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Gaskill v. Life Insurance Co.

United States District Court, E.D. Missouri, Eastern Division

March 23, 2018

RODNEY GASKILL, Plaintiff,
v.
LIFE INSURANCE COMPANY OF NORTH AMERICA, d/b/a CIGNA INSURANCE GROUP and SOUTHEAST MISSOURI HOSPITAL, Defendants,

          OPINION, MEMORANDUM AND ORDER

          HENRY EDWARD AUTREY UNITED STATES DISTRICT JUDGE.

         This matter is before the court on Defendant Life Insurance Company of North America, d/b/a Cigna Insurance Group's Motion to Dismiss, [Doc. No. 14]. Plaintiff opposes the motion. For the reasons set forth below, the Motion is granted.

         Facts and Background

         On May 17, 2017, Plaintiff filed this action against defendants Life Insurance Company of North America d/b/a Cigna Insurance Group and Southeast Missouri Hospital under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001-1461, to recover benefits owed under an employee welfare benefit plan and damages from defendants' breach of their fiduciary duties and failure to provide certain documents upon request.

         In his Complaint, Plaintiff alleges that he was a full-time employee of Southeast Hospital for sixteen years and had worked seven years for Arch Air.

         During his employment, Plaintiff became permanently and totally disabled while working as a nurse at Southeast Hospital. He was not able to perform the material and substantial duties of his job during the first twenty-four (24) months of his disability, and thereafter has not been able to perform the material and substantial duties of any gainful job for which he is reasonably fitted by his education, training, or experience.

         Plaintiff alleges he submitted his claim for benefits on March 14, 2013, in which he alleged he was totally and permanently disabled such that he could not perform any job in the open labor market that he was qualified to perform based on his education, training, and work experience and could not earn over 80% of his indexed earnings. Plaintiff alleged that his disability resulted from a combination of physical and mental deficits. Plaintiff supported his claim with documentation from his treating physicians and a vocational expert and psychologist.

         Plaintiff's claim was denied based on the functional capacity evaluation by physical therapist and a transferable skills analysis based on the therapist's report. Plaintiff alleges that the report misrepresents the true nature of the testing because Plaintiff could not finish the testing due to his physical condition. Further, Plaintiff contends that the therapist had an intern administer the testing and he did not physically observe all of the testing.

         Despite his written requests, defendants failed to provide him with all the documents he requested.

         Plaintiff seeks to recover benefits owed under the Plan, damages, interest, attorneys' fees, and penalties for defendants' failure to produce the Plan documents.

         Defendant Life Insurance Company of North America moves to dismiss Plaintiff's complaint under Federal Rule of Civil Procedure 12(b)(6). Defendant argues that Plaintiff's claim under 29 U.S.C. § 1132(c) fails against it because it is not the plan administrator. Plaintiff also responds that Life Insurance Company of North America can be held liable for § 1132(c) penalties for failing to provide him with the Plan documents because it performed plan administrator functions.[1]

         Motion to Dismiss Standard

         A motion to dismiss under Rule 12(b)(6) challenges the legal sufficiency of the complaint. See Carton v. General Motor Acceptance Corp., 611 F.3d 451, 454 (8th Cir. 2010); Young v. City of St. Charles, 244 F.3d 623, 627 (8th Cir. 2001). To survive a motion to dismiss, the complaint must include “enough facts to state a claim to relief that is plausible on its face.” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 570 (2007). To meet the plausibility standard, the complaint must contain “more than labels and conclusions.” Id. at 555. Rather, the complaint must contain “factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 129 S.Ct. 1937, 1949 (2009).

         A complaint must be liberally construed in the light most favorable to the plaintiff. Eckert v. Titan Tire Corp., 514 F.3d 801, 806 (8th Cir. 2006). The Court must accept the facts alleged as true, even if doubtful. Twombly, 550 U.S. at 555. Thus, a well-pleaded complaint may proceed even if ...


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