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Patchell v. Cigna Health and Life Insurance Co.

United States District Court, W.D. Pennsylvania

March 28, 2018

ANTHONY PATCHELL, on his own behalf and on behalf of all others similarly situated, and AMANDA PATCHELL, his wife, Plaintiffs,
v.
CIGNA HEALTH AND LIFE INSURANCE COMPANY, and LIFE INSURANCE COMPANY OF AMERICA, Defendants.

          MEMORANDUM OPINION

          KIM R. GIBSON UNITED STATES DISTRICT JUDGE

         I. Introduction

         Pending before the Court is Defendants' Motion to Dismiss Plaintiffs' Amended "Class Action and ERISA Complaint." (ECF No. 27.) Although Plaintiffs have not responded to Defendants' Motion to Dismiss (ECF No. 27) or Memorandum of Law in Support thereof (ECF No. 28), the deadline for Plaintiffs' response-March 2, 2018-has passed and, thus, Defendants' Motion to Dismiss is ripe for disposition.[1]

         For the reasons that follow, this Court will GRANT Defendants' Motion.

         II. Jurisdiction and Venue

         The Court has subject matter jurisdiction pursuant to 28 U.S.C. 1331 because Plaintiffs' claims are brought under the Employee Retirement Income Security Act ("ERISA"). Venue is proper in this district pursuant to 28 U.S.C. § 1391(b)(2) because a substantial portion of the events or omissions giving rise to Plaintiffs' claims occurred in the Western District of Pennsylvania.

         III. Background

         A. Procedural History

         Plaintiffs commenced this action on September 7, 2017 by filing a Complaint before this Court. (ECF No. 1.) Defendants filed their first Motion to Dismiss on November 13, 2017. (ECF No. 12.) However, prior to a decision on this first Motion to Dismiss, this Court granted Plaintiffs' request to file an Amended Complaint. (ECF No. 22.)

         Plaintiffs filed their Amended Complaint on January 24, 2018. (ECF No. 26.) Plaintiffs' Amended Complaint is organized into six counts: (1) a claim under ERISA to recover overpayment for breach of fiduciary duty, by Mr. Patchell and Ms. Patchell; (2) a claim for loss of consortium by Ms. Patchell; (3) a claim for ERISA violations by the purported class of Plaintiffs; (4) a claim incorporating by reference Count I on behalf of the entire class of Plaintiffs; (5) a motion for a preliminary injunction on behalf of Mr. Patchell; and (6) a claim seeking disgorgement of profits by Mr. Patchell and the purported class of Plaintiffs. (Id. at 9-19.)

         On February 9, 2018, Defendants filed the pending Motion to Dismiss Plaintiffs' Amended "Class Action and ERISA Complaint" and an accompanying Memorandum of Law in support thereof. (ECF Nos. 27, 28.) To date Plaintiffs' have neither responded to nor moved for an extension of the deadline to respond to Defendants' Motion to Dismiss Plaintiffs' Amended "Class Action and ERISA Complaint."

         B. Plaintiffs' Allegations[2]

         Mr. Patchell obtained a Life Insurance Policy Company of North America ("LINA") Disability Policy (the "Policy") through his employer. (ECF No. 26 at ¶ 6.) In February 2010, a judge determined that Mr. Patchell is permanently disabled. (Id. at ¶ 12.) Thereafter, Mr. Patchell began receiving short-term disability ("STD") benefits from LINA pursuant to his Policy. (Id. at ¶¶ 12-16.) At some unspecified point, Mr. Patchell began receiving long-term disability ("LTD") benefits under his Policy. (Id. at ¶ 35.)

         Mr. Patchell's LTD benefit totaled $4, 513.00 per month, which resulted in Mr. Patchell receiving a monthly check for $2, 868.00.[3] (Id. at ¶ 17.) Of this monthly payment, $1721.40 went to Mr. Patchell and $1, 147.60 went to Mr. Patchell's counsel as an attorney's fee. (Id. at ¶ 18.)

         On January 7, 2016, LINA suspended all payments to Mr. Patchell after it determined that it had overpaid him because Mr. Patchell's monthly benefit did not take into account offsets due to Social Security benefits received by his children. (Id. at ¶ 23.) LINA "clawed back" these overpayments by withholding Mr. Patchell's future LTD payments under his Policy. (Id. at ¶¶ 19, 23, 24, 41.)

         Mr. Patchell had previously disclosed his children's Social Security benefits to LINA on a questionnaire he completed prior to receiving STD benefits. (Id. at ¶ 24.)

         C. The Policy

         Plaintiffs did not attach Mr. Patchell's Policy to their Amended Complaint. However, the Defendants attached the Policy to their motion to dismiss. (See ECF No. 28-1.)

         1. The Court May Consider the Policy at the Motion to Dismiss Stage

         "To decide a motion to dismiss, courts generally consider only the allegations contained in the complaint, exhibits attached to the complaint and matters of public record." Schmidt v. Skolas, 770 F.3d 241, 249 (3d Cir. 2014) (quoting Pension Benefit Guar. Corp. v. White Consol. Indus., Inc., 998 F.2d 1192, 1196 (3d Cir. 1993)); see also Borough of Moosic v. Darwin Nat. Assur. Co., 556 Fed.Appx. 92, 95 (3d Cir. 2014) ("Generally, a district court ruling on a motion to dismiss may not consider matters extraneous to the pleadings.") (internal citations omitted).

         "However, an exception to the general rule is that a 'document integral to or explicitly relied upon in the complaint' may be considered 'without converting the motion to dismiss into one for summary judgment.'"[4] Schmidt, 770 F.3d at 249 (quoting In re Burlington Coat Factory Sec. Litig., 114 F.3d 1410, 1426 (3d Cir. 1997)) (emphasis in original); see also Schuchardt v. President of the United States, 839 F.3d 336, 353 (3d Cir. 2016) (stating that a court deciding a 12(b)(6) motion may consider "documents] integral to or explicitly relied upon in the complaint") (emphasis in original) (internal citations omitted).

         "Documents are integral when the plaintiff's claims are based on the document." Hearbest, Inc. v. Adecco USA, No. 13CV1026, 2013 WL 4786232, at *3 (W.D. Pa. Sept. 6, 2013) (quoting In re Donald J. Trump Casino Sec. Litig., 7 F.3d 357, 368 n. 9 (3d Cir. 1993)); Ayco Co., L.P. v. Upton, No. 12CV0712, 2012 WL 3746193, at *3 (W.D. Pa. Aug. 29, 2012); Langweiler v. Borough of Newtown, No. CIV.. A 10-3210, 2011 WL 1809264, at *5 (E.D. Pa. May 12, 2011); Apple Am. Grp., LLC v. GBC Design, Inc., No. CV 3:15-325, 2018 WL 948772, at *10 (W.D. Pa. Feb. 15, 2018) (Gibson, J.)

         The Court finds that the Policy is integral to Plaintiffs' Amended Complaint. All of Plaintiffs' claims are based on their central allegation that LINA improperly suspended Mr. Patchell's LTD benefits owed to him under the Policy. (See, generally, ECF No. 26.) Moreover, the Amended Complaint references Mr. Patchell's Policy on numerous occasions. (See, e.g., Id. at ΒΆΒΆ 6, 10, 11, 19, 20, 21, 22.) Thus, the Policy is "integral to" Plaintiffs' Amended Complaint. Therefore, the Court may consider the ...


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