United States District Court, W.D. Louisiana, Shreveport Division
ELIZABETH ERNY FOOTE MAGISTRATE JUDGE
claims she is entitled to life insurance benefits under
policies purchased by her late husband's employer. Before
the Court are motions to dismiss filed by Defendants Lincoln
National Life Insurance Company ("Lincoln") [Record
Document 13] and United of Omaha Life Insurance Company
("United") [Record Document 34] and a motion for
partial summary judgment filed by Plaintiff [Record Document
38]. Because Plaintiff is not entitled to benefits under the
terms of either insurance policy, Lincoln's motion
[Record Document 13] and United's motion [Record Document
34] are GRANTED, and the motion for partial
summary judgment [Record Document 38] is DENIED AS
Background Prior to Litigation
is the widow of Donald Swenson ("Swenson"), a
former employee of Eldorado Casino Resort Shreveport
("Eldorado"). [Record Document 11 at 1-2]. Swenson
took medical leave on January 1, 2013. [Id. at 3].
Some time later, Eldorado's disability insurance carrier
denied his application for disability benefits, finding that
his cancer was a pre-existing condition. [Id. at 4].
As his health improved, he attempted to return to work, but
Eldorado did not assign him to any shifts before his death on
April 18, 2014. [Id. at 3, 34].
2013, Eldorado maintained a group life insurance policy
through Lincoln (the "Lincoln Plan"), which
provided employees with basic personal life insurance and
optional supplemental coverage. [Record Document 1-6 at 8,
12]. Eldorado was the plan administrator, while Lincoln was
the claims administrator with the "sole discretionary
authority to determine eligibility and to administer claims
in accord with its interpretation of policy provisions."
[Record Document 17-1 at 5]. Plaintiff alleges that
Swenson's coverage included $36, 000 in group life
insurance benefits and $100, 000 in voluntary supplemental
benefits and that she and Swenson paid all required premiums.
[Record Document 11 at 5].
the Lincoln Plan specifies a number of events that result in
termination of coverage, two are relevant here: the
termination of the Lincoln Plan itself and an employee's
cessation of active work, which the Lincoln Plan defines as
working at least thirty-five hours per week. [Record Document
1-6 at 8, 12, 20, 23]. The Lincoln Plan terminated on
December 31, 2013, when Eldorado switched insurance carriers
to United. [Record Documents 1-2 at 1, 5 and 1-6 at 23]. To
mitigate the effects of a sudden loss of insurance, the
Lincoln Plan provides several mechanisms allowing insureds to
remain covered after events that would otherwise terminate
coverage. First, by paying premiums as they become due, an
employee who ceases active work due to disability may
continue coverage for up to twelve months. [Record Document
1-6 at 23]. Second, if certain conditions are met, an
employee under sixty who becomes totally disabled can
continue life insurance coverage without paying premiums; the
policy documents refer to this as the "Extension of
Death Benefit" [Id. at 30]. Third, the Lincoln
Plan provides an employee a right to convert a terminating
group policy to an individual policy if coverage terminates
for a reason other than the termination of plan itself (the
"Conversion Privilege"). [Id. at 34]. If
coverage terminates because the Lincoln Plan does, an
employee with five years of continuous coverage under the
plan may also exercise the Conversion Privilege.
[Id.]. In either situation, the time period in which
to apply for and purchase a conversion policy is thirty-one
days from the termination of coverage. [Id.].
However, if the employee is not given notice of the right to
convert, the period extends sixty additional days.
January 1, 2014, Eldorado began offering life insurance
through United (the "United Plan") under two
separate, but nearly identical policies, one for a basic
plan, [Record Document 1-2 at 39-76], and one for
supplemental coverage, [id. at 77-120]. Eldorado
convened meetings for interested employees to enroll in the
new coverage. Swenson v. Hldorado Casino Shreveport Joint
Venture (Swenson I), No. 15-CV-2042, 2016 WL1084279, at
*1 (W.D. La. Jan. 6, 2016), report and recommendation
adopted, No. 15-CV-2042, 2016 WL 1109097 (W.D. La. Mar.
18, 2016). Like the Lincoln Plan, the United Plan identifies
Eldorado as the plan administrator and grants United
discretion to administer claims. [Record Document 1-2 at 65,
72, 110, 117]. Plaintiff alleges that Swenson applied for
$122, 000 in basic and supplemental life insurance coverage.
