United States District Court, E.D. Louisiana
ORDER AND REASONS
ZAINEY, UNITED STATES DISTRICT JUDGE
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.
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).
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.
STANDARD OF REVIEW
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).
Claim One - Claim for Penalties under ERISA §
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).
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.
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 ...