Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-alnd-5_16-cv-00635/USCOURTS-alnd-5_16-cv-00635-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 28:1441eri - Petition for removal - E.R.I.S.A.

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UNITED STATES DISTRICTCOURT

NORTHERN DISTRICTOF ALABAMA

NORTHEASTERN DIVISION

TARIF QANADILO,

Plaintiff,

vs.

URS CORPORATION, et al.,

Defendants.

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Case No. 5:16-cv-635

MEMORANDUM OPINION AND ORDER OF DISMISSAL

Plaintiff, Tarif Qanadilo, originally filed this case in the Circuit Court of

Jackson County, Alabama, asserting “Claims Under the Alabama Workers

Compensation Act” (Count One), “Bad Faith and Refusing and/or Failing to Provide

Benefits” (Count Two), and “Negligence” (Count Three) against defendants URS

Corporation, AECOM, and AETNA.

1 Defendants subsequently removed the case to

this court, asserting federal jurisdiction on the grounds that plaintiff’s state lawclaims

are pre-empted by the Employee Retirement Income Security Act of 1974 (“ERISA”),

29 U.S.C. § 1001 et seq., and that all the requirements for diversity jurisdiction had

been satisfied.

2

See 28 U.S.C. § 1332(a).

This court entered an order on May 9, 2016, severing plaintiff’s workers

1

See doc. no. 1-1 (Complaint), at 1-4. Plaintiff also asserted claims against several fictitious

defendants, but those claims will be disregarded because there is no fictitious party practice in the

federal courts. See New v. Sports & Recreation, Inc., 114 F.3d 1092, 1094 n.1 (11th Cir. 1997).

2 Doc. no. 1 (Notice of Removal).

FILED

 2016 Oct-04 AM 09:33

U.S. DISTRICT COURT

N.D. OF ALABAMA

Case 5:16-cv-00635-CLS Document 29 Filed 10/04/16 Page 1 of 10
compensation claim and remanding it to the Circuit Court of Jackson County. See

doc. no. 11 (Order of Partial Remand); 28 U.S.C. § 1445(c) (“A civil action in any

State court arising under the workmen’s compensation laws of such State may not be

removed to any district court of the United States.”).

The case currently is before the court on two motions for judgment on the

pleadings. The first of those motions was filed by defendant Aetna Life Insurance

Company (“Aetna”) (which asserts it was improperly named in the complaint as

“AETNA”).

3 The second motion was filed jointly by defendants AECOM Global II,

LLC, which asserts that it is the successor-in-interest to the entity described in the

complaint as “URS Corporation,” and AECOM.

4 Upon consideration of the motions,

briefs, and pleadings, the court concludes that both motions are due to be granted.

I. STANDARD OF REVIEW

Federal Rule of Civil Procedure 12(c) provides that: “After the pleadings are

closed — but early enough not to delay trial — a party may move for judgment on the

pleadings.” Fed. R. Civ. P. 12(c).

“Judgment on the pleadings is proper when no issues of material

fact exist, and the moving party is entitled to judgment as a matter of law

based on the substance of the pleadings and any judicially noticed

3

See doc. no. 13 (Defendant Aetna Life Insurance Company’s Motion for Judgment on the

Pleadings).

4

See doc. no. 16 (AECOM and AECOM Global II, LLC’s Motion for Judgment on the

Pleadings).

2

Case 5:16-cv-00635-CLS Document 29 Filed 10/04/16 Page 2 of 10
facts.” Andrx Pharm., Inc. v. Elan Corp., 421 F.3d 1227, 1232-33 (11th

Cir. 2005). [A district court must] accept all the facts in the complaint

as true and view them in the light most favorable to the nonmoving

party. Cannon[ v. City of West Palm Beach], 250 F.3d [1299,] 1301

[(11th Cir. 2001)].

Cunninghamv. District Attorney’s Office for Escambia County, 592 F.3d 1237, 1255

(11th Cir. 2010) (alterations supplied). “Dismissal is not appropriate unless the

complaint lacks sufficient factual matter to state a facially plausible claim for relief

that allows the court to drawa reasonable inference that the defendant is liable for the

alleged misconduct.” Jiles v. United Parcel Service, Inc., 413 F. App’x 173, 174

(11th Cir. 2011) (citing Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 556, 570

(2007)).

