Court Opinion

ID: 9893734
Source: CourtListenerOpinion
Date Created: 2023-10-30 15:00:57.035156+00
Date Added: 2024-06-11T09:05:01.995006
License: Public Domain

USCA11 Case: 22-12459    Document: 38-1      Date Filed: 10/30/2023   Page: 1 of 12

                                                    [DO NOT PUBLISH]
                                    In the
                 United States Court of Appeals
                         For the Eleventh Circuit

                           ____________________

                                 No. 22-12459
                           Non-Argument Calendar
                           ____________________

        GREGORY PARSLEY, DDS,
                                                       Plaintiﬀ-Appellant,
        versus
        GREAT-WEST LIFE AND ANNUITY INSURANCE CO.,

                                                     Defendant-Appellee.

                           ____________________

                  Appeal from the United States District Court
                      for the Southern District of Florida
                     D.C. Docket No. 0:22-cv-60800-AHS
                           ____________________
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        2                          Opinion of the Court                  22-12459

        Before ROSENBAUM, JILL PRYOR, and BRANCH, Circuit Judges.
        PER CURIAM:
               Gregory Parsley, proceeding pro se, appeals the district
        court’s dismissal of his civil complaint for breach of contract as
        time-barred. After review, we affirm.
                                      I.       Background
                On April 16, 2022, Parsley, through counsel, filed a civil
        complaint against Great-West Life and Annuity Insurance
        Company (“Great-West”) in Florida state court. The complaint
        alleged the following. Great-West serviced disability insurance
        policies, including Parsley’s policy. Parsley’s disability policy was
        intended “to compensate [Parsley] on a monthly basis should he
        suffer a total disability due to injuries or sickness.” On July 19, 2013,
        Parsley filed a claim for benefits with Great-West asserting that he
        was disabled due to end-stage kidney failure. After Great-West
        denied the claim, Parsley appealed; Great-West denied the appeal
        on March 1, 2014. Parsley then filed a second appeal, which
        Great-West denied on November 19, 2014. 1 Almost five years
        later, Parsley filed a third appeal, which was denied on March 7,

        1 Parsley alleged that neither the March or the November 2014 denial was

        designated as a “final denial or decision.”
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        22-12459                   Opinion of the Court                                3

        2019. 2 Parsley then waited over three years before filing the
        underlying complaint in Florida state court.
               Parsley alleged that under the insurance contract
        Great-West owed him monthly payments and interest from
        “August 2011 and going forward to age 65” because it failed to
        honor its obligations under the terms of the contract. He asserted
        that Great-West breached the implied contractual covenant of
        good faith, fair dealing, and commercial reasonableness. Parsley
        sought judgment awarding all contract benefits plus interest, costs,
        and attorney’s fees.
               Parsley attached a copy of the insurance policy to the
        complaint. In relevant part, the policy provided that if an insured
        disagreed with Great-West’s benefit determination, the insured
        could appeal the decision by sending a notice of appeal along with
        certain other information to Great-West. Great-West would then
        notify the insured of its “written final decision . . . within 60 days of
        [Great-West’s] receipt” of the insured’s appeal. Furthermore, the
        policy prohibited the insured from instituting any legal action
        “(1) prior to the date of [Great-West’s] final decision on the appeal;
        nor (2) more than three years after the date of the Company’s final
        decision on the appeal.” Finally, the policy contained a choice-of-

        2 In his complaint, Parsley alleged that the third appeal was denied on April 15,

        2019, but in his response to the motion to dismiss, he conceded that the third
        appeal was in fact denied on March 7, 2019. He also acknowledged that he
        had a fourth appeal that was denied on April 15, 2019.
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        4                        Opinion of the Court                     22-12459

        law provision, providing that all policy-related disputes between
        the insured and Great-West were governed by Illinois law.
               Great-West removed the case to federal court on the basis
        of diversity jurisdiction under 28 U.S.C. § 1332. Great-West then
        moved to dismiss the complaint under Federal Rule of Civil
        Procedure 12(b)(6), arguing that the claim was time-barred by the
        policy’s language that prohibited an insured from initiating a legal
        action “more than three years after the date of the Company’s final
        decision on the appeal.” Great-West asserted that it issued its final
        decision on March 31, 2014 when it denied Parsley’s first appeal. 3
        Therefore, pursuant to the policy’s terms, Parsley had until March
        31, 2017, to initiate legal action, and his April 1, 2022, complaint
        came too late. Moreover, Great-West asserted that even if the
        limitations period ran from the date of Great-West’s denials of the
        second appeal on November 19, 2014, or the third appeal on March
        7, 2019, the suit was still time-barred.
               In support of its motion to dismiss, Great-West attached the
        denial letters it sent Parsley on March 31, 2014, November 19, 2014,
        and March 7, 2019. The March 2014 letter explained that it had
        “reviewed [Parsley’s] entire claim file as well as Great-West’s

