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RIESER v. STANDARD LIFE INSURANCE CO.

June 24, 2004.

LORETTA RIESER, Plaintiff,
v.
STANDARD LIFE INSURANCE CO., et al., Defendants.



The opinion of the court was delivered by: BERLE M. SCHILLER, District Judge

MEMORANDUM AND ORDER

Presently before the Court is Plaintiff's Motion for Reconsideration of the Court's Order dated May 25, 2004, dismissing all claims against Defendant Canada Life Assurance Company. For the reasons set out below, the Court denies Plaintiff's motion.

As the Third Circuit has stated:
The purpose of a motion for reconsideration . . . is to correct manifest errors of law or fact or to present newly discovered evidence. Accordingly, a judgment may be altered or amended if the party seeking reconsideration shows at least one of the following grounds: (1) an intervening change in the controlling law; (2) the availability of new evidence that was not available when the court granted the motion for summary judgment; or (3) the need to correct a clear error of law or fact or to prevent manifest injustice.
Max's Seafood Cafe ex rel. Lou-Ann, Inc. v. Quinteros, 176 F.3d 669, 677 (3d Cir. 1999) (internal citations omitted).

  Plaintiff proposes two grounds for reconsideration. First, Plaintiff argues that this Court's Order is "contrary to the principles of notice pleading" because the Amended Complaint averred that Plaintiff was covered under the Canada Life Assurance Company's life insurance policy. (Pl.'s Mot. for Recons. at 1.) In support, Plaintiff cites cases for the general proposition, which was acknowledged in this Court's Order, that courts considering a motion to dismiss "must accept as true the factual allegations in the complaint and all reasonable inferences that can be drawn therefrom." (Id. (citing Nami v. Fauver, 82 F.3d 63, 65 (3d Cir. 1996).) As stated in the original Order, a court may consider, in addition to the complaint, an undisputably authentic document attached to a defendant's motion where the plaintiff's claims are based on that document. Pension Benefit Guar. Corp. v. White Consol. Indus., 998 F.2d 1192, 1196 (3d Cir. 1993). If this Court were not permitted to do so, "a plaintiff with a legally deficient claim could survive a motion to dismiss simply by failing to attach a dispositive document on which it relied." Pension Benefit Guar. Corp, 998 F.2d at 1196; Goodwin v. Elkins & Co., 730 F.2d 99, 113 (3d Cir. 1984) (Becker, J., concurring) ("A contrary holding would enable plaintiffs to survive a 12(b)(6) motion where the terms of the document on which the claim is based would render the complaint insufficient as a matter of law, simply by refusing to attach the document to the complaint.") Thus, Plaintiff's bare assertion that he was covered by the Canada Life policy could not withstand Defendant's motion to dismiss in light of this Court's conclusion that "under the clear and unambiguous terms of both the detailed plan document and the [Summary Plan Document], Mr. Rieser was not an insured under the Canada Life plan." (Memo. and Order dated May 25, 2004 at 6.)

  Plaintiff's second proposed ground for reconsideration is that this Court's Order is based on an unwarranted and inaccurate assumption of fact. In its Order, this Court found that because, according to Plaintiff's allegations, Mr. Rieser was not "actively at work" when the Canada Life policy went into effect on November 1, 2000, he was not covered under its terms, which explicitly stated that it applied only to those employees who were "actively at work" on the effective date or who later became full time employees "actively at work" after the effective date. Id. at 5. This Court's conclusion was not an "assumption of fact." Rather, the conclusion was a legal determination based upon both a clear contract provision and Plaintiff's own admission that Mr. Rieser was not "actively at work" at the time of the policy's effective date. (Am. Compl. ¶¶ 11-12.) Furthermore, Plaintiff's response to Defendant's motion to dismiss made no attempt to argue that the "actively at work" requirement was not applicable to Mr. Rieser.*fn1 Nonetheless, Plaintiff now argues that she has "uncovered ample evidence to support her claim that at the time of his death her husband had life insurance coverage under the Canada Life group insurance policy." (Pl.'s Mot. for Recons. at 4.) The "ample evidence" that Plaintiff presents to this Court, however, which can be characterized as ambiguous and, at times, irrelevant, fails to demonstrate that Mr. Rieser was insured under a Canada Life insurance policy.*fn2 Plaintiff has not provided evidence that Gross-Given paid premiums to Canada Life on behalf of Mr. Rieser or that Canada Life ever received premium payments on behalf of Mr. Rieser, despite the fact that such evidence, if it exists, should be readily ascertainable.

  For the reasons stated above, this Court denies Plaintiff's motion for reconsideration. An appropriate Order follows. MEMORANDUM AND ORDER

  Plaintiff Loretta Rieser brings this action alleging violations of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001-1461, against Defendants Standard Insurance Company*fn3 ("Standard") and Gross Given Manufacturing Company ("Gross Given"). Presently before this Court are Defendants Standard and Gross Given's motions for summary judgment.*fn4 For the reasons set out below, Defendants' motions are granted.