While the applicable pleading standard does not require “detailed factual

allegations,” Twombly, 550 U.S. at 550, it does demand “more than an unadorned,

the-defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662,

678 (2009) (citations omitted). As the Supreme Court stated in Iqbal:

A pleading that offers “labels and conclusions” or “a formulaic

recitation of the elements of a cause of action will not do.” [Twombly,

550 U.S., at 555]. Nor does a complaint suffice if it tenders “naked

assertion[s]” devoid of “further factual enhancement.” Id., at 557.

To survive a motion to dismiss, a complaint must contain

sufficient factual matter, accepted as true, to “state a claim for relief that

is plausible on its face.” Id., at 570. A claim has facial plausibility

when the plaintiff pleads factual content that allows the court to draw

the reasonable inference that the defendant is liable for the misconduct

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Case 5:16-cv-00635-CLS Document 29 Filed 10/04/16 Page 3 of 10
alleged. Id., at 556. The plausibility standard is not akin to a

“probability requirement,” but it asks for more than a sheer possibility

that a defendant has acted unlawfully. Ibid. Where a complaint pleads

facts that are “merely consistent with” a defendant’s liability, it “stops

short of the line between possibility and plausibility of ‘entitlement to

relief.’” Id., at 557 (brackets omitted).

Two working principles underlie our decision in Twombly. First,

the tenet that a court must accept as true all of the allegations contained

in a complaint is inapplicable to legal conclusions. Threadbare recitals

of the elements of a cause of action, supported by mere conclusory

statements, do not suffice. Id., at 555 (Although for the purposes of a

motion to dismiss we must take all of the factual allegations in the

complaint as true, we “are not bound to accept as true a legal conclusion

couched as a factual allegation” (internal quotation marks omitted)).

Rule 8 marks a notable and generous departure from the hyper-technical,

code-pleading regime of a prior era, but it does not unlock the doors of

discovery for a plaintiff armed with nothing more than conclusions.

Second, only a complaint that states a plausible claim for relief survives

a motion to dismiss. Id., at 556. Determining whether a complaint

states a plausible claim for relief will, as the Court of Appeals observed,

be a context-specific task that requires the reviewing court to draw on

its judicial experience and common sense. 490 F.3d, at 157-158. But

where the well-pleaded facts do not permit the court to infer more than

the mere possibility of misconduct, the complaint has alleged — but it

has not “show[n]” — “that the pleader is entitled to relief.” Fed. Rule

Civ. Proc. 8(a)(2).

In keeping with these principles a court considering a motion to

dismiss can choose to begin by identifying pleadings that, because they

are no more than conclusions, are not entitled to the assumption of truth.

While legal conclusions can provide the framework of a complaint, they

must be supported by factual allegations. When there are well-pleaded

factual allegations, a court should assume their veracity and then

determine whether they plausibly give rise to an entitlement to relief.

Iqbal, 556 U.S. at 678-79 (emphasis supplied) (first alteration supplied, other

4

Case 5:16-cv-00635-CLS Document 29 Filed 10/04/16 Page 4 of 10
alterations in original).

II. ALLEGATIONS OF PLAINTIFFS’ COMPLAINT

Plaintiff is a former employee of URSCorporation.

5 He medically retired from

his position on September 14, 2013, believing that he had a genetic disability

unrelated to his work.

6 For his bad faith claim, he asserts:

9. Plaintiff paid for and was supplied by URS a disability benefit

coverage policy, managed by Defendant AETNA, which provided for,

among other things, “Accident and Sickness Benefit Coverage” and

“Long-Term Disability (LTD) Benefit Coverage.” . . . The “Accident

and Sickness Benefit” paid for up to a “maximum payment period of 26

weeks” in the case that Plaintiff should become “totally disabled.” . . .

However, if Plaintiff was to become “unable to return to work due to

[his] continued disability after [his] Accident and Sickness payments are

exhausted, Long-Term Disability Benefit Coverage . . . provides [him]

with an income.” . . . Two options were available — “replacement of 60

percent of your benefit pay, up to a maximum benefit of $10,000 a

month” or “replacement of 70 percent of your benefit pay, up to a

maximum benefit of $11,667 a month.”

