United States District Court, E.D. Missouri, Eastern Division
MEMORANDUM AND ORDER
A. ROSS UNITED STATES DISTRICT JUDGE
matter is before the Court on Defendant Aetna Life Insurance
Company's (“Aetna”) Motion to Dismiss. (Doc.
10.) Plaintiff Tiffany Ausler has filed a response in
opposition (Doc. 19), and Aetna has replied (Doc. 23).
makes the following allegations (see Docs. 1, 19):
Plaintiff was employed by Boeing Corporation as a software
engineer for more than thirteen years. As a Boeing employee,
Plaintiff was eligible for the company's short-term
disability (“STD”) and long-term disability
(“LTD”) compensation plans, which are
administrated by Aetna and subject to the Employee Retirement
Income Security Act of 1974 (“ERISA”), 29 U.S.C.
§ 1001-1461. Aetna provided Boeing employees with a plan
brochure detailing things like eligibility
requirements, the benefits claims process, and how to appeal
from a denial. (Doc. 10-2 at 37-151 (see also, Doc.
10-1 (The Boeing Company Master Welfare Plan)).) It notes
that Aetna serves as the plan's “service
representative, ” with the authority to approve or deny
disability claims and to review denials on appeal.
(Id. at 61)
The Plan Brochure
plan brochure is divided into thirteen sections, including
Section 1 - Eligibility and Enrollment; Section
2 - Short-Term Disability Plan; Section 3 -
Long-Term Disability Plan; and Section 9 - Claims
and Appeals. (Doc. 10-2 at 43.) Section 1 of the plan
brochure defines who is eligible for Boeing's seven
employer-sponsored benefits plans. (Doc. 10-2 at 40.) Initial
eligibility determinations are made by the Boeing Service
Center and appeals are considered by Boeing's Employee
Benefit Plans Committee. (Id. at 121-22.) Section 2
of the plan brochure explains that STD benefits are available
if an employee becomes disabled as a result of a
pregnancy-related condition, accidental injury, or illness.
(Id. at 61.) If an employee is disabled for
twenty-six weeks, she “may be eligible for benefits
under the [LTD] plan.” (Id.) Section 3 of the
plan brochure explains the amount and duration of LTD
benefits. (Id. at 67-76.) On page 3-10, the brochure
explains how to claim LTD benefits:
How to Submit a Long-Term 1Disability Claim
If you are receiving benefits under the Short-Term Disability
Plan and you continue to be disabled, you do not need to
submit a claim for long-term disability benefits under this
. . .
If you are not receiving benefits under the Short-Term
Disability Plan, you will need to initiate a claim for
long-term disability benefits by calling Boeing Total Access
at the start of your medical leave.
. . .
You must initiate your claim within 90 days of the date your
26-week waiting period under this plan ends . . . A claim
submitted more than one year after your 90-day disability
claim-filing period will not be covered unless you are
(Id. at 76.)
9 is divided into four subsections with headings set apart in
bold letters. (Doc. 10-2 at 116.) The first subsection
How to Submit a Claim or File an Appeal
This section describes two types of claim review and appeal
procedures . . .:
• Benefit claims and appeals.
• Eligibility claims and appeals.
(Id. at 117.) Next is Benefit Claims
Process, which includes a procedure for filing a claim
for benefits and appealing if your claim is denied.
(Id.) After that is Eligibility Claims
Process, again explaining how to file a claim and appeal