        3 In response to Parsley’s contention that the March 2014 letter denying

        Parsley’s first appeal and the subsequent November 2014 letter denying the
        second appeal were not formally designated as a “final denial or decision,”
        Great-West argued that nothing in the policy required Great-West’s letters to
        include such language. Furthermore, Great-West argued that nothing in the
        letters indicated that Parsley’s claim remained open or that Great-West was
        going to continue investigating the claim.
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        22-12459               Opinion of the Court                         5

        administrative records under the ADA Income Protection Plan in
        order to address the current status of [Parsley’s] coverage and
        provide a comprehensive response to [his] appeal for disability
        income benefits.” Great-West then explained that Parsley’s
        coverage under the policy ended on July 1, 2011, on the day he
        “became unemployed following closure of the dental offices in
        which [he] worked.” And because his coverage terminated July 1,
        2011, “there [were] no benefits available for total disability
        commencing December 2011. . . . As such, Great-West has no
        alternative but to maintain its denial of benefits on the grounds that
        no coverage was in effect at the time total disability
        commenced. . . . ”
               The November 2014 letter stated that Great-West had
        reviewed Parsley’s appeal “dated October 30, 2014,” along with the
        new evidence he submitted, but its determination “remain[ed]
        unchanged.” Great-West explained that it “[had] no alternative but
        to maintain [its] denial of benefits based on the fact there was no
        coverage in effect at the time [Parsley’s] total disability
        commenced, whether that was August, September or December of
        2011.”
                The third letter dated March 7, 2019, was directed to
        Parsley’s counsel. It provided that Great-West had reviewed a
        letter from Parsley’s counsel “dated February 11, 2019, along with
        attachments referencing [Parsley’s] prior medical treatment,” but
        Great-West “respectfully decline[d] to re-open the claim.”
        Additionally, in this letter, Great-West provided a detailed
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        6                      Opinion of the Court                 22-12459

        background of Parsley’s claim, including that “Great-West issued a
        final decision in response to [Parsley’s] appeal in a letter dated
        November 19, 2014.”
                Parsley, through counsel, opposed Great-West’s motion to
        dismiss. He acknowledged that Great-West denied his third appeal
        on March 7, 2019, and he conceded that his claim was subject to
        “the 3-year statute of limitation” in the policy. Nevertheless, he
        argued that the limitations period ran from a fourth letter he
        received on April 15, 2019. He maintained that “it [was] improper
        to attempt to resolve the statute of limitations issue without the
        benefit of additional discovery” and that the issue of which of the
        letters constituted Great-West’s final decision was “a matter to be
        clarified with discovery and potentially expert witness testimony
        regarding finality and what is common in the industry.” Parsley
        attached the April 15, 2019, letter to his response. Like the previous
        letter, this one was addressed to Parsley’s counsel, and stated that
        Great-West had received counsel’s “correspondence dated April 8,
        2019” but it
              remain[ed] convinced that the ﬁnal decision reached
              regarding Dr. Parsley’s claim was correct and that the
              time limitation language [Great-West] previously
              referenced [did] not require [it] to entertain
              previously made or new arguments made more than
              three years after what was plainly a ﬁnal decision
              which Dr. Parsley and Great-West have both treated
              as such.
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        22-12459                   Opinion of the Court                                7

               Great-West, in turn, argued that the court should dismiss
        the complaint as time-barred because the face of the complaint and
        documents incorporated by reference made clear that Parsley’s
        lawsuit was untimely. 4 It maintained that each of the three letters
        it submitted were central to Parsley’s claim and affirmed that
        Great-West issued its final decision more than three years prior to
        the instant lawsuit, and that no additional discovery was necessary
        in order to determine finality. 5
               Upon review, the district court granted Great-West’s
        motion to dismiss, concluding that Parsley’s complaint was time-
        barred. The district court determined that the November 2014
        letter and the March 2019 letter made “clear that the actual final
        decision on [Parsley’s] appeal occurred no later than November 19,
        2014.” 6 In support, the district court highlighted that the