  I. BACKGROUND

  Plaintiff is the widow of David R. Rieser, who was employed by Gross Given at its Warminster, Pennsylvania facility from February 19, 1952 until January 28, 1998. (Am. Compl. ¶ 12.) On January 28, 1998, at the age of sixty-one, Mr. Rieser ceased active employment due to a disability. (Id. ¶¶ 12-13.) In the fall of 1997, in anticipation of his leaving active employment, Mr. Rieser met with Gross Given's Director of Human Resources, David Riccio, who explained that Mr. Rieser would be eligible for both short-term and long-term disability benefits and that his life insurance would continue only during the period he was covered by Gross Given's disability plan. (Riccio Aff. ¶¶ 4-5, 7.) This information was memorialized in a memorandum sent to Mr. Rieser on November 6, 1997. (Id. Ex. 1.) The memorandum states:
During the disability period, Gross Given continues your health, life insurance. This coverage would be the same as it is when you begin your disability, including family coverage. Premiums for the insurance would continue to be paid by Gross Given.
(Id.) After leaving active employment, Mr. Rieser was granted long-term disability ("LTD") benefits through Gross Given's LTD provider, Standard. (Def. Standard's Mot. for Summ. J., Ex. A at 204, 228 (Administrative R.).)

  According to the terms of Mr. Rieser's Standard life insurance policy ("Life Policy"), an insured's life insurance benefits continue during the disability period in one of two ways. Under the "Waiver of Premium" provision, life insurance continues without payment of premiums if the individual meets the following criteria: (1) the individual became disabled while insured under the group life policy; (2) the individual was under the age of sixty at the time he became disabled; and (3) the individual is unable to perform with reasonable continuity the material and substantial duties of any occupation for which he is suited in light of his education, training and experience. (Id. at 12-13.) In the event that these criteria are not met, premiums must be paid in order to keep the individual's life insurance in force. (Id. at 15-16.)

  Shortly after becoming disabled, Mr. Rieser applied for a waiver of premium. By letter dated October 14, 1998, Standard reiterated the aforementioned provisions governing the continuation of life insurance during disability and denied his application for a waiver because Mr. Rieser was over the age of sixty when he became disabled. (Id. at 316-317.) Furthermore, the letter informed Mr. Rieser that his life insurance would terminate upon the earlier of the following events: "A. the date of termination of your status as a Member; or B. the cessation of premium payments for your insurance." (Id.) The letter instructed Mr. Rieser to contact Gross Given regarding the status of his membership and premium payments. (Id.)

  According to the terms of the LTD Policy, Mr. Rieser, who became disabled at age sixty-one, was eligible for a maximum disability benefit period of three years and six months. (Id. at 49.) This benefit period began to run when he became eligible for LTD benefits on May 29, 1998. (Id. at 34, 228.) Accordingly, Mr. Rieser's maximum benefit period would end on November 28, 2001. (Id. at 284-86.) This information was conveyed to Mr. Rieser in a letter from Standard Life dated April 15, 1999. (Id. ("The Gross Given Manufacturing Co[.] group policy states that individuals who become disabled at age 61 are eligible for benefits for a maximum of three years and six months. Therefore, your maximum benefit period would end on November 28, 2001.").) The November 28, 2001 disability coverage termination date was reiterated in a letter from Standard Insurance on December 4, 2000, and again on November 8, 2001. (Id. at 64, 289.) Both Ms. and Mr. Rieser were aware that the disability benefits period would expire on November 28, 2001. (Rieser Dep. at 28-31.)

  Despite Gross Given's commitment to pay Mr. Rieser's life insurance premiums during his disability period, Gross Given only continued to pay the premiums on Mr. Rieser's Standard Life Policy from January 28, 1998 until November 1, 2000, (Brady Aff. ¶ 7; Def. Standard's Reply, Ex. 1 ¶ 11 (Stipulation of Facts)), because on October 31, 2000, Gross Given terminated its agreement with Standard and switched to a new insurance provider, Canada Life Assurance Company ("Canada Life").*fn5 (Def. Standard's Reply, Ex. 1 ¶ 10 (Stipulation of Facts).) Accordingly, Mr. Rieser's Standard Life Policy was terminated. On November 13, 2002, Mr. Rieser died at the age of sixty-six, more than two years after the Standard Life Policy was terminated and almost one year after his disability period had ended. (Am. Compl. ¶ 11.)

  Thereafter, Ms. Rieser filed claims for benefits with both Standard and Canada Life. (Id. ¶ 30.) The Standard Life Policy expressly provides Standard discretionary authority to determine an individual's eligibility for benefits. The Life Policy provides:
Except for those functions which the Group Policy specifically reserves to the Policyowner, we have full and exclusive authority to control and manage the Group Policy, to administer claims, and to interpret the Group Policy and resolve all questions arising in the administration, interpretation, and application of the Group Policy.
Our authority includes, but is not limited to:
. . .
3. The right to determine:
a. Eligibility for insurance;
b. Entitlement to benefits;
c. Amounts of benefits payable;
(Id. at 6 (Life Policy), 344 (Summ. Plan Description).) Canada Life possesses similar discretionary ...

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