United States District Court, W.D. Washington, Seattle
LAURA D. JANTOS, Plaintiff,
THE PRUDENTIAL LIFE INSURANCE COMPANY OF AMERICA, Defendant.
Honorable Richard A. Jones United States District Judge.
matter comes before the Court on Defendant The Prudential
Life Insurance Company of America's Motion to Dismiss.
Dkt. # 38. Plaintiff Laura Jantos opposes the motion. Dkt. #
40. For the reasons that follow, the Court GRANTS in part and
DENIES in part Defendant's motion.
is a beneficiary to a Long Term Disability (LTD) Plan that
Defendant administers. Dkt. # 33 (Amended Complaint) at
¶¶ 2, 3. After suffering a traumatic brain injury,
Plaintiff submitted a claim for benefits under the LTD Plan.
Id. at ¶ 5. Defendant approved her claim and
paid her benefits pursuant to the Plan. Id.
Plaintiff never contested the amount of her monthly benefit.
point, Defendant terminated Plaintiff's benefits.
Id. at ¶ 12. Plaintiff appealed the decision,
and Defendant ultimately agreed to reinstate her benefits.
Id. Plaintiff now claims that Defendant has been
underpaying her benefits and brings this lawsuit under the
Employee Retirement Income Security Act of 1974 (ERISA).
Civ. P. 12(b)(6) permits a court to dismiss a complaint for
failure to state a claim. The rule requires the court to
assume the truth of the complaint's factual allegations
and credit all reasonable inferences arising from those
allegations. Sanders v. Brown, 504 F.3d 903, 910
(9th Cir. 2007). A court “need not accept as true
conclusory allegations that are contradicted by documents
referred to in the complaint.” Manzarek v. St. Paul
Fire & Marine Ins. Co., 519 F.3d 1025, 1031 (9th
Cir. 2008). The plaintiff must point to factual allegations
that “state a claim to relief that is plausible on its
face.” Bell Atl. Corp. v. Twombly, 550 U.S.
544, 568 (2007). If the plaintiff succeeds, the complaint
avoids dismissal if there is “any set of facts
consistent with the allegations in the complaint” that
would entitle the plaintiff to relief. Id. at 563;
Ashcroft v. Iqbal, 556 U.S. 662, 679 (2009).
typically cannot consider evidence beyond the four corners of
the complaint, although it may rely on a document to which
the complaint refers if the document is central to the
party's claims and its authenticity is not in
question. Marder v. Lopez, 450 F.3d 445, 448 (9th
Cir. 2006). A court may also consider evidence subject to
judicial notice. U.S. v. Ritchie, 342 F.3d 903, 908
(9th Cir. 2003).
Exhaustion of Remedies
first claim arises under 29 U.S.C. § 1132(a)(1)(B). Dkt.
# 33 (Amended Complaint) at ¶ 16. She alleges that
Defendant underpaid her LTD benefits, and she seeks to
enforce her rights under the Plan as well as clarify her
right to future benefits under the terms of the Plan.
Id. To bring such a claim, Plaintiff “must
avail . . . herself of a plan's own internal review
procedures before bringing suit in federal court.”
Vaught v. Scottsdale Healthcare Corp. Health Plan,
546 F.3d 620, 626 (9th Cir. 2008); Diaz v. United Agr.
Employee Welfare Ben. Plan and Trust, 50 F.3d 1478, 1483
(9th Cir. 1995); Amato v. Bernard, 618 F.2d 559, 568
(9th Cir. 1980). Though this exhaustion requirement is a
court-created doctrine, it is long settled that Congress
intended for plaintiffs to exhaust their remedies prior to
bringing suit in a federal forum. Diaz, 50 F.3d at
1483. Doing so reduces frivolous litigation, promotes
consistent treatment of claims, minimizes costs of claim
settlement, and allows for “proper reliance on
administrative expertise.” Id.
Plan provided that it would pay sixty-percent of
Plaintiff's monthly earnings up to $15, 000. Dkt. # 39 at
p. 18. Accordingly, when the Plan approved Plaintiff's
LTD benefits, it multiplied her monthly earnings by
sixty-percent to calculate her scheduled benefit of $9, 500.
Id. at p. 54. In addition to approving her benefits,
Defendant directed Plaintiff to contact a claims handler or
other representative should she have any questions regarding
her scheduled benefits. Id. at pp. 54-55. Moreover,
the Plan provided information on how to file a claim, and
authorized Plaintiff to “start legal action regarding
[her] claim 60 days after proof of claim has been given and
up to 3 years from the time proof of claim is required,
unless otherwise provided under federal law.”
Id. at pp. 36-38.
claims an exception to her exhaustion requirement. See,
generally, Dkt. # 40. Plaintiff explains that if
Defendant's approval letter is not an “adverse
benefit determination, ” and it is not, then she may
sidestep any exhaustion requirement and bring a lawsuit
within the time frame noted in the Plan. Id. at pp.
24-25. The Court disagrees. Plaintiff must attempt to utilize
Defendant's internal resources before venturing into a
federal forum. Diaz, 50 F.3d at 1484 (“If the
denial letters left Diazes in the dark . . ., a toll-free
telephone call could have shed light on the matter. Diazes
fail to explain why that phone call was not made, nor have
they suggested that the call would have been
unproductive.”). Had Plaintiff called her claims
handler or any other representative-information that
Defendant provided in its benefits approval letter-to seek
clarification regarding her scheduled benefits, she may have
had the opportunity for an internal review. In fact,
Defendant proved that it could resolve Plaintiff's issues
both internally and in her favor based on Plaintiff's
appeal in 2016. Dkt. # 33 (Amended Complaint) at ¶ 12.
Internal resolution and judicial economy are not mere details
in ERISA's construction, and the Court takes
Plaintiff's exhaustion requirement seriously.
Accordingly, the Court GRANTS Defendant's motion to
dismiss Plaintiff's first claim under 29 U.S.C. §
1132(a)(1)(B) without prejudice.
Plaintiff's Second Claim under 29 U.S.C. ...