Preview:

UNITED STATES DISTRICT COURT DISTRICT OF MAINE

ELIZABETH A. MCLAUGHLIN, Plaintiff v. UNUM LIFE INSURANCE COMPANY OF AMERICA, ATHENA NEUROSCIENCES INC. LONG TERM DISABILITY PLAN, Defendants

) ) ) ) ) ) ) ) ) ) ) )

Docket no. 02-67-P-S

ORDER GRANTING THE MOTION TO DISMISS SINGAL, District Judge Plaintiff has brought an action against her employee welfare benefit plan and her long term disability insurer to: 1) recover benefits due to her under the plan, 2) enforce her rights under the plan, and 3) clarify her right to future benefits under the plan. Presently before the Court is Defendant UNUM Life Insurance Company of America's ("UNUM") Motion to Dismiss (Docket #4). For the reasons discussed below, the Court GRANTS Defendant's Motion to Dismiss.

I. STANDARD OF REVIEW When evaluating a motion to dismiss under Rule 12(b)(6), the court takes the well-pleaded facts as true and draws all reasonable inferences in the plaintiff's favor. Gorski v. N.H. Dep't of Corr., 290 F.3d 466, 473 (1st Cir. 2002). A defendant is entitled to dismissal only if it appears to a certainty that the plaintiff would be unable to recover

under any set of facts. Correa-Martinez v. Arrillaga-Belendez, 903 F.2d 49, 52 (1st Cir. 1990). Nonetheless, granting a motion t dismiss based on a limitations defense is o

appropriate when the pleader's allegations leave no doubt that an asserted claim is timebarred. LaChapelle v. Berkshire Life Ins. Co., 142 F.3d 507, 509 (1st Cir. 1998). Ordinarily, a court may not consider any documents beyond the complaint, or not expressly incorporated therein when addressing a motion to dismiss, unless the motion is converted into one for summary judgment. Alternative Energy, Inc. v. St. Paul Fire and Marine Ins. Co., 267 F.3d 30, 33 (1st Cir. 2001). Courts may, however, consider outside material when the complaint relies upon documents whose authenticity is not challenged. Id. Such documents "merge[] into the pleadings" and the court may properly consider them under a Rule 12(b)(6) motion to dismiss. Beddall v. State Street Bank and Trust, Comp., 137 F.2d 12, 17 (1st Cir. 1998). Here, Plaintiff's Complaint refers to the Policy at issue and relies, in part, on several letters exchanged by the parties to assert the date upon which the claim was officially denied. The Court considers these documents to have "merged" into the

pleadings for the purposes of evaluating the Defendant's Motion to Dismiss.

II. BACKGROUND Plaintiff, Elizabeth McLaughlin ("McLaughlin"), is a former emp loyee of Athena Neurosciences, Inc. ("Athena") who suffers from Chronic Fatigue Syndrome ("CFS") 1 and Fibromyalgia. 2 As an employee of Athena, McLaughlin was a participant in

1

McLaughlin's CFS symptoms include severe fatigue, headaches, impaired memory, muscle pain (myalgia), recurrent fever, sore throat and tender soft tissue spots.
2

Fibromyalgia is characterized by chronic, unexplained pain in specified muscular tissue points.

2

Athena's long-term disability plan ("Plan"). UNUM issued and administered a long-term disability policy to the Plan ("Policy"). In or about May 1994, McLaughlin filed a claim for long term disability benefits with UNUM. By letter dated August 16, 1994, UNUM granted McLaughlin's request for long term disability benefits under the Plan effective July 13, 1994. UNUM decided, however, that McLaughlin's claim fell within the insurance policy's mental illness limitation, which provided that UNUM would pay no more than twenty- four months of benefits for any disability due to "mental illness."3 McLaughlin repeatedly challenged UNUM's classification of her disability as a mental illness by submitting records of her physical problems. UNUM, however,

maintained its classification of McLaughlin's disability and, thereby, discontinued McLaughlin's long term disability benefits under the Plan effective July 13, 1996. In response, McLaughlin, requested a review of this denial by letter dated August 5, 1996. In her letter, McLaughlin again explained that CFS and Fibromyalgia are

physical disorders, but that her disabled condition caused her to suffer some secondary depression. By letter dated August 7, 1996, however, UNUM officially denied

McLaughlin's claim. McLaughlin maintains she remains physically disabled under the terms of the Plan. To date, UNUM has not paid McLaughlin's disability benefits for any period after July 1996. McLaughlin, therefore, brings this single count complaint against UNUM and the Plan alleging that UNUM violated her rights under 29 U.S.C.

Download GZS_10082002_1-02cv67_McLAUGHLIN_v_UNUM.pdf

Maine Law