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Nicholas v. Cigna Life Insurance Co. of New York

United States District Court, D. Massachusetts

February 25, 2016

MELISSA NICHOLAS, Plaintiff,
v.
CIGNA LIFE INSURANCE COMPANY OF NEW YORK, Defendant.

MEMORANDUM AND ORDER

ALLISON D. BURROUGHS U.S. DISTRICT COURT

I. Introduction

In this action brought under the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”), Melissa Nicholas (“Ms. Nicholas”) challenges the decision of CIGNA Life Insurance Company of New York (“CLICNY”) denying her benefits under the Pfizer Health and Welfare Long Term Disability Plan (the “LTD Plan”), administered and underwritten by CLICNY and sponsored by her former employer, Pfizer, Inc. (“Pfizer”). [ECF No. 1 (“Complt.”)]. Ms. Nicholas has brought three causes of action against CLICNY. First, she seeks relief under 29 U.S.C. § 1132 to recover benefits due under the LTD Plan. Id. ¶¶ 54-59. Second, she contends that CLICNY breached a settlement agreement entered between state insurance regulators and several insurance companies under the control of CIGNA, Corp. Id. ¶¶ 60-64. Third, she seeks attorney’s fees and costs under 29 U.S.C. § 1132 (g). Id. ¶¶ 65-66.

Currently before the Court are (1) Ms. Nicholas’ Motion to Take Limited Focused Discovery [ECF No. 30], which requests that several interrogatories and document requests be allowed, and (2) CLICNY’s Motion for Judgment on the Pleadings and Motion to Strike Demand for Jury Trial, which seeks to dismiss the second count for breach of contract and to strike Ms. Nicholas’ demand for a jury trial. [ECF No. 21]. For the reasons stated herein, Ms. Nicholas’ Motion to Take Discovery is GRANTED IN PART and CLICNY’s Motion for Judgment on the Pleadings and Motion to Strike Demand for Jury Trial is GRANTED.

II. Background

A. Procedural History

From September 1997 to March 2006, Ms. Nicholas worked at Pfizer, most recently as a European Financial Shares Services Quality Manager. [R. 156; R. 1051].[1] Ms. Nicholas’ last day of work was March 27, 2006, after which she applied for long-term disability (“LTD”) benefits under the LTD Plan. [R. 132-146; R. 1051]. In her original claim for benefits, Ms. Nicholas stated that she was unable to work because of severe chronic pain caused by bulging discs in her spine and psoriatic arthritis in her spine, sacrum, and hips. [R. 137].

By letter dated November 22, 2006, CLICNY denied Ms. Nicholas’ claim for LTD benefits. [R. 1050-1053]. In April 2007, Ms. Nicholas appealed and after an additional review, CLICNY again denied her claim. [R. 1079-1081]. In December 2007, Ms. Nicholas again appealed and CLICNY declined to consider her second appeal. [R. 1173]. While this process was ongoing, Ms. Nicholas applied for benefits under the Social Security Act and in April 2007, the Social Security Administration issued a decision finding Ms. Nicholas disabled as of September 1, 2006. [R. 339-342].

In November 2009, through a new attorney, Ms. Nicholas sought an additional appeal of CLICNY’s decision to deny her LTD benefits and CLICNY agreed to complete an appeal review. [R. 1186-1215; R. 2887]. By letter dated March 19, 2010, CLICNY issued a check to Ms. Nicholas in the amount of $127, 870.80, which represented benefits due to her from September 28, 2006 to September 27, 2008 (the “Own Occupation” period under the LTD Plan). [R. 2894]. In a subsequent letter, CLICNY declined to provide LTD benefits beyond that point, finding that Ms. Nicholas was capable of performing light and sedentary occupations. [R. 2919-2921]. CLICNY subsequently considered two additional appeals and both times declined to extend benefits beyond the Own Occupation period. [R. 3237-3239; R. 3403-3406]. On November 2014, Ms. Nicholas filed her Complaint with this Court. [ECF No. 1].

B. Regulatory Settlement Agreement

On May 13, 2013, the Life Insurance Company of North America, Connecticut General Life Insurance Company, CIGNA Health and Life Insurance, the Massachusetts Division of Insurance and other state insurance regulators entered into a Regulatory Settlement Agreement (“RSA”). [ECF No. 2]. The three companies that signed the RSA (collectively the “CIGNA Companies”) are under the control of CIGNA, Corp. [ECF No. 1 ¶ 45]. The RSA arose from a series of examinations by state insurance regulators into the claim handling practices of the CIGNA Companies. [ECF No. 2 at 1-2]. Under the RSA, the CIGNA Companies agreed to institute a plan of corrective action, establish a remediation program to reevaluate certain LTD claims that were previously denied, and to pay fines. Id. at 3.

Ms. Nicholas’ breach of contract claim relates to the RSA’s remediation program. The RSA required the CIGNA Companies to remediate LTD claims made by residents of several states, including Massachusetts, which were denied or terminated from January 1, 2009 to December 31, 2010. Id. at Ex. F. Ms. Nicholas alleges that CLICNY was bound by the RSA and breached it by failing to remediate her claim. [ECF No. 1 ¶ 63].

III. Discussion

A. Motion to Take ...


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