United States District Court, D. Maryland
Brittany L. Lewis, Legal Guardian of the Property of JCL, a Minor
Aetna Life Insurance Company, et al.
Catherine C. Blake United States District Judge
Lewis, as legal guardian of the property of her daughter,
JCL, sues Aetna Life Insurance Company ("Aetna"),
LJT & Associates, Inc. ("LJT"), and LJT &
Associates, Inc. Welfare Plan (the "Plan"), for the
improper denial of benefits under an employee benefits plan
subject to the Employee Retirement Income Security Act of
1974 ("ERISA"), pursuant to 29 U.S.C. §
1132(a)(1)(B). Lewis brings a claim for denial of
supplemental life insurance benefits (Count I), and a claim
for denial of basic and supplemental accidental death and
personal loss benefits (Count II). LJT and the Plan have
filed a motion to dismiss both counts, and Aetna has filed a
motion to dismiss Count II. The motions have been fully
briefed and no oral argument is necessary. For the reasons
stated below, the court will grant in part and deny in part
LJT and the Plan's motion to dismiss, and will grant
Aetna's motion to dismiss.
9, 2016, Justin Lewis died in a car accident when, while driving
in Maryland, he "for 'an unknown reason' ...
left the roadway and struck a tree." (Compl.
¶¶ 11, 13). The postmortem toxicology report found
that Justin Lewis's blood ethanol content
("BAC") was .21%. (Id. ¶ 17). Through
his employment with LJT, Justin Lewis had enrolled in the
Plan, which provided basic life insurance and accidental
death and personal loss ("ADPL") benefits, and
Justin Lewis had also enrolled in supplemental basic life
insurance and supplemental ADPL. (Id. ¶¶
8, 9). Justin Lewis was enrolled in the Plan at no cost, and
LJT deducted from his pay each month $11.70 for the
supplemental life insurance and $4.50 for the supplemental
ADPL benefits. (Id. ¶¶ 8, 10). The
beneficiary of the life insurance and ADPL benefits was
Justin Lewis's then three-year-old daughter, JCL.
(Id. ¶¶ 1, 9, 12). Brittany Lewis, the
ex-wife of Justin Lewis and mother of JCL, is the legal
guardian of the property of JCL. (Id. ¶ 1).
Lewis timely filed for benefits. (Id. ¶ 18). On
August 17, 2016, LJT prepared and submitted to Aetna a proof
of death, and on March 10, 2017, submitted to Aetna a second
proof of death, which apparently revised the amounts Justin
Lewis was owed under his various -enrollments. (Id.
¶¶ 19, 20). According to LJT's proof of death
form, Justin Lewis "had Basic Life Insurance in the
amount of $46, 000, Supplemental Life Insurance in the amount
of $150, 000, Basic ADPL benefits in the amount of $46, 000,
and Supplemental ADPL benefits in the amount of $150,
000." (Id. ¶ 20). Aetna paid Brittany
Lewis $45, 091.05 for basic life insurance, but by letters
dated April 7, 2017, and April 14, 2017, denied her claims
for supplemental life insurance benefits, and basic and
supplemental ADPL benefits, respectively. (Id.
denied the supplemental life insurance benefits because it
claimed that Justin Lewis had never submitted evidence of his
good health, even though he was required to because he
enrolled in the plan more than thirty days after his
eligibility date. (Id. ¶ 33). Therefore,
although Justin Lewis paid a premium every month for the
coverage, Aetna claimed he was never actually approved.
(Id. ¶ 39). According to Brittany Lewis,
neither Aetna nor LJT have any correspondence informing
Justin Lewis he was required to submit proof of insurability,
and it appears that Aetna and LJT both claimed that it was
the other's responsibility to provide such notice.
(Id. ¶¶ 40-43). Additionally, "[t]he
Plan provides Aetna will rely upon representations of LJT as
to eligibility for coverage and as to any fact concerning
eligibility" and LJT previously determined Justin Lewis
was properly enrolled for supplemental life benefits.
