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Rumpf v. Metropolitan Life Insurance Co.

July 23, 2010

ELIZABETH M. RUMPF
v.
METROPOLITAN LIFE INSURANCE CO., ET AL.



The opinion of the court was delivered by: Baylson, J.

MEMORANDUM

The central issue presented is the timeliness of Plaintiff's suit for ERISA benefits. Presently before the Court is the Motion for Summary Judgment filed by Defendants Metropolitan Life Insurance Company ("MetLife"), Constellation Energy Group Inc. f.k.a. Baltimore Gas and Electric Company ("CEG"), and Constellation Energy Group Employee Benefits Plans. (Doc. 24). Plaintiff Elizabeth M. Rumpf was an employee of CEG and alleges violations of §§ 502(a)(1)(B), 502(a)(3), and 502(c) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1132(a)(1)(B), 1132(a)(3), and 1132(c), arising out of Defendants' denial of her claim for long-term disability benefits. For the reasons that follow, the Court will grant Defendants' Motion in part and deny it in part.

I. Facts and Procedural History

Plaintiff was an employee of CEG from January 17, 1981 through February 1, 2004. During this period, CEG provided its employees with long-term disability benefits through a Disability Insurance Plan ("the Plan") of which Plaintiff was a participant. The Plan was insured through a group disability policy issued by MetLife to CEG ("the Policy"). MetLife was the Claims Administrator for the Plan, and the Director of Benefits for CEG served as Plan Administrator. (Doc. 24 Ex. O, at 3). As noted, the present case arises from a claim made by Plaintiff for long-term disability benefits under the Plan.

Because of some confusion in the briefing and attachments to the briefs on the present Motion, the Court determined that it would be appropriate to allow the parties to offer evidence at a hearing prior to oral argument. Therefore, at the hearing which took place on July 19, 2010, Plaintiff testified concerning her claim for disability benefits and identified certain documents which she had received and denied any knowledge of other documents. Defense counsel cross-examined Plaintiff and also identified certain documents.

A. Relevant Policy and Plan Documents

Central to plaintiff's claim for benefits, and to the Motion before the Court, are three documents pertaining to the Policy and the Plan. First is the Certificate of Insurance, which, as Defendants explain, represents the "group policy of insurance that funds the benefits provided by [CEG] under the [Plan]." (Doc. 24 Ex. O, at 13). The parties do not dispute that, prior to the commencement of this litigation, Plaintiff had not received a copy of the Certificate of Insurance. According to Defendants, this document "is distributed by [CEG] to its employees upon request," and neither "plaintiff [n]or her attorneys []ever made any request to the Plan Administrator... for a copy of the Certificate of Insurance." (Doc. 24 Ex. O, at 8--9). As is relevant to the present Motion, the Certificate of Insurance contains the following language:

E. Time Limits on Starting Lawsuits

No lawsuit may be started to obtain benefits until 60 days after proof [of the claim] is given.

No lawsuit may be started more than 3 years after the time proof must be given.

(Doc. 14 Ex. A, at 27).*fn1

Second is the Plan itself, which incorporates the policy by reference and provides that "[i]f the terms of the Policy and this Plan are inconsistent, the terms of the Policy shall govern." (Doc. 31 Ex. 8, at 1, 2). Article 5 of the Plan details the procedures surrounding denials of claims for benefits and appeals of those denials. It makes clear that

[t]he procedure for review of claims outlined in this Article 5 is the exclusive method available for resolving any claims under the Plan, notwithstanding the existence of other Employer procedures applicable to Employee grievances in other areas. No Employee or beneficiary is entitled to bring any action, whether at law or in equity against any Employer or their respective agents, officers or Employees, including the Plan Administrator, or his/her designees, in connection with any right, privilege or benefit provided under this Plan unless and until, as a condition precedent, all the remedies provided under this Article 5 have been exhausted. (Doc. 31 Ex. 8, at 8). The Plan does not contain any reference to the limitations period set forth in the Certificate of Insurance.

