number of letters and other exhibits documenting her efforts.

The ERISA statute is silent as to whether exhaustion of administrative remedies is a
prerequisite to bringing a civil action challenging the denial of beneifts. Kross v. Wester Electric Co.
Inc., 701 F.2d 1238, 1244 (7 Cir. 1983). The decision to require exhaustion is therefore a matter
within the discretion of the trial court. Powell v. AT@T Communications, Inc., 938 F.2d 823, 825 (7"
Cir, 1991). Recognizing the public policy benefits that go along with the requirement of exhaustion,
courts within this Circuit routinely require the plaintiff to exhaust her administrative remedies before
filing suit in federal court. See Vallone v. Heidemann, 76 F.Supp. 2d 864, 867 (N.D.IIL. 1999) (“It is
generally well settled in this circuit the plaintiff must exhaust all appeal procedures before filing a
lawsuit regarding a termination of benefits.”). Accordingly, the Court believes that the plaintiff in
this case should be required to exhaust her administrative remedies before filing suit.

A plaintiffs allegation that she has exhausted her administrative remedies is generally
sufficient to withstand a Rule 12(b)(6) motion to dismiss. Frank v. Ameritech Corp., No. 98 C 5506,
1999 WL 1011107 at *4 (N.D.IIl. Oct. 12, 1999); Gerlib v. R.R. Donnelley & Sons Company, No. 95
C7401, 1997 WL 672645 at *4 (N.D.IIl. Oct. 27, 1997); Sumpter v. Mack Chicago Corporation, 918
F.Supp. 256, 259 (N.D.IIl. 1996). After carefully reviewing McDougall’s submissions, the Court finds
that McDougall’s amended complaint sufficiently alleges exhaustion of administrative remedies. As
described above, the amended complaint describes McDougall’s considerable efforts to challenge
defendants’ coverage determination. McDougall claims that she repeatedly appealed to both Aetna
and UPS, but got nowhere. McDougall further contends that she sent defendants all the requested
documentation, including medical records, to support her challenges. Moreover, McDougall submits
voluminous correspondence documenting her repeated attempts to appeal defendants’ decision.

While defendants are correct to point out that McDougall has not styled her allegations in concise,

4



address McDougall’s January 3, 2002 submissions. Three months later, McDougall received a letter
from Aetna restating the denial of benefits. The letter again directed McDougall to appeal with the
local UPS human resources department if she disagreed with their coverage determination. On May
6, 2002, McDougall again complied with Aetna’s request. On May 31, 2002, McDougall received
yet another letter from Aetna restating their rationale for denying coverage, but received nothing
from UPS responding to her May 6, 2002 letter. Accordingly, McDougall sent a final letter to UPS
threatening legal action if she did not get a timely response. On August 1, 2002 UPS responded
stating that it was sending her concerns to Aetna’s appeal board. Then, on August 21, 2002, Aetna
issued McDougall a third letter formally denying coverage. At this point, McDougall decided to
initiate the present legal proceedings. Defendants now argue that McDougall’s amended complaint
fails to state a claim because McDougall has not alleged that she exhausted her administrative
remedies before filing suit.
Il. Standard of Review

A Rule 12(b) (6) motion to dismiss for failure to state a claim is granted only where it is
beyond doubt that the plaintiff is unable to prove any set of facts that would entitle her to relief.
Conley v. Gibson, 355 U.S. 41, 45-46 (1957). The court must take all well pleaded facts and
allegations as true and must view them in the light most favorable to the plaintiff. Ellsworth v. City of
Racine, 774 F.2d 182, 184 (7" Cir. 1985), cert. denied, 475 U.S. 1047 (1986). Furthermore, plaintiff
is entitled to all reasonable inferences that may be drawn from the complaint. Id.

IIL. Discussion

Defendants argue that McDougall’s complaint is deficient because McDougall does not

specifically allege that she exhausted her administrative remedies before filing suit. In response,

McDougall insists that she followed all relevant appeal procedures before bringing suit and attaches a

3



numbered paragraphs, the Court is mindful that pro se pleadings are held to less exacting standards
than those prepared by counsel and are to be liberally construed. Haines v, Kemer, 404 U.S. 519
(1972) (per curiam); McCormick v. City of Chicago, 230 F.3d, 325 (7% Cir. 2000). Considering the
amended complaint’s factual allegations together with the attached exhibits, the Court finds that
McDougall’s has sufficiently alleged exhaustion.
IV. Conclusion

McDougall has sufficiently alleged that she exhausted her administrative remedies before

filing the present action. Defendants’ motion to dismiss is therefore denied.

IT IS SO ORDERED.

