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Wiessmann v. Northwestern Mutual Life Insurance Co.

United States District Court, E.D. Pennsylvania

May 22, 2018



          Goldberg, J.

         Plaintiff Robin Wiessmann has sued Defendant Northwestern Mutual Life Insurance Company (“Northwestern”) based on its refusal to pay benefits under a disability insurance policy. Following the Rule 12(b)(6) dismissal of the original Complaint without prejudice, Plaintiff filed an Amended Complaint on September 18, 2017. Defendant has now moved to dismiss the Amended Complaint in its entirety. For the following reasons, I will grant the motion in part and deny it in part.


         The following facts are taken from Plaintiff's Amended Complaint:[1]

         Plaintiff is the owner and beneficiary of a disability income insurance policy (the “Policy”) issued by Defendant Northwestern on December 28, 1989. The Policy has been and remains in full force and effect up through at least the date of filing the Amended Complaint. The Policy provides for payment of benefits for total disability in the event Plaintiff is unable to perform one or more of the principal duties of her occupation, or for partial disability in the event she faces at least a 20% loss of time spent at her occupation. (Am. Compl. ¶¶ 7-9.)

         At all relevant times, Plaintiff was employed, or in pursuit of employment, within her occupation as a high-level financial services executive. From 2007 to January 2009, she served as Treasurer of the Commonwealth of Pennsylvania, acting as the sole fiduciary for the Commonwealth's $22 million assets and overseeing the day-to-day management of those assets. Her principal duties included: overseeing a team that managed substantial financial assets and the cash flow associated with them, largely through face-to-face interactions; spending significant periods of time sitting at a desk or table while conducting such interactions, performing sophisticated financial analysis, or conducting conference calls; significant amounts of travel by plane, train, and car, both in and outside of the Commonwealth; physically attending and sitting for frequent meetings with those she supervised and others; and putting in fifty to sixty hours of work weekly. (Id. ¶¶ 10-13.)

         In May 2008, Plaintiff came under medical care for both diverticulitis and lumbar disc disease. Despite the increasing severity of these conditions, Plaintiff finished her term as the Pennsylvania Treasurer. After her term ended, Plaintiff expected to be able to move to a similarly high level position in her occupation, but that proved to be impossible due to her medical conditions, which caused excruciating physical pain and left her physically exhausted. As a result, she could not engage in any extensive job interviewing. Although she was able to complete one interview, she had to refuse this corporate position because she could not perform its principal duties, which were similar to her Treasurer position. On most days, Plaintiff was in so much pain that she could not leave her bed or bathe. (Id. ¶¶ 15- 24.)

         During her term as Treasurer, Plaintiff sat on the Board of Directors of the Vantage Fund. Sitting on such boards was necessary and valuable to Plaintiff for purposes of professional networking and the board position placed few physical and time demands on her. Thus, despite her medical limitations, she was able to fulfill her board responsibilities. Even after she completed her term as Treasurer, Plaintiff decided to continue on the Vantage Fund board and, subsequently, to add a board position with Met Pro. (Id. ¶¶ 25-27, 29.)

         In the January 2009 to January 2010 time period, Plaintiff continued to be treated for diverticulitis and lumbar disc disease, without improvement. She put herself on a special diet to reduce her stomach inflammation. From January 2010 to January 2015, Plaintiff's diverticulitis slowly improved and, due to extensive physical therapy, her symptoms from the lumbar disc disease improved. Nonetheless, she remained unable to sit for long periods of time at a desk or at meetings, to travel frequently, or to work more than 60-75% of the 50-60 hour work weeks. (Id. ¶¶ 30-33.)

