United States District Court, W.D. Kentucky, Bowling Green Division
MEMORANDUM OPINION AND ORDER
N. Stivers, Judge United States District Court.
matter comes before the Court on Defendant's Motion to
Dismiss, or in the alternative, Motion to Remand (DN 7),
Defendant's Motion for Extension of Time to File Reply
(DN 11), and Plaintiffs Motion to Strike Reply as Untimely
Filed (DN 14). For the following reasons, Defendant's
Motion to Dismiss is DENIED, Defendant's
Motion for Extension of Time to File Reply is
GRANTED, and Plaintiffs Motion to Strike
Reply as Untimely Filed is DENIED
Jennith Coontz ("Coontz") was employed at American
Greetings Corporation. (Notice Removal Ex. A, at 2, DN 1-2
[hereinafter Compl.]). As part of her employment, Coontz had
accidental death and dismemberment ("AD&D")
benefits through two plans: the American Greetings
Corporation Personal Accidental Death and Dismemberment Plan
and the American Greetings Corporation Voluntary Accidental
Death and Dismemberment Plan (collectively the
"Plan"), which were both issued by Defendant
Metropolitan Life Insurance Company ("MetLife").
(Def's Mot. Dismiss Ex. 1, DN7-1).
4, 2016, Coontz submitted to MetLife a claim for AD&D
benefits based on the loss of sight in her right eye. (Compl.
¶ 12). On July 7, 2016, MetLife issued an initial denial
of Coontz's claim for benefits on the basis that the
"loss of sight was contributed to by the complications
arising from the treatment of the lung surgery, therefore,
under the terms of the Plan the loss was not the direct
result of an accidental injury." (Compl. ¶ 14;
Def's Mot. Dismiss Ex. 2, DN 7-3). Further, MetLife
determined that even if the loss of sight had been the result
of an accident, a Plan exclusion precluded payment "for
any loss caused or contributed to by . . . physical or mental
illness or infirmity, or the diagnosis or treatment of such
illness or infirmity." (Def's Mot. Dismiss Ex. 2).
regard to the "Notice of Benefit Determination on
Appeal, " the Plan provides that an appeal decision must
be rendered within 60 days of receipt of the appeal.
(Def's Mot. Dismiss Ex. 1, at 49-50, DN 7-1). This 60-day
period can be extended for an additional 60 days "if the
claims administrator both determines that special
circumstances require an extension of time for processing the
claim, and notifies the covered person (or authorized
representative), before the initial sixty (60) day period
expires, of the special circumstances requiring the extension
of time and the date by which the claims administrator
expects to render a determination." (Def's Mot.
Dismiss Ex. 1, at 49-50). Further, the Plan requires not only
a first appeal, but a "second-level appeal" before
suit can be initiated. (Def's Mot. Dismiss Ex. 1, at 50).
In particular, the Plan provides:
If the covered person is not satisfied with the outcome of
the appeals procedure, the covered person has the right to
bring a civil action under section 502 (a) of the Employee
Retirement Income Security Act of 1974. The covered person
may not initiate a legal action against the plan until the
covered person has completed the [sic] both the initial and
second level appeal process.
(Def's Mot. Dismiss Ex. 1 at 50).
letter dated July 15, 2016, Coontz appealed MetLife's
decision. (Compl. ¶ 17). On August 16, 2016, she
supplemented her appeal with additional information. (Compl.
advised Plaintiff by letter dated August 25, 2016, (the
"Extension Letter") that it was "continuing to
review [her] appeal dated August 16, 2016." (Compl.
¶ 20; Def's Mot. Dismiss Ex. 3, at 1, DN 7-4).
MetLife further advised that "[i]t will be necessary for
us [MetLife] to obtain additional information; therefore,
completion of your [Coontz's] appeal will be delayed for
a short period of time." (Compl. ¶ 20; Def's
Mot. Dismiss Ex. 3). Finally, the Extension Letter advised
Coontz that "[w]e will notify you of our findings for
ERISA use: within sixty (60) days of receiving the necessary
information." (Compl. ¶ 20; Def's Mot. Dismiss
Ex. 3, at 1).
MetLife had not ruled on Coontz's initial appeal, she
filed this action in Casey Circuit Court on December 13,
2016. (Compl. ¶ 22). MetLife subsequently removed the
case to this Court. (Notice Removal, DN 1). MetLife has now
moved to dismiss the case arguing that Coontz failed to
exhaust her administrative remedies before filing suit.
(Def's Mot. Dismiss, DN 7). This matter is ripe for
Court has "original jurisdiction of all civil actions
arising under the Constitution, laws, or treaties of the
United States." 28 U.S.C. § 1331.
MetLife's Motion to Dismiss
has moved to dismiss the Complaint on the basis that Coontz
failed to exhaust her administrative remedies and
alternatively requests remand of this matter to MetLife for
completion of the administration record. (Def's Mot.
Dismiss 6-10). A complaint is subject to dismissal if it
"fail[s] to state a claim upon which relief can be
granted." Fed.R.Civ.P. 12(b)(6). When considering a
motion to dismiss under Rule 12(b)(6), the Court must
construe the complaint in a light most favorable to the
nonmoving party, accepting "as true all factual
allegations and permissible inferences therein." See
Gazette v. City of Pontiac,41 F.3d 1061, 1064 (6th Cir.
1994) (citing Westlake v. Lucas,537 F.2d 857, 858
(6th Cir. 1976)). The nonmoving party, however, must plead
more than bare legal conclusions. See Lillard v. Shelby
Cty. Bd. of Educ,76 F.3d 716, 726 (6th Cir. 1996). In
order to survive a 12(b)(6) motion, "[the] complaint
must contain (1) 'enough facts to state a claim to relief
that is plausible, ' (2) more than 'a formulaic
recitation of a cause of action's elements, ' and (3)
allegations that suggest a 'right to relief above a
speculative level.'" Tackett v. M & G Polymers,
USA, LLC,561 F.3d 478, 488 (6th Cir. 2009) (quoting
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