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Cannon v. Aetna Life Insurance Co.

United States District Court, D. Massachusetts

June 17, 2015

GREGORY CANNON, Plaintiff,
v.
AETNA LIFE INSURANCE COMPANY and PHARMERICA LONG TERM DISABILITY PLAN, Defendants.

MEMORANDUM AND ORDER

DENISE J. CASPER, District Judge.

I. Introduction

Plaintiff Gregory Cannon ("Cannon") brings this action against Aetna Life Insurance Company ("Aetna") and Pharmerica Long Term Disability Plan (the "Plan") (collectively, the "Defendants") alleging the unlawful denial of benefits under the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001, et. seq. D. 1. The Defendants move to dismiss or, in the alternative, to stay the case. D. 15. For the reasons stated below, the Court DENIES the motion to dismiss and ALLOWS the motion to stay.

II. Standard of Review

In considering a motion to dismiss for failure to state a claim upon which relief can be granted pursuant to Fed.R.Civ.P. 12(b)(6), the Court will dismiss a pleading that fails to plead "enough facts to state a claim to relief that is plausible on its face." Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). To state a plausible claim, a claim need not contain detailed factual allegations, but it must recite facts sufficient to at least "raise a right to relief above the speculative level... on the assumption that all the allegations in the complaint are true (even if doubtful in fact)." Twombly, 550 U.S. at 555. "A pleading that offers labels and conclusions' or a formulaic recitation of the elements of a cause of action will not do.'" Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Twombly, 550 U.S. at 555). "Nor does a complaint suffice if it tenders naked assertion[s]' devoid of further factual enhancement.'" Id . (quoting Twombly, 550 U.S. at 557) (alteration in original). At bottom, a claim must contain sufficient factual matter that, accepted as true, would allow the Court "to draw the reasonable inference that the defendant is liable for the misconduct alleged." Id . However, "[i]n determining whether a [pleading] crosses the plausibility threshold, the reviewing court [must] draw on its judicial experience and common sense.'... This context-specific inquiry does not demand a high degree of factual specificity.'" García-Catalán v. United States, 734 F.3d 100, 103 (1st Cir. 2013) (internal citations omitted).

III. Factual Background

Unless otherwise indicated, the facts are as alleged in the complaint and taken as true for the purpose of the pending motion. Cannon, formerly a pharmacist, stopped working on August 18, 2010 because he suffered from multiple ailments. D. 1 ¶ 18. He was insured under the Plan, which was administered by Aetna. Id . ¶¶ 6, 10. Cannon received short term disability ("STD") benefits from Aetna from August 18, 2010 through October 3, 2010. Id . ¶ 19. Aetna terminated Cannon's STD benefits effective October 4, 2010, stating that Cannon was not "totally disabled" as defined by the terms of the Plan. Id . ¶ 20.

On May 24, 2011, Cannon's counsel requested that Aetna review Cannon's eligibility for long term disability ("LTD") benefits and provided supporting documentation. Id . ¶ 24. Aetna did not respond. Id . ¶ 25. At some point after Cannon's counsel sent a follow-up letter, counsel received a voice mail from an Aetna employee stating that Aetna refused to review Cannon's claim. Id . ¶ 27. On July 27, 2011, counsel again wrote to Aetna, including additional medical information and LTD application forms. Id . ¶ 28. Counsel submitted further information in December 2011 and January 2012. Id . ¶¶ 30, 32. Aetna has not provided a written response to Cannon's request for LTD benefits. Id . ¶ 37.

IV. Procedural History

Cannon initiated this action on June 17, 2014. D. 1. The Defendants have now moved to dismiss for failure to state a claim pursuant to Fed.R.Civ.P. 12(b)(6). D. 15. The Court held a hearing on the pending motion and took the matter under advisement. D. 28.

Cannon has a related matter pending before this Court. On March 21, 2012, Cannon sued Aetna, the Plan and Pharmerica Temporary Disability Income Plan seeking to recover both LTD and STD benefits. See Civ. Action No. 12-cv-10512-DJC, D. 1. On February 18, 2013, the parties to that action stipulated to a dismissal without prejudice of Cannon's claim for LTD benefits. Id., D. 35. On September 17, 2013, the Court ordered that Cannon's case be remanded to Aetna "to allow the independent, reviewing physicians... to update their reports after the record is supplemented with the additional medical records..., including records from Cannon's primary care physician." Id., D. 52 at 24. Upon its supplemental review, Aetna upheld its decision to deny STD benefits to Cannon. See id., D. 61. The defendants in the related matter have moved for summary judgment, id., D. 86, and Cannon has responded with his own motion for summary judgment, id., D. 88 (filed under seal). The Court will hold a hearing on both pending summary judgment motions on July 15, 2015. Id., D. 95.

V. Discussion

A. Exhaustion of administrative remedies

The Defendants first argue that Cannon failed to exhaust his administrative remedies because he did not pursue an administrative appeal. D. 16 at 7. Exhaustion of administrative remedies is required before a plaintiff may assert an ERISA claim. Drinkwater v. Metro. Life Ins. Co., 846 F.2d 821, 826 (1st Cir. 1988); Botelho v. Liberty Life Assur. Co. of Boston, No. 11-11801-GAO, 2012 WL 3929983, at * 1 (D. Mass. Sep. 10, 2012) (stating that "it is well settled in this ...


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