United States District Court, D. Minnesota
MEMORANDUM AND ORDER
A. Magnuson, United States District Court Judge.
matter is before the Court on Defendants' Motion to
Dismiss. (Docket No. 17.) For the following reasons, the
Motion is granted in part and denied in part.
Lori Ann Stover previously worked for Delta Air Lines, Inc.
(“Delta”) as a flight attendant, and participated
in the Delta Air Lines Inc. Optional Insurances Plan (the
“Plan”), a Delta-sponsored employee-benefit plan
governed by ERISA. She participated in two Plan programs in
particular: Group Accident Insurance and Private Pilots
Accident Insurance. The parties have not defined these
programs, but it appears they provided Stover with up to
$350, 000 and $165, 000, respectively, in benefits for
job-related injuries. Defendant Prudential Insurance Co. of
America (“Prudential”) insured the Plan, while
Defendant Administrative Committee of Delta Air Lines, Inc.
was the fiduciary for, and administered, the Plan.
Plan included several provisions regarding claim processing.
First, it required that “proof of the loss for which
[a] claim is made” must be submitted within “90
days after the date of the loss.” (Kamps Aff. (Docket
No. 20) Ex. C at 39.) Second, a Plan participant could appeal
the denial of a claim within 180 days from receipt of the
denial. Determination of the appeal must then occur within 45
days, but this 45-day period could be extended by an
additional 45 days under special circumstances, which would
require prior notice. (Id. at 45-46.) Finally, no
legal action under the Plan may “be brought more than
three years after the end of the time within which proof of
loss is required.” (Kamps Aff. Ex. D. at 30.)
August 24, 2012, Stover was injured when a flight on which
she was working suddenly encountered turbulence. She was
thrown to the floor and landed on her right side, injuring
her right arm, her shoulder, and her hand. Subsequently, she
was diagnosed with Reflex Sympathetic Dystrophy, causing her
“severe, intractable pain.” She underwent several
surgeries in an attempt to remedy the problems, but she
continues to suffer from extreme pain, difficulty turning her
head, and limited motility and function in her right arm and
hand. She alleges she has been unable to work in any capacity
since the date of the incident. Following her injury, Stover
contacted Prudential to submit claims under the Plan. She
alleges Defendants gave her the runaround despite repeated
telephone calls, emails, and letters. Eventually, however,
Prudential gave Stover a claim-submittal form, and she
promptly submitted her claim, asserting permanent disability.
about September 3, 2013, Prudential denied Stover's claim
by letter, concluding that she was not permanently disabled.
The letter stated that she could appeal this determination,
that a determination on the appeal would be made within 45
days, and that the 45-day period could be extended only if
Prudential provided prior notification. Lastly, the letter
advised that once the appeal was decided, Stover could elect
either to seek a further appeal or to commence an action
under ERISA. The letter made no mention of the Plan's
three-year time limit for commencing a lawsuit.
September 10, 2013, Stover informed Prudential that she
received the letter denying her claim and that she was
“attempt[ing to] appeal, ” and she inquired what
further steps she needed to take. She heard nothing further
from Prudential. Prudential contends it did not receive her
further action occurred until Stover commenced this lawsuit
on December 9, 2016, more than three years later. Her
two-Count Amended Complaint alleges (1) that Defendants
violated ERISA § 502(a)(1)(B), 29 U.S.C. §
1132(a)(1)(B), by failing to process her claims properly and
(2) in the alternative, that Defendants breached fiduciary
duties owed to her under ERISA by not properly processing the
claims. Notably, she seeks an order from this Court remanding
the matter to Defendants with instructions to permit her to
resubmit her claims; she does not seek an award of benefits.
Defendants now move to dismiss.
argue that Count I of Stover's Amended Complaint, which
alleges that Defendants violated ERISA by failing to properly
process her claims for benefits, is untimely. The Court
contains no statute of limitations for claims under §
502(a)(1)(B). Heimeshoff v. Hartford Life & Acc. Ins.
Co., 134 S.Ct. 604, 610 (2013). As a result,
ERISA-governed plans may impose their own limitation periods
for commencing lawsuits, as long as those periods are
reasonable. Id. at 612. Here, Stover does not
contend that the Plan's three-year limitation period for
commencing a lawsuit is unreasonable. This period runs from
the “end of the time within which proof of loss is
required.” Proof of loss, in turn, “must be
furnished within 90 days after the date of the loss.”
Defendants assert that Stover's loss occurred on August
24, 2012, the date of her injury, because she marked this
date as the date of loss on the claim form. (Stover Decl.
(Docket No. 27) Ex. 5 at 1.) Thus, they argue that proof of
loss was due 90 days later, November 22, 2012, and Count I
had to be filed no later than three years after that date, or
November 22, 2015. Because Stover did not sue until nearly
the end of 2016, Defendants argue that Count I is time-barred
and must be dismissed.
determine Stover's date of loss, the Court must look to
the Plan's terms and construe them according to their
“literal and natural meaning.” Admin. Comm.
of Wal-Mart Stores, Inc. Assocs.' Health & Welfare
Plan v. Shank, 500 F.3d 834, 838 (8th Cir. 2007)
(citation omitted). Defendants make no effort to undertake
such an analysis here or identify the Plan's definition
of the term “loss, ” which is not synonymous with
injury or accident. Indeed, the Plan defines an
“injury” as “injury to the body of a
Covered” employee and “loss” as any of a
prescribed set of 14 different types of injuries, including
death or loss of sight. (Kamps Aff. Ex. D at 16, 29.) In