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Gatti v. Western Pennsylvania Teamsters & Employers Welfare Fund

March 24, 2008

STEVEN M. GATTI, SR., PLAINTIFF,
v.
WESTERN PENNSYLVANIA TEAMSTERS & EMPLOYERS WELFARE FUND, DEFENDANT.



The opinion of the court was delivered by: Ambrose, Chief District Judge

OPINION AND ORDER

Synopsis

This action asserts claims under ERISA section 502(a) to recover benefits allegedly improperly denied by Defendant.*fn1 Defendant has moved pursuant to Federal Rule of Civil Procedure 12(c) to dismiss this action based on Plaintiff's failure to exhaust his administrative remedies prior to commencing the action. For the reasons set forth below, I grant Defendant's motion and dismiss the action.

OPINION

A. Legal Standard

Federal Rule of Civil Procedure 12(c) states: "Motion for Judgment on the Pleadings.

After the pleadings are closed - but early enough not to delay trial - a party may move for judgment on the pleadings." (West 2008). "Judgment will not be granted unless the movant clearly establishes there are not material issues of fact, and he is entitled to judgment as a matter of law." Milgrub v. Continental Cas. Co., 2007 WL 625039, at *3 (W.D. Pa. Feb. 22, 2007) (quoting Sikirica v. Nationwide Ins. Co., 416 F.3d 214, 220 (3d Cir. 2005)). "The Court 'must view the facts presented in the pleadings and the inferences drawn therefrom in the light most favorable to the nonmoving party.'" (Id.)

In addition to the pleadings, the parties have submitted an attorney's affidavit and various letters between counsel. Rule 12(d) provides that "[i]f on a motion under Rule 12(b)(6) or 12(c), matters outside the pleadings are presented to and not excluded by the court, the motion must be treated as one for summary judgment under Rule 56." Fed. R. Civ. P. 12(d) (West 2008). As the Third Circuit has explained, "[m]erely attaching documents to a Rule 12(c) motion, however, does not convert it to a motion under Rule 56. In ruling on a motion to dismiss, a trial court 'may consider an undisputedly authentic document that a defendant attaches as an exhibit to a motion to dismiss if the plaintiff's claims are based on the document.'" Citisteel USA, Inc. v. General Elec. Co., 78 Fed.Appx. 832, 835 (3d Cir. 2003) (quoting PBGC v. White Consol. Indus., 998 F.2d 1192, 1196 (3d Cir. 1993), cert. denied, 510 U.S. 1042 (1994)). "Further, in ruling on a motion a court generally has 'discretion to address evidence outside the complaint.'" Id. (quoting Pryor v. Nat'l Collegiate Athletic Ass'n, 288 F.3d 548, 559 (3d Cir. 2002)).

Here, neither side has questioned the authenticity of the documents submitted in support of and in opposition to the motion. Accordingly, I will consider that evidence in ruling on Defendant's Rule 12(c) motion for judgment on the pleadings.

II. Statement of Relevant Facts

Defendant Western Pennsylvania Teamsters & Employers Welfare Fund (the "Fund") provides for the payment of health and welfare benefits to eligible members of participating companies signatory to collective bargaining agreements entered into with local unions. The Fund is subject to the provisions of ERISA. At all relevant times, Plaintiff was an eligible participant under the Fund's Benefit Program Plan A (the "Plan"), a copy of which is annexed to the Complaint as Exhibit A.

Plaintiff was injured in a motor vehicle collision on May 15, 2007. As a result of the injuries he sustained, Plaintiff was unable to work for a period of nine weeks from May 15 through July 16, 2007. Plaintiff sought non-occupational accident benefits under the terms of the Plan in the amount of $200 per week for the nine-week period. While Plaintiff submitted all the necessary documentation of his eligibility, he refused to execute a Subrogation Acknowledgment Form. On this basis, the Fund refused to pay the requested benefits.

The Plan sets forth certain "Claim Review Procedures." (Complaint, Ex. A at 14.) It provides:

If your claim has been either denied or partly denied, you have 60 days to appeal this denial by requesting the Trustees ...


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