Third is the SPD, which summarizes the terms of the Plan and provides guidance to Plan participants on various issues and questions regarding the Plan, including how to file a claim for benefits. The SPD relevant to the present case became effective in January 2000. Defendant has produced a copy of this SPD, which contains 22 pages marked at the bottom as "Disability" and then 14 pages marked as "Admin." (Defs.' Ex. 3). Plaintiff contends that she did not receive this copy of the SPD, but only received a shortened version of it containing the "Disability" pages. Based on the testimony of Plaintiff, whom the Court found to be credible, the Court finds as a fact that the only document which Plaintiff received during the relevant time period is this shortened version of the SPD. Despite Defendants' cross-examination, the Court concludes that Plaintiff did not receive a longer version of the SPD containing the "Admin" pages.

The shortened version of the SPD, of which Plaintiff had a copy, does not have any reference or content concerning what would happen if a disability claim were denied. There is no mention of a right or requirement of an internal appellate review, a right to file a suit in court, or any limitations period for filing suit.

The "Admin" section, which Plaintiff did not receive, contains provisions that "[i]f you have a claim for benefits that is denied or ignored, in whole or in part, you may file suit in state or federal court," and then explains the process for appealing the denial of a claim for benefits. (Defs.' Ex. 3, admin-6 to -7). Consistent with the Plan, this portion of the SPD states "[y]ou have the right to seek an appeal of your denied claim" and that "[y]ou must follow these procedures before you take any legal action related to your claim." (Defs.' Ex. 3, admin-7). The "Admin" portion has no reference to any limitations period for taking such legal action, nor does it mention the Certificate of Insurance.

B. Plaintiff's Claim for Long-Term Disability Benefits

On February 2, 2004, Plaintiff ceased working at CEG due to a diagnosis of major depression and anxiety. By letter dated May 10, 2004, CEG informed Plaintiff she may qualify for disability benefits under the Plan. (Doc. 24 Ex. C). Plaintiff filed her proof of claim for long-term disability benefits under the Plan on May 13, 2004. On May 14, CEG sent Plaintiff material related to her claim; the parties agree that this material included a copy of the SPD. Plaintiff claims that she did not receive any documents other than the shortened version of the SPD; as noted, the Court finds Plaintiff credible as to this point.

MetLife denied Plaintiff's claim for benefits on July 30, 2004 because Plaintiff did not meet the Plan's definition of "disabled." (Doc. 24 Ex. E). MetLife's letter stated that, "[b]ecause your claim was denied in whole or in part, you may appeal this decision by sending a written request for appeal to MetLife Disability," and then provided information on the appeal process. The letter also specified that, "[i]n the event your appeal is denied in whole or in part, you will have the right to bring a civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974."

Plaintiff appealed the denial of her claim by letter dated January 13, 2005. (Doc. 24 Ex. H). On February 16, 2005, MetLife upheld the denial. (Doc. 24 Ex. I). The letter stated, inter alia, that Plaintiff "has the right to bring civil action under Section 502(a) of the Employee Retirement Income Security Act of 1974," and that she "has exhausted her administrative remedies under the plan, and no further appeals will be considered."

Subsequently, Plaintiff and her counsel made multiple requests from MetLife for documents relating to her claim, such as copies of all Plan documents and of the contents of her claim file. Through these requests, Plaintiff or her counsel received, inter alia, copies of the SPD and Plan, but not of the Certificate of Insurance. Plaintiff's counsel made one request for documents from CEG, on November 14, 2008; this request was for "a copy of the [SPD] that was in effect in January and February of 2004." (Doc. 24 Ex. L). In response, CEG provided copies of the full version of the SPD and of the Plan.

Plaintiff subsequently brought suit in this Court against Defendants, filing a Complaint on February 9, 2009 (Doc. 1), and a First Amended Complaint ("the Complaint") on February 13, 2009 (Doc. 2). Plaintiff alleged Defendants violated §§ 502(a)(1)(B) and 502(a)(3) of ERISA in their handling of her claim for benefits, and sought declaratory, injunctive, and monetary relief for these violations. Plaintiff's allegations raise three general claims: unlawful denial of benefits, breach of fiduciary duty, and failure to provide documents.*fn2 Per stipulation (Doc. 5), on May 21, 2009, Defendants filed their Answer with Affirmative Defenses to the First Amended Complaint (Doc. 6). On June 24, 2009, Defendants filed a Motion for Judgment on the Pleadings (Doc. 11), which the Court, after hearing argument, denied (Doc. 21). Following discovery, Defendants filed the present Motion for Summary Judgment on ...


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