Opinion
No. 1:02-CV-813
July 18, 2003
OPINION
Plaintiff, Richard Bentley ("Plaintiff"), has brought this action against Defendant, Metropolitan Life Insurance Company ("MetLife"), pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. § 1001 to 1461, to recover long-term disability ("LTD") benefits allegedly owing under the Guardian Industries Long-Term Disability Insurance Plan (the "Plan"). Before the Court is MetLife's motion for Entry of Judgment on the Administrative Record, or in the Alternative Motion for Summary Judgment. The Court will grant MetLife's motion because Plaintiff has failed to exhaust his administrative remedies under the Plan prior to filing this suit.
In the caption of this case and in Plaintiff's Answer to Defendant's Motion for Summary Judgment, Plaintiff's counsel has spelled Plaintiff's sur name "Bently." However, it appears from the Administrative Record that Plaintiff's sur name is actually spelled "Bentley."
Factual and Procedural Background
Plaintiff was employed by Guardian Industries ("Guardian") prior to March 16, 1998. On April 26, 1998, Plaintiff applied for LTD benefits under the Plan. Allstate Insurance Company, the administrator of the Plan at that time, approved Plaintiff's claim for LTD benefits on October 6, 1998. (A.R. at 464.) Plaintiff's LTD benefits commenced on September 18, 1998.
At that time, Guardian's policy was issued by Allstate Insurance Company. The policy was assumed by MetLife on or around July 1999, and MetLife administers the policy to date.
In May 2000, MetLife requested updated medical records from Plaintiff's treating physician. (A.R. at 210.) By October 2000, MetLife suspected that Plaintiff was engaged in employment, which would invalidate Plaintiff's eligibility for LTD benefits. MetLife retained a private investigation firm, Bonnamy Associates, to conduct surveillance on Plaintiff. (Surveillance Records, A.R. at 174-97.) According to Bonnamy Associates' records, Plaintiff was observed conducting a drywall business under the name "R R Drywall." (Id.) On May 22, 2000, Plaintiff signed and filed a notarized Certificate of Person Conducting Business Under Assumed Name, which stated that Plaintiff was the person "owning, conducting or transacting" business as R R Drywall. (Certificate of Persons Conducting Business Under Assumed Name, A.R. at 173.)
In February 2001, MetLife sent to Plaintiff a questionnaire entitled "activities of Daily Living" that asked whether Plaintiff had engaged in any work since he left his employment with Guardian and what income Plaintiff was receiving. (Activities of Daily Living, A.R. at 159-61.) Plaintiff responded that he had not engaged in work and his only income was from Social Security. (Id.) On April 5, 2001, MetLife requested copies of Plaintiff's 1999 and 2000 individual income tax returns, tax returns and proof of all monies earned by R R Drywall, (Letter from Lockwood to Bentley of 4/5/01, A.R. at 158), and Plaintiff's physicians' office notes and results of any objective testing conduced since June 2000, (Letter from Lockwood to Drs. Riddle and Anderson of 4/5/03, A.R. at 156.) Plaintiff's medical records state numerous times that he was working in late 2000 and in early 2001. (Medical Records, A.R. 124-144.) Plaintiff did not provide to MetLife copies of his individual income tax returns, but Plaintiff did provide copies of the 1099 tax forms and checks for R R Drywall, which evince that Plaintiff was engaged in the drywall business. (Financial Records, A.R. at 46-64.)
On June 13, 2001, MetLife sent a letter to Plaintiff informing him that MetLife had completed its evaluation of his eligibility for continued LTD benefits and concluded that Plaintiff was no longer eligible based on his "present earnings and lack of medical to substantiate [his alleged] disability." (Letter from Lockwood to Bentley of 6/13/01, A.R. at 43-44.) MetLife terminated Plaintiff's LTD benefits on June 13, 2001. (Id.) The letter also stated:
In the event a claim has been denied, in whole or in part, you may request a review of the claim in writing. This request for review should be sent to MetLife, at the address noted in this letter, no more than 60 days after you receive notice of denial of the claim. When requesting this review, please state the reason(s) you believe the claim was improperly denied, and submit any request to review pertinent documents. You may also submit additional medical or vocational information and any facts, data, questions or comments you deem appropriate for us to give your appeal proper consideration. MetLife will evaluate all the information and advise you of our determination in a timely manner.
(Id.)
