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Muchicka v. Hartford Life And Accident Insurance Co.

United States District Court, W.D. Pennsylvania

July 9, 2015

REBECKA L. MUCHICKA, Plaintiff,
v.
THE HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY, Defendant.

Joseph R. Bock Counsel for Plaintiff

Brian P. Downey Pepper, Hamilton & Scheetz Counsel for Defendant

MEMORANDUM OPINION [1]

ROBERT C. MITCHELL, United States Magistrate Judge.

I. INTRODUCTION

Presently before the Court is Defendant The Hartford Life and Accident Insurance Company’s (“Hartford” or “Defendant”) motion to dismiss [ECF No. 9] Plaintiff Rebecka L. Muchicka’s complaint for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6). For the reasons that follow, Defendant’s motion is denied.

II. BACKGROUND

Plaintiff has brought the present claim under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq., (“ERISA”) for Hartford’s failure to pay long-term disability benefits that Plaintiff alleges are owed to her by Hartford.

Plaintiff was employed by West Penn Allegheny Health System, Inc. (“West Penn”) as a vascular technician starting in June 2008. West Penn provided an employer-sponsored welfare benefit plan for its employees through Hartford.

On or about January 15, 2009, Plaintiff was forced to pull her car over while she was driving to work because she felt dizzy. She was admitted to the West Penn Hospital emergency room that day and complained of dizziness, vomiting, muscle and joint pain. Over the next few months, Plaintiff was treated for extreme pain in her joints of her hands, feet, ankles, knee and shoulders. She also suffered from tremors throughout her body mostly while walking. Over the course of these months she was seen by numerous physicians including a neurologist, endocrinologist, neurosurgeon and a vascular surgeon. The pathology was noted to include severe peripheral neuropathy, adrenal dysfunction, and chronic pain syndrome characterized by multifocal joint pain.

Plaintiff began receiving short-term disability benefits from through the Hartford benefits plan for a period of 26 weeks through July 15, 2009. Once Plaintiff exhausted her short term disability benefits, she applied for, and began receiving long-term disability benefits under the Hartford plan beginning July 15, 2009. On or about February 1, 2011, Hartford sent Plaintiff a notice regarding her continued eligibility for long-term disability benefits. Hartford informed Plaintiff that she would have to meet a different definition of “disability” in order to retain her long-term disability benefits and that Hartford initiated an investigation and requested that Plaintiff submit additional information regarding her disability to which Plaintiff complied. After Hartford completed reviewing Plaintiff’s claim, on or about October 18, 2011, Plaintiff received notice from Hartford that her long-term disability claims would be terminated. Hartford based its decision, in part, on the change in its policy definition of “disability” as of July 15, 2011, which required the claimant to be disabled from any occupation in order to continue receiving long-term disability benefits. Plaintiff appealed this decision and Hartford upheld its original determination terminating Plaintiff’s long-term disability benefits. This action ensued.

Hartford moves to dismiss Plaintiff’s complaint and argues that the statute of limitations challenging Hartford’s denial of benefits has run. Plaintiff responds that her claim is timely.

The motion to dismiss involves two discrete policy provisions. The policy first provides a three year statute of limitations for any legal action taken against Hartford:

Legal Actions: When can legal action be taken against Us? Legal action cannot be taken against Us:
1) Sooner than 60 days after the date proof of loss is given; or 2) more than three years after the date Proof of Loss is required to be given ...

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