10. All total, Plaintiff only ever received a total of $65,000 and

no more.

11. Defendants[’] disability coverage program was intentionally

and/or recklessly and/or negligently written in such a way as to confuse

Plaintiff with regard to his benefits coverage, such that he had to hire a

lawyer just to figure out why they stopped paying him.

7

To support his negligence claim, plaintiff asserts:

5 Doc. no. 1-1 (Complaint) ¶ 1.

6

Id. ¶ 8.

7

Id. ¶¶ 9-11 (third ellipsis in original, other ellipses supplied) (fourth bracketed alteration in

original, other bracketed alterations supplied).

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Case 5:16-cv-00635-CLS Document 29 Filed 10/04/16 Page 5 of 10
14. Defendants had a duty to properly maintain records, handle

disability benefits according to the contract between Defendants and

Plaintiff, a duty to take care of the plaintiff by providing disability

income, and other duties to be determined and amended as necessary.

15. Defendants failed to properly maintain the Plaintiff’s records,

failed to handle Plaintiff’s disability benefits according to contract, [and]

failed to provide disability income to the Plaintiff, thereby breaching

their duties to the Plaintiff.

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III. DISCUSSION

Defendants assert that plaintiff’s state law claims are pre-empted by ERISA,

and that those claims are due to be dismissed because plaintiff failed to exhaust his

available administrative remedies.

9 This court already has determined that the state

law claims are pre-empted by ERISA,

10 and there is no reason to depart from that

determination. The ERISA statute provides that it “shall supersede any and all State

laws insofar as they may now or hereafter relate to any employee benefit plan.” 29

U.S.C. § 1144(a). Additionally, courts have consistently held that state law claims

like those asserted by plaintiff fall under the pre-emption clause. See, e.g., Walker v.

8

Id. (alteration supplied).

9 Additionally, Aetna asserts that its decision with regard to plaintiff’s entitlement to benefits

was in accordance with the terms of the applicable plan and was not arbitrary and capricious. See

doc. no. 14 (Memorandum in Support of Defendant Aetna Life Insurance Company’s Motion for

Judgment on the Pleadings), at 11-18. AECOM and AECOM Global II, LLC adopt all of Aetna’s

arguments, and also assert that they did not issue, administer, or control the plan at issue here. See

doc. no. 17 (AECOM and AECOM Global II, LLC’s Brief in Support of Motion for Judgment on

the Pleadings), at 5-6. It is not necessary to address those arguments, because the motions for

judgment on the pleadings can be resolved on the alternative grounds discussed herein.

10

See doc. no. 11 (Order of Partial Remand), at 1 n.3.

6

Case 5:16-cv-00635-CLS Document 29 Filed 10/04/16 Page 6 of 10
Southern Company Services, Inc., 279 F.3d 1289, 1293 (11th Cir. 2002) (“[T]he

Alabama tort of bad faith is preempted.”) (alteration supplied); Dearmas v. Av-Med,

Inc., 865 F. Supp. 816, 818 (S.D. Fla. 1994) (holding that a claim for “negligence in

the administration of the plan” was pre-empted).

Because plaintiff’s claims fall under ERISA, plaintiff was required to exhaust

his administrative remedies prior to bringing suit in federal court.

“The law is clear in this circuit that plaintiffs in ERISA actions

must exhaust available administrative remedies before suing in federal

court.” Counts v. Amer. Gen’l Life & Acc. Ins. Co., 111 F.3d 105, 108

(11th Cir. 1997). This exhaustion requirement applies equally to claims

for benefits and claims for violation of ERISAitself. Perrino v. S. Bell

Tel. & Tel. Co., 209 F.3d 1309, 1316 n. 6 (11th Cir. 2000). “However,

a district court has the sound discretion ‘to excuse the exhaustion

requirement when resort to administrative remedies would be futile or

the remedy inadequate,’ . . . or where a claimant is denied ‘meaningful

access’ to the administrative review scheme in place.” Id. at 1315

(internal citations omitted). “The decision of a district court to apply or

not apply the exhaustion of administrative remedies requirement for

ERISA claims is a highly discretionary decision which we review only

for a clear abuse of discretion.” Id.

