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Cooksey v. Metropolitan Life Insurance Company

United States District Court, N.D. Texas, Dallas Division
Jun 17, 2004
No. 3:02-CV-2583-M (N.D. Tex. Jun. 17, 2004)

Summary

holding plaintiff's employer was not a proper defendant under ERISA

Summary of this case from Greenbaum v. Sedgwick Claims Mgmt. Servs., Inc.

Opinion

3:02-CV-2583-M.

June 17, 2004


MEMORANDUM ORDER


Before the Court is Defendants' Motion for Summary Judgment, filed on March 19, 2004. The Court grants Defendants' Motion for Summary Judgment.

I. BACKGROUND

Plaintiff was a Kroger Company ("Kroger") employee, who went on an employer-approved medical leave of absence on July 5, 2001. Kroger employees can be on approved medical leave for a maximum of one year; if, at the expiration of one year of approved medical leave, an employee does not return to active work, the employee is terminated. In late 2001, while on medical leave, Plaintiff participated in open enrollment for 2002 insurance benefits under The Kroger Co. Health Welfare Plan ("the Kroger Plan"). She enrolled in $25,000 of dependent life insurance coverage for her husband, Mr. Cooksey. Metropolitan Life Inurance Company ("MetLife") insures the life insurance benefits under the Kroger Plan and serves as the claims administrator, while Kroger serves as the plan administrator. After enrolling in the dependent life insurance coverage, Plaintiff remained on approved medical leave. Since she failed to return to active work after one year of approved medical leave, she was terminated on July 5, 2002. Plaintiff's husband died on August 3, 2002, and MetLife denied Plaintiff's claim for dependent life insurance benefits.

On October 25, 2002, Plaintiff filed suit in state court against MetLife and Kroger, alleging various state law causes of action. Defendants removed this action, and Plaintiff did not seek remand On March 19, 2004, Defendants filed a Motion for Summary Judgment, arguing that (1) all the asserted state law claims are preempted by ERISA, which provides Plaintiff's exclusive remedy under Section 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B); (2) Kroger is not a proper Defendant to an ERISA claim for benefits under Section 502(a)(1)(B); and (3) MetLife's decision to deny Plaintiff's dependent life insurance claim was not an abuse of discretion and thus Plaintiff's claim under Section 502(a)(1)(B) fails as a matter of law.

II. ANALYSIS

A. Are Plaintiff's State Law Claims Preempted by ERISA?

Plaintiff asserts various state law claims premised on MetLife's failure to pay Plaintiff's dependent life insurance benefits and MetLife and Kroger's dealings with Plaintiff. ERISA Section 514(a) expressly preempts "any and all State laws insofar as they may now or hereafter relate to any employee benefit plan described in section 1003(a) of this title." 29 U.S.C. § 1144(a). Further, state law claims are preempted to the extent a claimant attempts to seek relief within the scope of ERISA's exclusive civil enforcement provisions. Pilot life Ins. Co. v. Dedeaux, 481 U.S. 41, 54 (1987) ("The deliberate care with which ERISA's civil enforcement remedies were drafted and the balancing of policies embodied in its choice of remedies argue strongly for the conclusion that ERISA's civil enforcement remedies were intended to be exclusive."). ERISA Section 502(a)(1)(B) provides the following exclusive remedy for plan benefits: "A civil action may be brought by a participant or beneficiary to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan." 29 U.S.C. § 1132(a)(1)(B).

The Kroger Plan, as a plan established by an employer to provide its participants benefits in the case of death, is an "employee welfare benefit plan" as defined by ERISA. 29 U.S.C. § 1002(1). Therefore, MetLife and Kroger argue that all of Plaintiff's state law claims are preempted for the following reasons: (1) "[s]ince all of Plaintiff's claims arise from MetLife's denial of her life insurance claims, it is indisputable that Plaintiff's state law claims `relate to' the Plan and thus, are preempted by ERISA," (Defs.' Br. at 6); and (2) "[w]here, as here, Plaintiff seeks to recover benefits from fiduciaries of an ERISA-governed plan, ERISA provides the exclusive avenue of recovery," (Defs.' Br. at 7).

In response, Plaintiff concedes that all of Plaintiff's state law claims are preempted by ERISA, except to the extent Plaintiff seeks to recover dependent life benefits under the Consolidated Omnibus Budget Reconciliation Act ("COBRA"). (Pl.'s Resp. Br. at 2). COBRA requires the plan sponsor of a group health plan to allow each qualified beneficiary who would lose coverage under the plan as a result of a qualifying event to elect continuation coverage. 29 U.S.C. § 1161(a). COBRA does not govern the continuation of life insurance benefits. Robin v. Metropolitan Life Ins. Co., 147 F.3d 440, 442 n. 4 (5th Cir. 1998) ("ERISA was amended in part by [COBRA] without, however, affecting life insurance."). Thus, Plaintiff has not asserted a cognizable claim for dependent life benefits under COBRA. However, Plaintiff has asserted a claim for dependent life benefits under the continuation coverage provision of the Kroger Plan, (Pl.'s Resp. Br. at 13), which Plaintiff is inartfully referring to as a claim under COBRA. A claim for benefits under the continuation coverage provision of an ERISA plan is governed by ERISA. See Levine v. Transamerica Life Cos., No. Civ. A. 99-1875, 2001 WL 333119 (E.D. La. Apr. 5, 2001) (Clement, J.) (compiling the cases holding that claims under conversion policies are governed by ERISA). Therefore, because Plaintiff's claim under the continuation coverage provision of the Kroger Plan is governed by ERISA and because Plaintiff has conceded that the remainder of her state law claims are preempted by ERISA, the Court grants Defendants' Motion for Summary Judgment on all of Plaintiff's state law claims. Section 502(a)(1)(B) of ERISA provides Plaintiff's sole remedy for the denial of her claim for dependent life benefits.

