group policies should be categorized together as an ERISA plan); Waks v. Empire Blue Cross/Blue Shield, 263 F.3d 872, 874-76 (9th Cir.2001) (discussing test for whether plan is subject to ERISA regulation and holding that an individual policy that has been converted from a group policy under an ERISA plan is no longer regulated by ERISA). For this reason, defendants’ motion to dismiss plaintiffs claims as preempted by ERISA is denied without prejudice to its renewal if upon the *120 development of the record there is a factual and legal basis for such renewal.

C. General Business Law § 349

Section 349 of New York’s General Business Law makes unlawful deceptive acts or practices in conducting a business or furnishing a service.

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Bluebook (online)
202 F. Supp. 2d 116, 2002 U.S. Dist. LEXIS 3557, 2002 WL 334468, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wiener-v-unumprovident-corp-nysd-2002.