L. 3 Jog

William J.
United Statés District Court



rTM

Minute Okder Form (06/97)

‘United States District Court, Northern District of Illinois

Ni f Assigned Judy ili: j Sitting Judge if Other
ange Magistrate Judge William J. Hibbler than Assigned Judge
CASE NUMBER 02 C 8024 DATE 9/3/2003
CASE MC DOUGALL vs. PELCHAT, et al.
TITLE

[In the following box (a) indicate the party filing the motion, e.g., plaintiff, defendant, 3rd party plaintiff, and (b) state briefly the nature

of the motion being presented.]

MOTION:
Defendants’ Motion to Dismiss (Doc. #8)
DOCKET ENTRY:
q@ a Filed motion of [ use listing in “Motion” box above.]
(2) oO Brief in support of motiondue
(3) o Answer brief to motion due___. Reply to answer brief due__.
(4) Oo Ruling/Hearingon____—_ set for__—_at
(5) Oo Status hearing[held/continued to} [set for/re-set for]on__—_ssetfor__—_att
(6) oa Pretrial conference[held/continued to] [set for/re-set for]on___—setfor__——sat__—.
(C) Oo Trial[set for/re-set for]on___——sat__— i.
(8) a [Bench/Jury trial] [Hearing] held/continued toa
(9) Q This case is dismissed [with/without] prejudice and without costs[by/agreement/pursuant to]

QFRCP4¢m) OC Local Rule 41.1 OFRCP41(a)(1) O FRCP41(a)(2).

do [Other docket entry} Defendants’ Motion to Dismiss (Doc. #8) is denied. Defendants to answer
the complaint by 9/26/03. Status hearing set for 10/15/03 at 9:30 a.m. to set discovery schedule. Enter
Memorandum Opinion and Order. The Clerk of the Court is directed to reinstate defendant UPS’ counsel

as attorneys of record.

al) {For further detail see order attached to the original minute order.]

No notices required, advised in open court
2

No notices required. number of notices

J | Notices mailed by judge's staff.

FO AL Onn
Notified counsel by telephone. of “ioe E03

Docketing to mail notices.

Mail AO 450 form. sors sid “fl woah ous

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Copy to judge/magistrate judge. lynoo yey

9/3/2003

date mailed notice

4 or ss 0
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IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION ~ }

LINDA S McDOUGALL, Ste 4~ ;
2003)
Plaintiff,

Vv.

No. 02 C 8024

SUSAN PELCHAT and
UNITED PARCEL SERVICE, INC.,
an Illinois corporation,

The Honorable William J. Hibbler

wee Ye SSeS YS SS SE YS

Defendants.

MEMORANDUM OPINION AND ORDER

Plaintiff Susan McDougall brings this civil action against defendants Susan Pelchat and
United Parcel Service, Inc. (UPS), pursuant to the Employee Retirement Income Security Act of
1974, 29 U.S.C, §§ 1001 et seg. McDougall claims that defendants failed to pay for medical
procedures allegedly covered under UPS’s group health insurance plan. Defendants have moved to
dismiss McDougall’s complaint pursuant to Fed.R.Civ.P. 12(b)(6). For the reasons below,
defendants’ motion is denied,

I. Background

McDougall, as the spouse of a UPS employee, is insured under a UPS comprehensive health

care coverage plan administered by Aetna U.S. Healthcare. The present dispute regards

McDougall’s efforts to obtain insurance coverage for varicose vein removal procedures. The relevant

| \\



facts, garnered from McDougall’s amended complaint and exhibits attached thereto!, are summarized
below.

In or about September 2000, McDougall sought Aetna’s authorization for varicose vein
treatment on her right leg. On September 29, 2000, Aetna sent McDougall a letter authorizing a
surgical procedure to disconnect and remove the offending veins from McDougall’s leg. In the same
letter, Aetna rejected coverage for a less invasive procedure that involved the injection of solution
into the undesired veins until it could review the doctor's post-operative notes to determine if this
alternate procedure was necessary.

On February 12, 2001, McDougall underwent the unauthorized solution procedure and
Aetna subsequently refused the resulting insurance claim.?- On March 22, 2001, McDougall wrote
Aetna regarding its coverage denial. In this letter, McDougall claimed that her doctor’s office
properly submitted the required post-operative notes and medical records that would entitle her to
full coverage. On May 4, 2001, Aetna replied that it had only authorized the surgical procedure,
but McDougall elected the cosmetic, solution option. Aetna directed McDougall to appeal to the
UPS human resources department if she disagreed with Aetna’s determination.

As directed, McDougall wrote the local UPS human resource department to appeal Aetna’s
coverage decision. On November 5, 2001, UPS acknowledged receipt of McDougall’s appeal and
instructed McDougall to submit her doctor’s treatment notes relating to the disputed procedure.
McDougall complied with UPS’s request on January 3, 2002.

On January 17, 2002, UPS wrote McDougall that it was still reviewing her appeal, but did not

‘Any written instrument which is an exhibit to a pleadings is part thereof for all purposes.
Fed. R. Civ. P. 10(c).

"It appears McDougall received some follow-up treatment on August 2, 2001.

2