(Id. ¶ 44).
denied Brittany Lewis's claim for ADPL benefits, relying
upon an exclusion in coverage for death caused by the
"use of alcohol or intoxicants or drugs while operating
any form of a motor vehicle." (Id. ¶ 50).
The exclusion further provides that "[o]perating the
motor vehicle while under the influence of alcohol is ... a
level which meets or exceeds the level at which intoxication
would be presumed under the laws of the state where the
accident occurred." (Id.). Aetna found that
Justin Lewis's death was caused by the use of alcohol
while driving because the toxicology report "showed Mr.
Lewis' BAC was 0.21%, which exceeds the Maryland legal
intoxication level." (Id. ¶ 51).
survive a motion to dismiss, the factual allegations of a
complaint "must be enough to raise a right to relief
above the speculative level on the assumption that all the
allegations in the complaint are true (even if doubtful in
fact)." Bell Atlantic Corp. v. Twombly, 550
U.S. 544, 555 (2007) (internal citations omitted). "To
satisfy this standard, a plaintiff need not
'forecast' evidence sufficient to prove the elements
of the claim. However, the complaint must allege sufficient
facts to establish those elements." Walters v.
McMahen, 684 F.3d 435, 439 (4th Cir. 2012) (citation
omitted). "Thus, while a plaintiff does not need to
demonstrate in a complaint that the right to relief is
'probable,' the complaint must advance the plaintiffs
claim 'across the line from conceivable to
plausible.'" Id. (quoting Twombly,
550 U.S. at 570). Additionally, although courts "must
view the facts alleged in the light most favorable to the
plaintiff," they "will not accept 'legal
conclusions couched as facts or unwarranted inferences,
unreasonable conclusions, or arguments'" in deciding
whether a case should survive a motion to dismiss. U.S.
ex rel. Nathan v. Takeda Pharm. North Am., Inc., 707
F.3d 451, 455 (4th Cir. 2013) (quoting Wag More Dogs, LLC
v. Cozart, 680 F.3d 359, 365 (4th Cir. 2012)).
LJT and the Plan are proper defendants
the Plan argue that they are not proper defendants because it
is Aetna, and not LJT or the Plan, that controls the payment
of benefits under the Plan. For the reasons stated below, the
court will not dismiss Count I as to LJT and the
law in this district is that the proper party defendant [in
an action to recover benefits] is the entity which holds the
discretionary decision-making authority over the denial of
ERISA benefits." Ankney v. Metropolitan Life
Ins., 438 F.Supp.2d 566, 574 (D. Md. 2006) (citing
Briggs v. Marriott Int'l, Inc., 368 F.Supp.2d
461, 471-72 (D. Md. 2005), aff'd 205 F. App'x. 183
(4th Cir.2006)); see also Trotter v. Kennedy Krieger
Inst., Inc., Civil No. 11-3422-JKB, 2012 WL 3638778, at
*3 (D. Md. Aug. 22, 2012).
the claims may be brought against the Plan. Courts in this
Circuit have stated that an ERISA benefits action may be
brought against the entity with decision-making authority and
the benefit plan itself. See Wingler v. Fidelity
Investments, No. WDQ-12-3439, 2013 WL 6326585, at *3
& n.4 (D. Md. Dec. 2, 2013) ("The proper
defendants in an ERISA benefits action are the benefit plan
and the entity with discretionary decision-making
authority."); Abbott v. Duke Energy Health &
Welfare Ben. Plan, No. 3:07-CV-00110, 2007 WL 2300797,
at *2 (W.D. N.C. Aug. 7, 2007) ("In an unpublished
decision, the Fourth Circuit sided with those circuits which
have employed a control test to determine whether a non-plan
party can be named," citing to Gluth v. Wal-Mart
Stores, Inc., No. 96-1307, 1997 WL 368625, at *6 (4th
Cir. 1997)). Therefore, it appears that the benefits
plan may be a proper defendant regardless of whether it has
discretionary decision-making authority over the denial of