The opinion of the court was delivered by: Ambrose, Chief District Judge.
OPINION and ORDER OF COURT
Defendants Employer, Plan Insurer and Plan Administrator seek the dismissal of a former employee's ERISA claims for denial of benefits and breach of fiduciary duties. The employee claims that the Defendants wrongly offset his short term disability payments based upon an award of benefits he received from the Veterans Administration for a military connected disability which predated his employment with Defendant Employer. The Motion to Dismiss the denial of benefits claim is denied as premature, as it seeks, not a review of the sufficiency of the allegations under Rule 12(b)(6), but a review of the actual decision of the administrator. The breach of fiduciary duties claim will go forward, but the employee is precluded from seeking as relief in that claim, payment of benefits or an injunction regarding the same.
Plaintiff Paul Adomaitis ("Adomaitis") worked for Defendant Alcoa Inc. ("Alcoa") for approximately twenty-five years before becoming disabled in 2006. During his employment he participated in Alcoa's Short Term Disability Plan ("STD") and Alcoa's Long Term Disability Plan ("LTD"). Upon becoming disabled, Adomaitis applied for STD. He was denied full benefits due to an offset.
The offset was attributed to a military service-connected disability which the Veterans Administration ("VA") had awarded Adomaitis prior to his employment with Alcoa.*fn1 Adomaitis timely appealed the denial of his benefits, to no avail.
Ultimately, Adomaitis initiated this action. He names as Defendants Alcoa, Broadspire Services, Inc., which was responsible for administering the STD and LTD plans, and Aetna Life Insurance Company, which provided insurance funding. He asserts two claims under ERISA. In Count I, he asserts a claim under § 502(a)(1)(B) of ERISA, 29 U.S.C. §1132(a)(1)(B) to recover benefits due under the STD and LTD Plans, to enforce his rights under these Plans and to clarify his future rights under these Plans. In Count II, Adomaitis contends that the Defendants breached their fiduciary duties under § 404 of ERISA, in violation of 29 U.S.C. § 1104, by failing to act exclusively for his benefit and in accordance with the Plans and by discriminating against him based upon his military service.
The Defendants have filed a Motion to Dismiss. See Docket No. 9. As to the denial of benefits claim set forth in Count I, the Defendants contend that both the STD and the LTD plans permitted them to offset the VA benefits. As to the claim in Count II for breach of fiduciary duties, the Defendants urge that Adomaitis is barred from pursuing such a claim and, in the alternative, that no breach occurred.
For the reasons set forth below, the Motion to Dismiss is denied as premature as to Count I and denied as to Count II, except that Count II shall be construed so as to exclude a demand for payment of benefits and / or an injunction regarding the same.
In deciding a Motion to Dismiss, all factual allegations, and all reasonable inferences therefrom, must be accepted as true and viewed in a light most favorable to the plaintiff. Colburn v. Upper Darby Twp., 838 F.2d 663, 666 (3d Cir. 1988), cert. denied, 489 U.S. 1065 (1988). I may dismiss a complaint only if it appears beyond a reasonable doubt that the plaintiff can prove no set of facts in support of his claims which would entitle him to relief. Conley v. Gibson, 355 U.S. 41, 45 (1957). In ruling on a motion for failure to state a claim, I must look to "whether sufficient facts are pleaded to determine that the complaint is not frivolous, and to provide the defendants with adequate notice to frame an answer." Colburn, 838 F.2d at 666.
While a court will accept well-pleaded allegations as true for the purposes of the Motion, it will not accept legal or unsupported conclusions, unwarranted inferences, or sweeping legal conclusions cast in the form of factual allegations. See Miree v. DeKalb County, Ga., 433 U.S. 25, 27 n.2 (1977). Moreover, the plaintiff must set forth sufficient information to outline the elements of his claims or to permit inferences to be drawn that these elements exist. See Fed. R. Civ. P. 8(2)(a) and Conley, 355 U.S. at 45-46. Matters outside the pleadings should not be considered. This includes "any written or oral evidence in support of or opposition to the pleadings that provides some substantiation for and does not merely reiterate what is said in the pleadings." Charles A. Wright and Arthur R. Miller, Federal Practice and Procedure, § 1366 (West 1990).
I. Count I - Denial of ...