        4 Great-West noted that Parsley did not dispute that the district court could

        consider the letters it attached to its motion to dismiss.
        5 Moreover, Great-West contended that, at a minimum, Parsley was on notice

        via the March 7, 2019, letter that Great-West’s decision was final and, at a
        minimum, Parsley should have filed his lawsuit within three years of that date.
        6 The court noted that, at the motion to dismiss stage, it could consider

        documents attached to a motion to dismiss if the attached documents were
        “central to the plaintiff’s claim and . . . undisputed, meaning [their]
        authenticity [was] not challenged.” See Day v. Taylor, 400 F.3d 1272, 1276 (11th
        Cir. 2005) (“[T]he court may consider a document attached to a motion to
        dismiss without converting the motion into one for summary judgment if the
        attached document is (1) central to the plaintiff’s claim and (2) undisputed.”).
        Although Parsley did not oppose the district court’s consideration of the letters
        submitted by Great-West and did not challenge their authenticity, “in an
        abundance of caution,” the district court decided that it would “only consider
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        8                          Opinion of the Court                         22-12459

        November 2014 letter stated that Great-West’s “determinations
        regarding the termination of Parsley’s coverage . . . remained
        unchanged” and Great-West had “no alternative but to maintain
        [its] denial of benefits based on the fact that there was no coverage
        in effect at the time [Parsley’s] total disability commenced.” The
        district court explained that this unambiguous language
        demonstrated that the letter constituted a final decision “because it
        definitively denie[d] the appeal and [gave] no indication that there
        [would] be further consideration of the appeal.” Furthermore, the
        district court explained that, under Illinois law, an insured’s
        repeated requests for modification of a prior final decision do not
        toll the limitation period. In other word’s Parsley’s contentions
        that each letter from Great-West in response to his repeated
        requests for Great-West to reconsider its decision constituted a
        new final decision from which the limitations period ran anew
        failed. Accordingly, the district court dismissed the complaint as
        time-barred. Parsley, proceeding pro se, filed a timely appeal of the
        dismissal.
                                        II.     Discussion
                Liberally construing Parsley’s briefs, 7 he argues that the
        district court erred in dismissing the complaint as time-barred

        those pieces of correspondence both referenced in [Parsley’s] Complaint and
        attached in the [motion to dismiss]”—i.e., the November 2014 denial letter and
        the March 2019 denial letter.
        7 We note that Parsley does not cite any case law or legal authority in his briefs.

        This fact alone provides a basis for us to affirm the district court because he
        effectively abandoned his claims. See Sapuppo v. Allstate Floridian Ins. Co., 739
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        22-12459                    Opinion of the Court                                   9

        because the April 2019 letter initiated the running of the limitation
        period, and it “was the first time Great-West used the term final
        decision.” 8 He also notes that Great-West never told him to not
        “send any more appeals” in the prior denial letters. 9

        F.3d 678, 681 (11th Cir. 2014) (“We have long held that an appellant abandons
        a claim when he either makes only passing references to it or raises it in a
        perfunctory manner without supporting arguments and authority.”); Singh v.
        U.S. Att’y Gen., 561 F.3d 1275, 1278 (11th Cir. 2009) (explaining that “an
        appellant’s brief must include an argument containing appellant’s contentions
        and the reasons for them, with citations to the authorities and parts of the
        record on which the appellant relies,” and that “simply stating that an issue
        exists, without further argument or discussion, constitutes abandonment of
        that issue and precludes our considering the issue on appeal”); see also GJR
        Invs., Inc. v. Cty. of Escambia, Fla., 132 F.3d 1359, 1369 (11th Cir. 1998)
        (explaining that although pro se pleadings are to be liberally construed, a court
        may not “serve as de facto counsel for a party” or “rewrite an otherwise
        deficient pleading in order to sustain an action”), overruled on other grounds as
        recognized in Randall v. Scott, 610 F.3d 701, 709 (11th Cir. 2010). Nevertheless,
        we set aside the abandonment issue and address the claims that Parsley
        preserved for appeal.
        8 This assertion is belied by the record. In its March 7, 2019, letter Great-West

        stated that it “issued a final decision in response to [Parsley’s] appeal in a letter
        dated November 19, 2014.”
        9 Parsley also argues for the first time that the three-year limitation period in

        the policy does not apply to him because he was “never informed of its
        existence” and “never received a booklet” concerning the policy, despite his
        requests for one over the years. Rather, he maintains that the applicable
        statute of limitations for a breach of contract claim under Illinois law is 10
        years. On the other hand, he also asserts for the first time in his reply brief
        that he was unaware that Illinois law governed the policy. However, in the
        district court proceedings, Parsley expressly conceded in his counseled
        response to the motion to dismiss that Illinois law governed the issues in this
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        10                         Opinion of the Court                         22-12459