[Record Document 11 at 31].
the United Plan, an employee becomes eligible for insurance
upon completion of a sixty-day eligibility waiting period,
which may be satisfied by sixty days of employment prior to
the plan's effective date. [Record Document 1-2 at 47,
87-88]. Coverage begins once an eligible employee actively
works, which the plan defines as working thirty-five hours
per week, or once an employee submits a written enrollment
request and commences active work. [Id. at 47-48,
87, 89]. The United Plan also provides that an employee who
was insured under a prior employer-sponsored plan on the day
before the effective date of the United Plan may continue
coverage if the employee is eligible but not actively working
due to sickness or injury, is not eligible for a continuation
of insurance under the prior plan, is not retired, is not
totally disabled, and is approved by United's home office
(the "Continuity Provision"). [Id. at
Swenson's death, Plaintiff submitted claims to both
insurers. [Record Document 1-2 at 1-6]. Lincoln denied her
claim because Swenson was too old to qualify for an Extension
of Death Benefit and because the Lincoln Plan terminated
prior to his death ("Lincoln's Benefits Denial
Letter"). [Id. at 4-6]. United denied benefits
because Swenson had not actively worked for Eldorado during
the policy period and because United had received no premiums
for Swenson ("United's Benefits Denial
Letter"). [Id. at 1]. Following these
denials, Eldorado issued a check to Plaintiff
"containing the life insurance premiums paid in the
amount of $330.30." [Record Documents 11 at 2 and 1-2 at
initially sued Lincoln, United, and Eldorado in state court,
alleging violations of Louisiana insurance law.
Swenson I, 2016 WL 1084279, at *2. Following
removal, the Court granted Plaintiff an opportunity to amend
her complaint after finding that the Employee Retirement
Income Security Act ("ERISA") preempted her claims.
See Id. at *5; Swenson I, No. 15-CV-2042,
2016 WL 6106483, at *2 (W.D.La. Oct. 19, 2016). Plaintiffs
amendment re-urged her state law claims and added fourteen
claims designated as federal causes of action. See
Swenson I, 2016 WL 6106483, at *2. Upon renewed motions
to dismiss, the Court dismissed with prejudice all state-law
claims, a federal claim for declaratory judgment, and federal
claims sounding in equity: detrimental reliance, promissory
or equitable estoppel, reformation, unjust enrichment, and
breach of fiduciary duty. Swenson I, No. 15-CV-2042,
2017 WL 1334307, at *3-7 (W.D. La. Apr. 7, 2017),
aff' sub nom. Swenson v. United of Omaha Ufe Ins.
Co., 876 F.3d 809 (5th Or. 2017); Swenson I,
2016 WL 6106483, at *2-3, *5-6. The Court rejected Plaintiffs
argument that administrative appeals would be futile and
dismissed her ERISA claims without prejudice for failure to
exhaust. Swenson 1, 2017 WL 1334307, at *5;
Swenson 1, 2016 WL 6106483, at *4. Plaintiff
appealed, and the Fifth Circuit affirmed the dismissal of her
state-law and equitable claims. Swenson I, 876 F.3d
at 812. While her appeal was pending, Plaintiff settled with
Eldorado. [Record Document 23-1 at 9].
Plaintiffs Administrative Appeals
the Court's dismissal of her claims for benefits,
Plaintiff appealed to both insurers. [Record Documents 1-4
and 11-2]. Lincoln denied her appeal as untimely
because the Lincoln Plan requires that any appeals be brought
within sixty days of the initial denial ("Lincoln's
Appeal Denial Letter"). [Record Document 1-5 at 2].
United also denied her appeal, asserting that Plaintiff was
ineligible for benefits because Swenson had not actively
worked before his death and because the Continuity Provision
did not apply ("United's Appeal Denial
Letter"). [Record Document 11-14 at 3-4]. United also
noted that Plaintiffs appeal was untimely, as the United Plan
requires beneficiaries to appeal within sixty days of denial.
[Id. at 4]. In response to these denials, Plaintiff
filed the instant suit.
Claims in the Current Suit
is an "enormously complex and detailed" statute
addressing the management of employer-provided health, life,
and retirement benefits. Mertens v. Hewitt Assocs.,
508 U.S. 248, 262 (1993). Pertinent to the instant suit,
ERISA authorizes a beneficiary to bring a civil action to
"recover benefits due to him under the terms of his
plan." 29 U.S.C. § 1132(a)(1)(B). In addition,
ERISA allows a beneficiary to "obtain other appropriate
equitable relief... to redress [ERISA] violations or... to
enforce any provisions of this subchapter or the terms of the
plan." Id. § 1132(a)(3). Finally, the
statute requires that plan administrators make available
various documents related to an employee's coverage.
Id. § 1132(c)(1). Plaintiff brings claims under
each of these provisions.