         In June 2014, Plaintiff submitted a claim and proof of disability to Defendant, seeking benefits under the Policy for periods of both total disability and partial disability. She provided Defendant with a statement of the nature and extent of her disability. (Id. ¶ 40.) On December 19, 2014, Defendant sent Plaintiff a list of “requirements” for receiving disability benefits. Approximately six months later, on June 30, 2015, Defendant notified Plaintiff that her claims for partial and total disability were denied. Despite her submission of additional information, Defendant continued to deny Plaintiff's disability claims through two appeals, up to and including November 24, 2015. Defendant asserted that, after January 2009, Plaintiff's occupation was a “board member.” (Id. ¶¶ 44, 46, 48, 49.)

         Plaintiff initiated suit in this Court on December 1, 2016. I dismissed her original Complaint under Federal Rule of Civil Procedure 12(b)(6), but granted leave to amend. Plaintiff filed her Amended Complaint on September 18, 2017, alleging claims for breach of contract (Count I), bad faith (Count II), and for a declaratory judgment (Count III). Defendant filed a second Motion to Dismiss on October 10, 2017, and Plaintiff responded to that Motion on October 27, 2017.


         Under Federal Rule of Civil Procedure 12(b)(6), a defendant bears the burden of demonstrating that the plaintiff has not stated a claim upon which relief can be granted. Fed.R.Civ.P. 12(b)(6); see also Hedges v. United States, 404 F.3d 744, 750 (3d Cir. 2005). The United States Supreme Court has recognized that “a plaintiff's obligation to provide the ‘grounds' of his ‘entitle[ment] to relief' requires more than labels and conclusions.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007) (quotations omitted). “[T]hreadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice” and “only a complaint that states a plausible claim for relief survives a motion to dismiss.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009). “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Id. A complaint does not show an entitlement to relief when the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct. Id.

         The United States Court of Appeals for the Third Circuit has detailed a three-step process to determine whether a complaint meets the pleadings standard. Bistrian v. Levi, 696 F.3d 352 (3d Cir. 2014). First, the court outlines the elements a plaintiff must plead to state a claim for relief. Id. at 365. Next, the court must “peel away those allegations that are no more than conclusions and thus not entitled to the assumption of truth.” Id. Finally, the court “look[s] for well-pled factual allegations, assume[s] their veracity, and then ‘determine[s] whether they plausibly give rise to an entitlement to relief.'” Id. (quoting Iqbal, 556 U.S. at 679). The last step is “a context- specific task that requires the reviewing court to draw on its judicial experience and common sense.” Id. (quoting Iqbal, 556 U.S. at 679).


         A. Count I - Breach of Contract

         Count I of the Amended Complaint alleges that Plaintiff was totally disabled from January 21, 2009 to January of 2010, and partially disabled from January 1, 2010 to January 1, 2015, but was improperly denied benefits under the Policy.[2] Defendant moves to dismiss this breach of contract claim, contending that the Amended Complaint fails to allege facts establishing either a “Total Disability” or “Partial Disability” as defined in the Policy. Addressing each of Defendant's arguments in support of its Motion, I find no basis for dismissal of this claim.

         1. Total Disability

         The Amended Complaint first contends that Plaintiff suffered a “Total Disability” from January 21, 2009 to January of 2010. The Policy defines “Total Disability” as follows:

Until the end of the Initial Period, the Insured is totally disabled when he is unable to perform the principal duties of his occupation. After the Initial Period, the Insured is totally disabled when he is unable to perform the principal duties of his occupation and is not gainfully employed in any occupation.

(Policy § 1.2.)

         In support of her “Total Disability” claim, Plaintiff asserts that after her term as Treasurer ended on January 20, 2009, she could not interview for positions in her occupation due to her medical conditions. Specifically, she alleges that:

As a result [of her medical conditions], Wiessmann could not engage in any extensive job interviewing, although she attempted to do so. Wiessman was able to complete only a single interview for one corporation position, but had to refuse the position because she could not perform its principal duties: being the upper level, day-to-day prime mover for a team accomplishing important financial work; sitting at a desk or table for extended periods of time to engage in face-to-face interactions, sophisticated financial analysis, or conference calls; engaging in significant ...

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