Dallas Fort Worth Insurance Lawyer Blog
The Employee Retirement Income Security Act of 1974 (ERISA) offers many of the same types of insurance coverage for individuals as other plans. The distinctions with ERISA is that the plan is a plan for employers to offer to employees that is set and governed by Federal Law rather than State Law.
ERISA plans offer retirement programs, life insurance, disability insurance, and health insurance. The Southern District of Texas, Houston Division, issued an opinion in November 2020, on a case that is governed by ERISA. The opinion is styled, Wagna Mina huerta v. Shell Oil Company and Shell Oil Comprehensive Welfare Benefits Plan.
This case discussed a couple of issues. One of those, rarely seen in an opinion, is discussed here.
The Plaintiff, Wagna is the widow of Arturo Huerta who was a participant in the Shell Oil Company ERISA plan. While employed, Arturo enrolled in the plan. Arturo was terminated on February 28, 2017, and died on May 18, 2017. Wagna filed for life insurance benefits. MetLife, the insurer, denied benefits because Arturo did not complete the forms to “port or convert” his coverage and no premiums were paid following his termination.
This lawsuit resulted. Wagna’s Amended Complaint asserts claims against Shell and the Plan for civil penalties under 29 U.S.C., Section 1132(c), which provides that any ERISA plan administrator who “fails or refuses to comply with a request for any information which such administrator is required by this subchapter to furnish to a participant or beneficiary … within 30 days after such request may in the court’s discretion be personally liable to such participant or beneficiary in the amount of up to [$110] a day from the date of such failure…” Wagna’s claims are based on Defendants’ alleged failure to provide: (1) “a copy of the MetLife Policy or the policy produced by MetLife on March 24, 2019” and (2) “copies of the June 12, 2017 telephone recordings” of conversations between Wagna, Shell, and MetLife regarding whether MetLife sent Arturo notices regarding conversion or portability options.
The Defendants filed a Rule 12(b)(6) motion to dismiss. A court may take judicial notice of public documents, and may also consider documents a defendant attaches to its motion to dismiss under 12(b)(6) if the documents are referenced in the plaintiff’s complaint and central to the plaintiffs’ claims.
ERISA Section 502(c)4 provides that:
Any administrator . . . who fails or refuses to comply with a request for any information which such administrator is required by this subchapter to furnish to a participant or beneficiary (unless such failure or refusal results from matters reasonably beyond the control of the administrator) by mailing the material requested to the last known address of the requesting participant or beneficiary within 30 days after such request may in the court’s discretion be personally liable to such participant or beneficiary in the amount of up to [$110] a day from the date of such failure or refusal, and the court may in its discretion order such other relief as it deems proper.
Shell does not dispute that as the plan administrator it was required to furnish Wagna with a copy of the MetLife Insurance Policy within 30 days of a written request or be subject to penalties. However, Shell contends that Wagna’s Amended Complaint does not allege facts that plausibly show it failed to meet this obligation. Wagna alleges that on September 5, 2018 she sent a letter to Shell asking for “The MetLife policy or sample policy that was in effect as of May 12, 2017.” On October 2, 2018, Shell provided a MetLife insurance policy that it represented was in effect as of May 12, 2017. The policy Shell provided has an effective date of January 1, 2005. Wagna alleges that the policy Shell produced was not actually the policy in effect as of May 12, 2017. Wagna’s allegation is based on the fact that MetLife attached to its March 2019 motion to dismiss a “policy” with an effective date of January 1, 2007. Wagna alleges that “To this day, Shell and the Plan have never produced a copy of the MetLife Policy or the policy produced by MetLife on March 24, 2019.”
Shell contends that Wagna’s allegations do not state a plausible claim because review of the MetLife’s submission shows that it did not attach a copy of the policy but only of a certificate of insurance, “a document separate from the policy itself.” Wagna does not allege that she submitted a written request for a copy of the certificate of insurance. Because the MetLife document is expressly referenced in the Amended Complaint, the Court may consider it in determining whether Wagna has stated a claim for purposes of Defendants’ motion to dismiss under 12(b)(6). However, the fact that the MetLife document appears to be a certificate of insurance and not the policy itself, does not fully resolve the issue as a matter of pleading. Wagna alleges Shell provided her with a policy with an effective date of January 1, 2005 and that the MetLife “policy” indicates an effective date of January 1, 2007. Based on the inconsistent effective dates, Wagna alleges Shell did not provide the requested policy. The Court cannot determine whether the date on the MetLife document reflects only the date of issuance of the certificate of insurance, or whether it reflects the effective date of the “Basic Life Insurance” policy to which is relates. Thus,from the face of the Amended Complaint, the Court cannot determine that Shell provided to Wagna on October 2, 2018 the policy that was in effect on May 12, 2017. This issue may be easily resolved on summary judgment, but it cannot be resolved on Defendants’ Rule 12(b)(6) motion.
The other issues in the case require a reading of the opinion. ERISA lawyers need to read the entire opinion.