Plaintiff's claim under the continuation coverage provision is examined in more detail, infra, at part II.C.3. of this Order.

B. Is Kroger a Proper Defendant to a Claim Under Section 502(a)(1)(B)?

Kroger argues that, because Kroger has no obligation to pay for benefits under the terms of the Kroger Plan, Kroger is not a proper defendant to a claim under Section 502(a)(1)(B). Plaintiff responds: "It is unclear from the record what role Kroger played in the denial of Plaintiff's claim and what role MetLife played. At the very least this confusion creates a fact issue as to whether Kroger, as Plan Administrator is a proper party to this lawsuit." (Pl.'s Resp. Br. at 19).

Under the terms of the Kroger Plan, it is clear that MetLife, not Kroger, is responsible for paying dependent life benefits. The Kroger Plan provides: "If a Dependent dies while Life Benefits are in effect for that Dependent, we will pay the amount of Life Benefits that is in effect for that Dependent on the date of that Dependent's death." (App. at 56). The Kroger Plan defines "we" as "Metropolitan." (App. at 46). Further, the Kroger Plan explicitly provides that the life insurance benefits are insured by MetLife: "The above listed benefits [including Life Benefits] are insured by Metropolitan Life Insurance Company." (App. at 77).

Because Kroger is not responsible for paying dependent life benefits under the Kroger Plan, Kroger is not a proper Defendant to a claim for benefits under the Kroger Plan. See Metropolitan Life Ins. Co. v. Palmer, 238 F. Supp.2d 826, 830 (E.D. Tex. Dec. 4, 2002) (holding that the participant's employer was not a proper defendant to a claim for benefits where, "[u]nder the express terms of the Plans, MetLife has the obligation to process and pay the proceeds."). Therefore, Court grants Kroger's Motion for Summary Judgment.

Because the Court finds that, under the Kroger Plan, Kroger is not responsible for paying dependent life benefits, the Court does not reach Kroger's argument that Kroger is per se an improper defendant in a suit for benefits under ERISA. The cases cited by Kroger stand for the proposition that only the plan itself is a proper defendant in a suit for benefits under ERISA. See Gelardi v. Pertec Computer Corp., 761 F.2d 1323, 1324 (9th Cir. 1985) ("ERISA permits suits to recover benefits only against the Plan as an entity."); Murphy v. Wal-Mart Assocs. Group Health Plan, 928 F. Supp. 700, 710 (E.D. Tex. 1996) ("The court has found no case [where] an entity other [than] the plan was successfully sued in its individual capacity for benefits under § 1132(a)(1)(B)."). The Fifth Circuit has not addressed this issue, and the Court need not reach it here. The Court notes that, if the Court were to follow the cases cited by Kroger, the Kroger Plan would be the sole proper defendant in a claim for benefits under ERISA, but MetLife has not moved for summary judgment on this ground.

C. Was MetLife's Decision to Deny Plaintiff's Claim an Abuse of Discretion?

1. Kroger Benefits Brochure

Plaintiff contends that the Kroger Benefits brochure entitled "Your Guide to Enrollment for 2002" should govern whether Plaintiff is entitled to dependent life benefits. The Court first notes that the Kroger Benefits brochure is not part of the administrative record. Second, although a summary plan description governs over a plan to the extent it conflicts therewith, the Kroger Benefits brochure does not constitute a summary plan description. See Hansen v. Continental Ins. Co., 940 F.2d 971, 982 (5th Cir. 1991) ("[T]his court holds that the summary plan description is binding, and that if there is a conflict between the summary plan description and the terms of the policy, the summary plan description shall govern."). The brochure is not titled a summary plan description and lacks most of the categories of information required to be contained in a summary plan description. See 29 U.S.C. § 1022. Third, the Court rejects Plaintiff's argument that the Kroger Benefits brochure conflicts with the Kroger Plan. Plaintiff argues that, because the Kroger Benefits brochure describes eligibility for "all full-time salaried and non-union hourly associates" and does not qualify that description with the term "active," the brochure conflicts with the plan. However, under the Kroger Plan, the "active" requirement affects the effective date of dependent life benefits, not the eligibility date for dependent life benefits. (Compare the "Dependent Benefits Eligibility Date" with the "Effective Dates of Dependent Benefits," App. at 46, 49). Finally, the Court finds that no reasonable person would construe the Kroger Benefits brochure as governing Plaintiff's entitlement to benefits. For example, the Kroger Benefits brochure does not include a provision explaining when dependent life benefits are paid. If the Kroger Benefits brochure were to govern the entitlement to benefits, a dependent's death would arguably not be a condition to a beneficiary's entitlement to dependent life benefits. The Court thus rejects Plaintiff's argument that the Kroger Benefits brochure, rather than the Kroger Plan, should govern Plaintiff's entitlement to benefits.

