United States District Court, D. New Hampshire
B. McCafferty United States District Judge
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.
Standard of Review
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).
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
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.”).
The LTD Plan
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.
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
Doc. no. 16-3 at 8 (capitalization modified).
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.
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
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.
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 ...