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Yerke v. Aetna

United States District Court, E.D. Pennsylvania

May 19, 2017

ALBERT YERKE, Plaintiff,
AETNA, Defendant.


          GERALD J. PAPPERT, J.

         Albert Yerke sued Aetna[1] in state court for breach of contract and for violating the Unfair Trade Practices Consumer Protection Law (“UTPCPL”) by denying him benefits under a long-term disability benefits plan maintained with Aetna by his employer, AutoZone. Aetna removed the case to federal court, basing federal jurisdiction on the preemptive effect of Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq. It then filed a motion to dismiss, contending that Yerke's claims are completely preempted by ERISA Section 502(a). For the reasons below, the Court grants Aetna's motion and allows Yerke leave to file an amended complaint asserting federal claims pursuant to ERISA.


         Yerke contends he was “covered under a long-term disability plan through his employment with AutoZone, which was insured by [Aetna].” (Compl., ECF No. 1-1.) He claims that although he was disabled from January 2, 2016 to September 16, 2016 and entitled to long-term disability benefits during that time, Aetna “has failed and refused to pay these benefits, despite demand for the same.” (Id.) He states that “[i]n addition to the claim for benefits, [he] seeks counsel fees of $2, 500.00 from Aetna due to its violation of the Unfair Trade Practices and Consumer Protection Law.” (Id.) Yerke attached to his Complaint a purported copy of the long-term disability plan. See (id.). The document, entitled “Leave of Absence Guide for AutoZoners, ” appears to be a guide provided by AutoZone to its employees with overviews of various benefit plans offered by the company.[2] (ECF No. 1-1.)

         Yerke filed his Complaint in the Montgomery County Court of Common Pleas on November 15, 2016. (ECF No. 1-1.) Aetna removed the case on December 19, 2016. (ECF No. 1.) On December 27, Aetna filed a motion to dismiss, arguing that Yerke's state law claims are both completely preempted under Section 502(a) and expressly preempted under Section 514(a). (Def.'s Mot., at 1, ECF No. 4-2.) Aetna also attached to its motion two documents specific to the disability benefits plan at issue: the Benefit Plan Booklet-Certificate, prepared by Aetna for AutoZone, and a copy of the group insurance policy.[3] (ECF Nos. 4-3 & 4-4.) Yerke filed his response on January 20, disputing the applicability of ERISA. (Pl.'s Resp., at 3, ECF No. 8-2.)


         To survive a motion to dismiss under Rule 12(b)(6), a plaintiff must plead factual allegations sufficient “to raise a right to relief above the speculative level . . . on the assumption that all the allegations in the complaint are true (even if doubtful in fact).” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007). The “mere possibility of misconduct” is not enough. Ashcroft v. Iqbal, 556 U.S. 662, 679 (2009). The court must construe the complaint in the light most favorable to the plaintiff. See Connelly v. Lane Constr. Corp., 809 F.3d 780, 790 (3d Cir. 2016) (citations omitted). However, a court need not accept as true inferences drawn by the plaintiff that are unsupported by facts. See Cal. Pub. Emps.' Ret. Sys. v. Chubb Corp., 394 F.3d 126, 143 (3d Cir. 2004).

         “While a complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual allegations, a plaintiff's obligation to provide the ‘grounds' of his ‘entitlement to relief' requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do.” Bell, 550 U.S. at 555 (2007) (citations and alterations omitted); see Iqbal, 556 U.S. at 678 (2009) (“Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.”). A court should “consider only the allegations in the complaint, exhibits attached to the complaint, matters of public record, and documents that form the basis of a claim.” Lum v. Bank of Am., 361 F.3d 217, 221 n.3 (3d Cir. 2004). Whether a complaint states a plausible claim for relief is a context-specific task that “requires the reviewing court to draw on its judicial experience and common sense.” Iqbal, 556 U.S. at 679 (citations omitted).



         To determine whether Yerke's claims are preempted, the Court must first decide whether the plan issued by Aetna to AutoZone for the benefit of AutoZone's employees is one that qualifies under ERISA. “ERISA is a comprehensive statute designed to promote the interests of employees and their beneficiaries in employee benefit plans.” Edmonson v. Lincoln Nat. Life Ins. Co., 725 F.3d 406, 413 (3d Cir. 2013) (citing Ingersoll-Rand Co. v. McClendon, 498 U.S. 133, 137 (1990)). ERISA governs two types of employee benefit plans, namely “employee welfare benefit plans” and “employee pension benefit plans.” 29 U.S.C. § 1002(3). An employee welfare benefit plan is defined as “any plan, fund, or program which was . . . established or maintained by an employer or by an employee organization . . . for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise . . . benefits in the event of sickness, accident, disability, death or unemployment.” 29 U.S.C. § 1002(1).

         A plan qualifies if, from the surrounding circumstances, a reasonable person can ascertain: (1) the intended benefits; (2) the class or classes of beneficiaries; (3) the source of financing; and (4) the procedures for receiving benefits. See Deibler v. United Food & Commercial Workers' Local Union 23, 973 F.2d 206, 209 (3d Cir. 1992) (citation omitted). These requirements are satisfied here. The long-term disability plan, sponsored and maintained by AutoZone and funded through a group insurance policy issued by Aetna, provides benefits to eligible employees in the event of disability. See (Def.'s Mot., at 1 n.1). The Benefit Plan Booklet-Certificate, which details the terms and conditions governing a plan participant's entitlement to benefits and is incorporated into the insurance policy by reference, see (ECF No. 4-4, at 9010), supports this conclusion. The “intended benefits” are those listed on pages 6-8. (ECF No. 4-3, at 6.) The “class of beneficiaries” is described on page 4. (Id. at 4.) The “source of financing” is the policy itself, which provides benefits to eligible beneficiaries. (Id. at 20.) Finally, the “procedures for receiving benefits” are set forth on page 19. (Id. at 19.)

         “One of the touchstones of a plan that is governed by ERISA is the ‘establishment and maintenance of a separate and ongoing administrative scheme, ' which the plan administrator must set up in order to determine eligibility for benefits.” Menkes v. Prudential Ins. Co. of Am., 762 F.3d 285, 290 (3d Cir. 2014) (quoting Shaver v. Siemens Corp., 670 F.3d 462, 476 (3d Cir. 2012)). The disability benefits Yerke seeks are disbursed pursuant to an administrative scheme in which Aetna functions both as the administrator and the claim fiduciary that makes eligibility determinations. A section of the policy titled “Claim Determinations; ERISA Claim Fiduciary” clarifies that, “[f]or the purpose of Section 503 ...

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