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Decola v. Prudential Insurance Co. of America

United States District Court, W.D. Kentucky, Louisville Division

March 24, 2017

BONNIE E. DECOLA, Plaintiff,
v.
PRUDENTIAL INSURANCE COMPANY OF AMERICA, Defendant.

          MEMORANDUM OPINION AND ORDER

          David J. Hale, Judge.

         When Plaintiff Bonnie Decola became disabled and could no longer work, she received benefits through her employer's disability plans, administered by Defendant Prudential Insurance. (Docket No. 12, PageID # 140) After paying benefits for several years, Prudential terminated Decola's claim and informed her on May 26, 2015, that she had 180 days to appeal Prudential's decision. (D.N. 8-1, PageID # 31) Two months later, Decola's counsel sent a letter informing Prudential that Decola was appealing and would be sending Decola's medical records as she received them. (D.N. 8-4, PageID # 99) Shortly thereafter, Decola's counsel sent another letter that reiterated her intention to appeal the termination and included some medical records from one of Decola's doctors but indicated that additional records would be submitted. (D.N. 8-5, PageID # 100) Prudential wrote back to say that Decola must inform Prudential when her appeal was complete. (D.N. 8-6, PageID # 126) Until Decola notified Prudential that her appeal was complete, Prudential would not review Decola's claim. (Id.) Decola's counsel failed to provide any further response or information until after the 180-day deadline had lapsed. (D.N. 8-7, PageID # 127)

         Prudential refused to consider Decola's appeal on the ground that Decola failed to submit a timely appeal. (D.N. 8-10, PageID # 130) Decola filed suit against Prudential, alleging that Prudential violated the Employee Retirement Income Security Act (ERISA) by wrongfully denying her disability benefits. (D.N. 1-1, PageID # 8) Prudential has moved to dismiss on the ground that Decola failed to exhaust her administrative remedies. (D.N. 8) Because the Court finds that Decola failed to exhaust her administrative remedies, the Court will grant Prudential's motion to dismiss.

         I. BACKGROUND

         Plaintiff Bonnie Decola worked as a truck driver for Penske Truck Leasing. (D.N. 1-1, PageID # 7; D.N. 12, PageID # 140) In 2008, Decola became disabled and could no longer work. (D.N. 12, PageID # 140) She applied for disability benefits under Penske's long-term disability (LTD) and short-term disability (STD) plans. (D.N. 1-1, PageID # 7; D.N. 8-1, PageID # 31) Defendant Prudential Insurance is the claims administrator of Penske's STD and LTD plan. (D.N. 8-1, PageID # 31)

         Prudential began paying Decola benefits under the STD and LTD plans. (Id.) Then, on May 26, 2015, Prudential terminated Decola's LTD claim. (D.N. 8-1, PageID # 31) The May 26 termination letter stated:

You have a right to appeal this decision. If you choose to do so, your appeal must be made in writing by you or your authorized representative, and submitted within 180 days of the date of receipt of this letter.

(Id., PageID # 32) Prudential added:

         Your appeal should contain:

• Your name, control number, and Social Security number (or claim number)
• The reasons that you disagree with our determination
• Medical evidence or information to support your position such as:
o Copies of therapy treatment notes o Any additional treatment records from physicians
o Actual test results (e.g., EMG, MRI)

(D.N. 8-3, PageID # 97-98) “Factoring in 14 days for receipt” of the termination letter, Decola had until December 6, 2015, to file an appeal. (D.N. 8-1, PageID # 31) On August 26, 2015, Plaintiff's then-counsel wrote a letter to Prudential, stating:

We are representing Ms. Decola in this matter and we are appealing the decision from the letter that was sent.
I am currently requesting medical records from Ms. Decola's doctors that she is currently seeing to show all updated records about her disabilities to show that there is no relief and wellness in her condition. I will be sending these records as I receive them. Again take this letter as an appeal, please allow time for the medical records to be obtained.

(D.N. 8-4, PageID # 99) Prudential did not respond to this letter. On September 2, 2015, her counsel sent another letter that stated:

As I have written before I have requested medical records from Ms. Decola's doctors. I am enclosing records from one of the doctors. It clearly shows her struggle with her gastro problems. I will ...

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