              We review de novo a district court’s ruling on a motion to
        dismiss, “accepting the allegations in the complaint as true and
        construing them in the light most favorable to the plaintiff.” Hill v.
        White, 321 F.3d 1334, 1335 (11th Cir. 2003).
               “Illinois law recognizes limitation periods as valid
        contractual provisions in an insurance contract.” Am. Access Cas.
        Co. v. Tutson, 948 N.E.2d 309, 312 (Ill. App. Ct. 2011). Here,
        Parsley’s policy, which he attached to his complaint, established a
        three-year limitation period from the date of Great-West’s “final
        decision on the appeal.” Parsley does not dispute that he received
        a letter in November 2014 denying his appeal. Rather, he argued
        below that the letter did not represent a final decision, in large part
        because it did not contain the words “final decision” and because
        no one told him to stop filing appeals. We disagree.
               Even assuming arguendo that we accepted Parsley’s
        argument that he did not understand that the November 2014
        letter was Great-West’s final decision on his appeal, his complaint

        case and that the applicable statute of limitations was three years. Thus, he
        failed to preserve for appeal any challenge to the applicability of Illinois law or
        the three-year statute of limitations period. See Walker v. Jones, 10 F.3d 1569,
        1572 (11th Cir. 1994) (providing that “an issue not raised in the district court
        and raised for the first time in an appeal will not be considered by this Court”).
        Consequently, we do not address these issues.
                Additionally, Parsley disputes the merits of Great-West’s decision to
        deny his disability claim and its conclusion that he did not have effective
        coverage. The merits of Great-West’s decision to deny Parsley’s disability
        claim was not an issue before the district court, and, therefore, is not properly
        before us.
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        22-12459                  Opinion of the Court                             11

        was still time-barred. Specifically, in its March 7, 2019, letter,
        Great-West expressly stated that it had “issued a final decision in
        response to [Parsley’s] appeal in a letter dated November 19, 2014.”
        Thus, there can be no debate that, at the latest, Parsley knew that
        there had been a “final decision” in his case as of March 7, 2019,
        triggering the three-year limitation period. 10 And even if the three-
        year limitation period ran from the March 7, 2019, letter, Parsley’s
        complaint filed on April 1, 2022, was outside that three-year
        window.
               To the extent that Parsley’s arguments suggested that the
        appeal was not final because Great-West continued to accept his
        letters seeking reconsideration and respond to them in 2019, his
        claim fails under Illinois law. Specifically, Illinois statute § 143.1
        governs the tolling of contractual limitation periods like the one
        here. Am. Access Cas. Co., 948 N.E.2d at 312; see also 215 Ill. Comp.
        Stat. 5/143.1. Section 143.1 provides that when, as here, an
        insurance policy “contains a provision limiting the period within
        which the insured may bring suit, the running of such period is
        tolled from the date proof of loss is filed, in whatever form is
        required by the policy, until the date the claim is denied in whole
        or in part.” 215 Ill. Comp. Stat. 5/143.1. In Vala v. Pac. Ins. Co., the
        plaintiff made a similar claim to that of Parsley, and argued that his
        policy’s one-year limitation period was tolled while the insurance

        10 In light of the notification in the March 7, 2019, letter that Great-West’s

        decision was final, we need not decide whether the March and November 2014
        letters were final decisions.
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        12                     Opinion of the Court                 22-12459

        company reinvestigated his claim following the initial denial, and,
        therefore, his complaint was timely filed. 695 N.E.2d 581, 582–83
        (1998). The Appellate Court of Illinois rejected this argument and
        held that, under § 143.1, unless the insurance company rescinds its
        denial of the claim, “[t]he period of time between [the insured’s]
        receipt of [the insurance company’s] denial and the reaffirmation
        of [the company’s] denial does not constitute time that can be
        tolled.” Id. at 584. Rather, tolling of the limitations period ceases
        “upon the date of the original (and never rescinded) denial
        pursuant to [§] 143.1.” Id. Thus, under § 143.1 and Vala, Great-
        West’s continued acceptance of Parsley’s requests for
        reconsideration did not otherwise toll the applicable three-year
        limitation period, which began to run on November 19, 2014,
        when Great-West denied Parsley’s appeal.
                Accordingly, for the above reasons, the district court did not
        err in dismissing Parsley’s complaint as time-barred.
               AFFIRMED.