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Breaux v. Reliance Standard Life Insurance Co.

United States District Court, E.D. Louisiana

October 11, 2019

ERNEST BREAUX
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY

         SECTION A “5”

          ORDER AND REASONS

          JAY C. ZAINEY, UNITED STATES DISTRICT JUDGE

         Before the Court is a Motion to Dismiss (Rec. Doc. 5) filed by Defendant Reliance Standard Life Insurance Company (“Reliance”) pursuant to Federal Rules of Civil Procedure (“FRCP”) 12(b)(6). Plaintiff Ernest Breaux opposes the motion, (Rec. Doc 6), and Reliance replied. (Rec. Doc 9). The motion, set for submission on September 4, 2019, is before the Court on the briefs without oral argument.

         I. BACKGROUND

         This suit arises from Breaux alleging that Reliance wrongfully denied him Accidental Death and Dismemberment benefits under an insurance policy between Breaux's employer, Laris Insurance Agency, LLC, and Reliance. (Rec. Doc 6, p. 1, Breaux's Opposition). Breaux's injury occurred on July 5, 2016 when he gashed his left foot while getting up from his home office desk. (Rec. Doc 1, p. 3, Breaux's Complaint). The wound from this injury became infected and led to him having his left leg amputated. Id. However, Reliance claimed an exclusion applied and refused to pay benefits to Breaux. (Rec. Doc. 4, p. 1, Reliance's Answer). Importantly for this suit, the parties agree that Breaux's claims are governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). (Rec. Doc 6, p. 1, Breaux's Opposition).

         Reliance filed this partial Motion to Dismiss under FRCP 12(b)(6) for the following three claims made by Breaux: (1) his claim for penalties under ERISA § 502(c)(1) for failure to timely provide plan documents, (2) his claim for penalties and attorneys' fees under state law, and (3) his claim for breach of contract under state law.

         II. STANDARD OF REVIEW

         FRCP 12(b)(6) permits a court to dismiss a complaint when a plaintiff has failed to state a claim for which relief can be granted. See Fed.R.Civ.P. 12(b)(6). “To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to 'state a claim to relief that is plausible on its face.'” Iqbal v. Ashcroft, 556 U.S. 662, 677 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). The factual matter contained in the complaint must allege actual facts, not mere legal conclusions portrayed as facts. Id. at 667 (“Although for the purposes of a motion to dismiss we must take all of the factual allegations in the complaint as true, we 'are not bound to accept as true a legal conclusion couched as a factual allegation.'”) (quoting Twombly, 550 U.S. at 555). Additionally, the factual allegations of a complaint must state a plausible claim for relief. Id. A complaint states a “plausible claim for relief” when the factual allegations contained therein, taken as true, necessarily demonstrate actual misconduct on the part of the defendant, not a “mere possibility of misconduct.” Id.; see also Jacquez v. Procunier, 801 F.2d 789, 791-92 (5th Cir.1986). Lastly, the Court “will not look beyond the face of the pleadings to determine whether relief should be granted based on the alleged facts[.]” Spivey v. Robertson, 197 F.3d 772, 774 (5th Cir. 1999).

         III. DISCUSSION

         A. Claim One - Claim for Penalties under ERISA § 502(c)(1)

         Reliance presents a simple three-step argument for why Breaux's claim for penalties under ERISA § 502(c)(1) must be dismissed. First, a litigant can only bring a claim under § 502(c)(1) against a Plan's “Administrator.” (Rec. Doc 9, p. 2, Reliance's Response). Second, “the employer [under ERISA] is deemed to be the Administrator when there is no document specifying [some other entity.]” Id. Third, no documents specify Reliance as the Plan's Administrator. Id. Thus, Reliance concludes Breaux cannot bring a claim against it for penalties under § 502(c)(1). Furthermore, Reliance notes that Breaux has failed to satisfy his burden under Rule 12(b)(6) by saying, “[s]ince Plaintiff has not even alleged in the Complaint that Reliance Standard is the Plan Administrator, he has not plead sufficient factual matter, accepted as true to state a claim to relief that is plausible on its face.” Id. (internal quotations omitted).

         Breaux counters Reliance's points by arguing that a Rule 12(b)(6) Motion is premature on this issue because “there are no plan documents before the Court and no facts before the Court stating who the Plan [A]dministrator is in this case.” (Rec. Doc 6, p. 4, Breaux's Opposition). More specifically, Breaux notes that for Rule 12(b)(6) motions, “courts are not to look beyond the pleadings. Defendant has not provided any documents that would support its claim that it is not the Plan administrator and even if it did, evaluating would be inappropriate in the context of a 12(b)(6) Motion to Dismiss.” Id.

         Here, the Court is persuaded by Breaux's reasoning and concludes dismissal of Breaux's § 502(c)(1) claim is premature. For instance, because the Plan documents were never filed into the record, the Court has no way of determining if Reliance was the Plan Administrator under the parties' agreement. More particularly, the ERISA statute defines the term “Administrator” as:

(i) the person specifically so designated by the terms of the instrument under which ...

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