Bickley v. Caremark RX, Inc., 461 F.3d 1325, 1328 (11th Cir. 2006).

The long-term disability plan documents applicable here state that a claimant

“will have 180 days following receipt of an adverse benefit decision to appeal the

decision.”

11 There is no allegation in plaintiff’s complaint, and no indication at any

other place in the record, that he filed any such appeal. Moreover, plaintiff does not

11 Doc. no. 6-2 (Long-Term Disability Plan), at ECF 19.

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Case 5:16-cv-00635-CLS Document 29 Filed 10/04/16 Page 7 of 10
deny in his briefing that he failed to exhaust his administrative remedies before filing

suit. Instead, he states that he

was unaware of this requirement; simply being unaware would be no

excuse, except that here, Aetna either intentionally or negligently failed

to provide the Plaintiff with unambiguous guides, notices, letters, or

other communications that would have resulted in his engaging in any

other remedies he may have had. Thus, the very essence of this claim,

that Defendant Aetna was ambiguous in the terms, language, and

communications with the Plaintiff, should excuse Plaintiff from not

engaging in a remedy that was hidden from him, intentionally or not, by

Defendant Aetna.

Doc. no. 19 (Plaintiff’s Motion in Opposition to “Defendant AETNA Life Insurance

Company’s Motion for Judgment on the Pleadings”), at 3-4.

That argument is unpersuasive, because plaintiff was adequately informed of

his right to seek administrative review. The letter conveying Aetna’s adverse claims

decision stated:

You are entitled to a reviewof this decision if you do not agree.

To obtain a review, you or your authorized representative should

submit a written request. Your request should include your group’s

name (e.g. employer), your name, social securitynumber, other pertinent

identifying information, comments, documents, records and other

information you would like to have considered. You may also ask for

copies of documents relevant to your request. Please mail or fax your

request for appeal to:

Aetna Life Insurance Company

Workability Appeals

P.O. Box 14578

Lexington, KY40512-4578

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Case 5:16-cv-00635-CLS Document 29 Filed 10/04/16 Page 8 of 10
Fax #: 855-733-1262

Your written request for reviewmust be mailed or delivered to the

address above within 180 days following receipt of this notice, or a

longer period if specified in your plan brochure or Summary Plan

Description. You will receive notification of the final determination

within 45 days following receipt of your request. This period may be

extended up to an additional 45 days if special circumstances require

such an extension, in which case you will be notified prior to the end of

the first 45 day period.

Doc. no. 6-5 (October 4, 2013 Letter), at 2.

There is no other indication that plaintiff’s resort to administrative remedies

would have been futile or resulted in an inadequate remedy, or that plaintiff was

denied meaningful access to the administrative review process. To the contrary, the

plan states that:

You may submit written comments, documents, records, and other

information relating to your claim, whether or not the comments,

documents, records, or information were submitted in connection with

the initial claim. You may also request that the Plan provide you, free

of charge, copies of all documents, records, and other information

relevant to the claim.

Doc. no. 6-2 (Long-Term Disability Plan), at ECF 19. This indicates that plaintiff

would have had ample opportunity to gather and present evidence in support of his

appeal.

In summary, plaintiff was adequately informed of, and had ample opportunity

to participate in, a meaningful administrative review process, but he did not take

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Case 5:16-cv-00635-CLS Document 29 Filed 10/04/16 Page 9 of 10
advantage of that opportunity. As a result, he cannot proceed with his ERISA claims

in this case. See Bickley, 461 F.3d at 1330 (affirming district court’s dismissal of

ERISAcomplaint for failure to exhaust administrative remedies).

IV. CONCLUSION AND ORDER

In accordance with the foregoing, both motions for judgment on the pleadings

are GRANTED, and all of plaintiff’s claims are DISMISSED without prejudice for

failure to exhaust administrative remedies. Costs are taxed to plaintiff. The Clerk is

directed to close this file.

DONE this 4th day of October, 2016.

______________________________

United States District Judge

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