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Wernimont v. Prudential Insurance Co. of America

United States District Court, Western District of Michigan, Southern Division

January 26, 2015

BRIAN J. WERNIMONT, Plaintiff,
v.
THE PRUDENTIAL INS. CO. OF AMERICA, Defendant.

OPINION

JANET T. NEFF, UNITED STATES DISTRICT JUDGE

Pending before the Court in this breach of contract case is Defendant’s Motion to Dismiss pursuant to Fed.R.Civ.P. 12(b)(6) (Dkt 35). Plaintiff filed a response (Dkt 37), and Defendant filed a reply (Dkt 38). Having reviewed the parties’ written submissions and accompanying exhibits, the Court finds that the relevant facts and arguments are adequately presented in these materials and that oral argument would not aid the decisional process. See W.D. Mich. LCivR 7.2(d). For the reasons discussed herein, the Court denies Defendant’s motion.

I. BACKGROUND

This case arises from Plaintiff’s February 6, 2007 car accident (Dkt 22, Amend. Compl. ¶ 7). Plaintiff, who worked in trust and estate administration and taxation, suffered a head injury and alleges that he lost his ability to focus and concentrate after the accident (id. ¶¶ 15-16). According to Plaintiff, he became disabled and ceased working due to his disability on August 31, 2008 (Def.’s Ex. A., Group Disability Ins. Employee Statement, Dkt 36-1 at 2).

On March 23, 2009, Plaintiff made a claim for long-term disability benefits under a group insurance contract issued by Defendant to the American Institute of Certified Public Accountants insurance trust (AICPA) (“the policy”) (Dkt 22, Amend. Compl. ¶ 9).[1] On May 12, 2009, Defendant notified Plaintiff that his request for benefits was denied (id. ¶ 10). Plaintiff alleges that he appealed “several times, with additional medical documentation being added each time, ” but Defendant continued to deny coverage (id. ¶11). Plaintiff indicates that his “latest appeal” was denied on July 26, 2013 (id. ¶ 12). Plaintiff expects his disability to continue “indefinitely” (id. ¶ 23).

Plaintiff initiated this action on August 27, 2013. His December 3, 2013 Amended Complaint alleges Breach of Contract (Count I), based on “Defendant’s refusal to pay long-term benefits ... contrary to its contractual obligations” (Dkt 22, Amend. Compl. ¶¶ 13, 28). Plaintiff seeks a declaratory judgment in his favor (Count II). Plaintiff invokes both diversity jurisdiction and federal-question jurisdiction under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 to 1461 (id. ¶¶ 3-4). Defendant did not file an Answer to the Amended Complaint, instead filing the instant motion to dismiss (Dkt 35), which is ripe for decision.

II. DISCUSSION

A. Motion Standard

Defendant moves to dismiss Plaintiff’s Amended Complaint under Rule 12(b)(6) of the Federal Rules of Civil Procedure, contending that Plaintiff has failed to state a claim upon which relief can be granted where the action was filed outside the limitations period provided for by the policy. In deciding whether to dismiss a claim under Rule 12(b)(6), a court must accept the plaintiff’s factual allegations as true and construe the complaint in the light most favorable to the plaintiff. Gunasekera v. Irwin, 551 F.3d 461, 466 (6th Cir. 2009). In addition to the allegations and exhibits of the complaint, a court may consider “public records, items appearing in the record of the case and exhibits attached to defendant’s motion to dismiss so long as they are referred to in the [c]omplaint and are central to the claims contained therein.” Bassett v. NCAA, 528 F.3d 426, 430 (6th Cir. 2008) (citing Amini v. Oberlin Coll., 259 F.3d 493, 502 (6th Cir. 2001)).

To survive dismissal, the complaint must contain enough facts to establish a “plausible, ” as opposed to merely a “possible, ” entitlement to relief. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citing Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 557, 570 (2007)). However, “the tenet that a court must accept as true all of the allegations contained in a complaint is inapplicable to legal conclusions.” Id. Whether contract language is ambiguous is a question of law. Aidamark, Inc. v. Roll Forming Corp., 580 F. App’x 408, 414 (6th Cir. 2014) (citing Wilkie v. Auto-Owners Ins. Co., 664 N.W.2d 776, 780 (Mich. 2003)); Farm Bureau Mut. Ins. Co. of Michigan v. Nikkel, 596 N.W.2d 915, 918 (Mich. 1999). The determination that a complaint was filed outside of the applicable limitations period is also a conclusion of law. CMACO Auto. Sys., Inc. v. Wanxiang America Corp., 589 F.3d 235, 242 (6th Cir. 2009).

B. Analysis

ERISA does not provide a statute of limitations for suits brought under § 502(a)(1)(B) to recover benefits; therefore, courts usually borrow the most closely analogous state limitations period. See Meade v. Pension Appeals & Rev. Comm., 966 F.2d 190, 194-95 (6th Cir. 1992). Choosing which statute to borrow is unnecessary where, as here, the parties have contractually agreed on a limitations period and do not dispute that the limitations period is “reasonable.” See Medical Mut. of Ohio v. k. Amalia Enter. Inc., 548 F.3d 383, 390 (6th Cir. 2008).[2]

The policy in this case includes the following two provisions that are relevant to resolving the limitations ...


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