The review procedure described in MetLife's letter mirrors the procedure set forth in the Plan:
CLAIM REVIEW RIGHTS
Guardian Industries has established a claim review procedure to assure that you receive the benefits to which you are entitled. In the event a claim is denied in whole or in part you will be notified in writing with an explanation. If you do not understand the reasons given contact the Insurance Company and request an explanation. If you feel the denial was not in accordance with the terms of the plan you may request a review of the claim and pertinent documents by submitting a written request for review to the Plan Administrator: Guardian Industries. This request must be received by the Plan Administrator no later than the 60th day after the claim denial is received by you. You may include with your request any comments or additional information which you think is relevant, and review pertinent documents. Within 60 days of the date your request for a review is received by the Plan Administrator you will receive a written decision. The Plan Administrator may extend the claim review period an additional 60 days, in which case you will be notified in writing of the reasons for the extension.
(Plan at 8, A.R. at 24.)
It is uncontested that Plaintiff did not file an appeal of MetLife's decision within the prescribed sixty-day period. On June 20, 2002, more than one year after MetLife's decision, Plaintiff's counsel sent a letter to MetLife requesting that MetLife justify its denial of Plaintiff's benefits. (Letter from Hubbell to MetLife of 6/20/02, A.R. at 42.) MetLife responded that Plaintiff had exceeded the time allowed to appeal his claim and that Plaintiff had been notified of MetLife's decision and his appeal rights by telephone on July 31, 2001, and by letter on August 1, 2001. (Letter from Lockwood to Hubbell of 7/23/02, A.R. at 38.)
Plaintiff filed the instant suit in Wexford County Circuit Court on September 24, 2002. The case was removed to this Court by MetLife on November 14, 2002.
Discussion
Under the administrative scheme of ERISA, a claimant may not file suit in federal court until the claimant has exhausted all administrative remedies available under the claimant's pension plan. Miller v. Metro. Life Ins. Co., 925 F.2d 979, 986 (6th Cir. 1991) ("The administrative scheme of ERISA requires a participant to exhaust his or her administrative remedies prior to commencing suit in federal court."). "[T]he exhaustion requirement enables plan fiduciaries to `efficiently manage their funds; correct their errors; interpret plan provisions; and assemble a factual record which will assist a court in reviewing the fiduciaries' actions.'" Baxter v. C.A. Muer Corp., 941 F.2d 451, 454 (6th Cir. 1991) (per curiam) (quoting Makar v. Health Care Corp. of Mid-Atlantic, 872 F.2d 80, 83 (4th Cir. 1989)). The exhaustion requirement "is the law in most circuits despite the fact that ERISA does not explicitly command exhaustion." Ravencraft v. UNUM Life Ins. Co. of Am., 212 F.3d 341, 343 (6th Cir. 2000). Unless the court finds that the claimant meets one of the exceptions to the exhaustion requirement, including futility of the administrative process or inadequacy of the administrative remedy, Baxter, 941 F.2d at 453 (citing Springer v. Wal-Mart Ass'n Group Health Plan, 908 F.2d 897, 899 (11th Cir. 1990)), the court will dismiss the claimant's suit without prejudice, Ravencraft, 212 F.3d at 344 (holding that dismissal without prejudice is proper when dismissing an action solely for failure to exhaust administrative remedies).
On June 13, 2001, MetLife notified Plaintiff that it was denying his LTD benefit claim. MetLife's letter stated in detail the reasons for its decision and set forth the procedure for Plaintiff to appeal its decision, including the sixty-day appeal deadline. It is uncontested that Plaintiff did not appeal MetLife's denial of his LTD benefits within the prescribed sixty-day period. There is no evidence in the Administrative Record that Plaintiff made an attempt to clarify or appeal MetLife's decision until more one year after the decision was rendered. Plaintiff thus failed to exhaust the administrative remedies available to him under the Plan prior to filing the instant claim. Accordingly, Plaintiff's claim against MetLife will be dismissed without prejudice.
Conclusion
For the foregoing reasons, Plaintiff's claim against MetLife will be dismissed without prejudice. An Order consistent with this Opinion with be entered.
ORDER
In accordance with the Opinion filed on this date,
IT IS HEREBY ORDERED that Defendant's, Metropolitan Life Insurance Company ("MetLife"), motion for Entry of Judgment on the Administrative Record, or in the Alternative Motion for Summary Judgment (docket no. 13) is GRANTED. IT IS FURTHER ORDERED that Plaintiff's, Richard Bentl[e]y, claim against MetLife is DISMISSED WITHOUT PREJUDICE.
This case is closed.