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Fortier v. Hartford Life And Accident Insurance Co.

United States District Court, D. New Hampshire

September 11, 2017

Theresa Fortier
v.
Hartford Life and Accident Insurance Company et al. Opinion No. 2017 DNH 187

          ORDER

          Landya B. McCafferty United States District Judge

         Plaintiff Theresa Fortier, a former doctor at the Dartmouth-Hitchcock Clinic (“DH Clinic”), alleges that defendants Hartford Life and Accident Insurance Company (“Hartford”) and the Dartmouth-Hitchcock Clinic Long Term Disability Plan (“LTD Plan”) unlawfully stopped paying long-term disability benefits to which she is entitled. Her first amended complaint consists of four counts: two brought pursuant to the Employee Retirement Income Security Act (“ERISA”) to recover benefits under the LTD Plan (Count I) and a life insurance plan (Count II); one alleging that a mental illness limitation in the LTD Plan violates the Americans with Disabilities Act (“ADA”) and “New Hampshire anti-discrimination laws” (Count III); and one seeking an award of attorney's fees and costs (Count IV). See doc. no. 13. Defendants move, pursuant to Federal Rule of Civil procedure 12(b)(6), to dismiss Counts I and III. Fortier objects.

         I. Standard of Review

         Under Federal Rule of Civil Procedure 12(b)(6), the court must accept the factual allegations in the complaint as true, construe reasonable inferences in the plaintiff's favor, and “determine whether the factual allegations in the plaintiff's complaint set forth a plausible claim upon which relief may be granted.” Foley v. Wells Fargo Bank, N.A., 772 F.3d 63, 71 (1st Cir. 2014) (citation omitted). A claim is facially plausible “when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009).

         II. Background

         The facts recited in this section are drawn from: (1) Fortier's first amended complaint; (2) exhibits attached to that complaint; and (3) certain documents attached to defendants' motion to dismiss and reply to Fortier's objection.

         Fortier contends that the court may not consider three of these documents when conducting its analysis: the LTD Plan policy, the LTD Plan certificate of insurance, and the certificate of insurance from a different long-term disability policy. Doc. nos. 16-2, 16-3, 22-1. A court may consider “documents central to plaintiffs' claims[] and documents sufficiently referred to in the complaint.” Brennan v. Zafgen, Inc., 853 F.3d 606, 610 (1st Cir. 2017) (original bracketing omitted) (quoting Watterson v. Page, 987 F.2d 1, 3 (1st Cir. 1993)). Here, the first amended complaint explicitly references the insurance documents and directly quotes from the LTD Plan certificate of insurance. See, e.g., doc. no. 13 ¶¶ 24, 69, 72. Moreover, these documents are central to Fortier's claims, as she seeks to recover benefits under the LTD Plan and argues that defendants reviewed her claim under the incorrect certificate of insurance. Thus, these documents are properly before the court. Cf. Prouty v. Hartford Life & Acc. Ins. Co., 997 F.Supp.2d 85, 89 (D. Mass. 2014) (“Where Plaintiff has not produced the document forming the basis of her lawsuit, it would be both unfair and improper to prevent Defendants from referencing that document in their motions to dismiss.”).

         A. The LTD Plan

         The LTD Plan provides long-term disability insurance coverage for employees of the DH Clinic. This coverage is fully insured by Hartford. The terms of the LTD Plan are contained in an insurance policy (“LTD policy”) and a certificate of insurance (“LTD certificate”). Doc. nos. 16-2; 16-3. The LTD certificate is expressly incorporated into the LTD policy. Doc. no. 16-2 at 8.

         The LTD Plan contains a maximum duration of benefits. See doc. no. 16-3 at 3. For those under the age of 63, the maximum duration of benefits is “to normal retirement age or 42 months, if greater.” Id. (capitalization modified). Under certain circumstances, however, the duration of coverage is limited. For instance, if a beneficiary is disabled due to mental illness, then benefits are only payable under the LTD Plan

1) for as long as [the beneficiary is] confined to a hospital or other place licensed to provide medical care for the disabling condition; or 2) if not confined, or after [the beneficiary is] discharged and still disabled, for a total of 24 month(s) for all such disabilities during [the beneficiary's] lifetime.

Doc. no. 16-3 at 8 (capitalization modified).

         The LTD Plan also contains procedures for appealing the denial of a claim. For instance, page 21 of the LTD certificate states that if a beneficiary's claim is denied, that beneficiary “must request review upon written application within 180 days of receipt of claim denial” regardless of whether that claim required a determination of disability by Hartford. Doc. no. 16-3 at 15 (numbering omitted). Page 39 of the LTD certificate contains similar requirements for determination of disability claims, stating that a beneficiary's appeal request “must be in writing and be received by the Insurance Company no later than 180 days from the date [the beneficiary] received [his/her] claim denial.” Id. at 33. Page 39 further states that “[o]n any wholly or partially denied claim, ” the beneficiary “must appeal once to the Insurance Company for full and fair review” and must “complete this claim appeal process before [he/she] file[s] an action in a court.” Id. Page 40 of the LTD certificate contains nearly identical procedures for claims not requiring a determination of disability, except that it specifies such an appeal be filed “no later than 60 days from the date [the beneficiary] received [his/her] claim denial” rather than 180 days. Id. at 34.

         B. Fortier's Claim

         At all times relevant to this case, Fortier was employed as a physician at the DH Clinic. Through her employment, Fortier was a beneficiary and participant under the LTD Plan. At some point during her employment, Fortier contracted a virus that ultimately caused her to suffer permanent cognitive deficits. These deficits have prevented Fortier from performing the essential functions of her work as a physician. And, though she has received continuous treatment since the onset of her illness, these deficits have prevented her from returning to her work at the DH Clinic. As Fortier has also been unable to pursue other employment as a result of her illness, she applied for long-term disability benefits through the LTD Plan.

         Hartford and the LTD Plan began paying Fortier long-term disability benefits on November 2, 2009. Defendants terminated these benefits on November 1, 2011, on the basis that Fortier's claim was subject to the 24-month limitation for mental illness claims. Fortier timely appealed that decision, and her benefits were reinstated on May 22, 2012.

         In July 2013, Fortier's attorney received a letter from Hartford. In this letter, Hartford once again stated that it had determined that Fortier's disability was caused by mental illness and was therefore subject to the mental illness limitation. The letter stated that Fortier's LTD benefits accordingly “will cease on 09/13/2013” unless Fortier was “hospitalized prior to that date, ” in which case “her benefits may be extended.” Doc. no. 16-4 at 1. The letter noted that Fortier was entitled, under ERISA, to appeal the denial of coverage, but stated that if ...


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