Claims Against Lincoln
seeks $136, 000 in life insurance benefits because Lincoln
"accept[ed] premiums from [P]laintiff and Mr. Swenson
and . . . fail[ed] to notify [P]laintiff and Mr. Swenson that
[Lincoln] did not consider Mr. Swenson as a covered
employee." [Record Document 11 at 21]. This process
allegedly resulted either in a continuation of life insurance
coverage or in the conversion of Swenson's group policy
to an individual one. [Id. at 22-23]. Plaintiff also
disputes Lincoln's stated reasons for denying coverage.
[Id. at 23-25]. Additionally, she alleges that
Lincoln failed to provide notice that Swenson's coverage
had terminated and notice of the Conversion Privilege.
[Id. at 21-22]. According to Plaintiff, these
alleged failures and inaccuracies entitle her to benefits.
Finally, she asserts a claim for statutory penalties for
Lincoln's failure to provide her with a complete record
during her administrative appeal, a set of equitable claims
(breach of fiduciary duty, equitable estoppel, detrimental
reliance, and unjust enrichment), and a request for
"Declaratory Judgment Relief." [Id. at
26-28, 36-42, 46].
Claims Against United
seeks $122, 000 in benefits to which she is allegedly entided
under the United Plan. [Id. at 31]. In response to
United's assertion that benefits are not due because
Swenson was not actively working, Plaintiff alleges that
Eldorado considered Plaintiff to be actively employed.
[Record Documents 1-2 at 1 and 11 at 3]. She contends that
under the United Plan coverage can begin by written
application without the necessity of active work and thus
that Swenson was insured because he had completed an
application form during the open enrollment period. [Record
Document 11 at 30-31]. She also asserts coverage based on
United's acceptance of premiums from Eldorado on
Swenson's behalf and the fact that Swenson died after the
conclusion of the plan's sixty-day eligibility waiting
period. [Id. at 31-32], Finally, she alleges that
Swenson was covered under the Continuity Provision.
[Id. at 32-36]. As she does against Lincoln,
Plaintiff also seeks equitable remedies and statutory
penalties. [Id. at 36-40, 42-46].
3. Pending Motions
Lincoln and United have filed motions to dismiss under Rule
12(b)(6) of the Federal Rules of Civil Procedure, asserting
that the terms of the Lincoln Plan and the United Plan
(collectively, the "Plans") bar Plaintiff from
receiving benefits. [Record Documents 13 and 34]. The parties
have filed oppositions and replies, which have been
considered by the undersigned. [Record Documents 16, 17, 36,
and 37]. Plaintiff has also filed a motion for summary
judgment against Lincoln seeking penalties for Lincoln's
refusal to produce documents relevant to Swenson's
coverage. [Record Document 38]. Lincoln has filed an
opposition to which Plaintiff has replied. [Record Documents
40 and 42].
Law and Analysis
Standard of Review
order to survive a motion to dismiss under Rule 12(b)(6), a
plaintiffs complaint must "state a claim to relief that
is plausible on its face." Bell Atl Corp. v.
Twombly, 550 U.S. 544, 570 (2007). "A claim has
facial plausibility when the plaintiff pleads factual content
that allows the court to draw the reasonable inference that
the defendant is liable for the misconduct alleged."
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citing
Twombly, 550 U.S. at 556). In determining whether
the plaintiff has stated a plausible claim, the court must
construe the complaint in the light most favorable to her,
see In re Great Lakes Dredge &Dock Co. J J , C,
624 F.3d 201, 210 (5 th Cir. 2010), and accept as true all
well-pleaded factual allegations, see Twombly, 550
U.S. at 555; In re Katrina Canal Breaches Siting,
495 F.3d 191, 205 (5th Cir. 2009). However,
"[t]hreadbare recitals of the elements of a cause of
action, supported by mere conclusory statements, do not
suffice." Iqbal, 556 U.S. at 678 (citing
Twombly, 550 U.S. at 555). Thus, the Court does not
have to accept as true "conclusory allegations,
unwarranted factual inferences, or legal conclusions."
Plotkin v. IP AxessInc, 407 F.3d 690, 696 (5th Cir.
2005) (citing Southland Sec. Corp. v. IN Spire Ins. Sols,
Inc., 365 F.3d 353, 361 (5th Cir. 2004)).
and United move to dismiss what they characterize as
Plaintiffs state-law claims on grounds of res judicata and
preemption. [Record Documents 13-1 at 9-16 and 34-1 at 4].
Plaintiffs claims for detrimental reliance, unjust
enrichment, and equitable estoppel are raised under ...