2. Standard of Review

The Court will review MetLife's factual determinations for an abuse of discretion, based solely on the evidence in the administrative record. Meditrust Fin. Sers. v. The Sterling Chems., Inc., 168 F.3d 211, 213 (5th Cir. 1999) ("Regardless of the administrator's ultimate authority to determine benefit eligibility, however, factual determinations made by the administrator during the course of a benefits review will be rejected only upon the showing of an abuse of discretion."); Schadler v. Anthem Life Ins. Co., 147 F.3d 388, 395 (5th Cir. 1998) ("As to the first determination — the findings of fact — we have held that the administrator's decision should always be reviewed for an abuse of discretion.").

When the Court applies the "abuse of discretion" standard of review, the Court follows the guidance of the Fifth Circuit and treats the "abuse of discretion" standard as synonymous with the "arbitrary and capricious" standard. See Meditrust Fin. Sers. v. The Sterling Chems., Inc., 168 F.3d 211, 214 (5th Cir. 1999) ("[T]here is only a `semantic, not a substantive, difference' between the arbitrary and capricious and the abuse of discretion standards in the ERISA benefits review context.").

Because the Kroger Plan gives MetLife the discretionary authority to determine eligibility for benefits and to construe terms of the Kroger Plan, the Court will review MetLife's interpretations of the Kroger Plan for an abuse of discretion. Estate of Bratton v. Nat'l Union Fire Ins. Co., 215 F.3d 516, 521 n. 4 (5th Cir. 2000) ("When an administrator has discretionary authority with respect to the decision at issue, the standard of review should be one of abuse of discretion."); Meditrust, 168 F.3d at 213 ("If the language of the plan grants such discretion, a court will reverse an administrator's decision only for an abuse of discretion."). The Kroger Plan provides:

In carrying out their respective responsibilities under the Plan, the Plan administrator and other Plan fiduciaries shall have discretionary authority to interpret the terms of the Plan and to determine eligibility for and entitlement to Plan benefits in accordance with the terms of the Plan. Any interpretation or determination made pursuant to such discretionary authority shall be given full force and effect, unless it can be shown that the interpretation or determination was arbitrary and capricious.

(App. at 79).

Kroger is the Plan administrator; therefore, this provision affords MetLife discretionary authority to interpret the Plan only if MetLife is a Plan fiduciary. An ERISA fiduciary includes anyone who "has discretionary authority or discretionary responsibility in the administration of such plan." 29 U.S.C. § 1002(21)(A). MetLife, as claims administrator, has the authority under the Kroger Plan to review denials of claims: "In the event a claim has been denied in whole or in part, you or, if applicable, your beneficiary can request a review of your claim by MetLife." (App. at 78). Therefore, MetLife is a Plan fiduciary to whom the Kroger Plan affords discretion to interpret the Plan. See Pacificare Inc. v. Martin, 34 F.3d 834, 837-38 (9th Cir. 1994) (holding that an insurer of a plan was a fiduciary of the plan because it had the discretion to approve or deny claims).

The parties agree that MetLife's interpretations of the Kroger Plan should be reviewed for an abuse of discretion. (Defs.' Br. in support of Motion at 9; Pl.'s Resp. Br. at 10).

Reviewing MetLife's interpretations of the Kroger Plan for an abuse of discretion, the Court will first determine whether MetLife's interpretation of the Kroger Plan is legally correct. Schadler, 147 F.3d at 394 n. 5. If not, the Court will determine whether MetLife's interpretation was an abuse of discretion. Id. While engaging in this review, the Court may consider limited evidence outside the administrative record. Id. at 394. For example, if proffered in a given case, the Court may consider evidence about whether the administrator's interpretations of plan provisions have been consistent. Id. at 394 n. 6.

The Court has deferred ruling on Plaintiff's April 19, 2004 Motion for Leave of Court to Supplement Administrative Record to the extent Plaintiff asks the Court to consider the supplemental documents when analyzing whether MetLife abused its discretion in interpreting the Kroger Plan. ( See the Court's May 7, 2004 Order). Upon reviewing the supplemental documents, the Court concludes that they are not properly considered by the Court while reviewing MetLife's interpretations of the Kroger Plan. Therefore, to the extent the Court has not already denied Plaintiff's Motion for Leave of Court to Supplement Administrative Record, the Court hereby denies Plaintiff's Motion.

Finally, the Court recognizes that MetLife, in the dual role of insurer of the Kroger Plan and as fiduciary responsible for reviewing the denial of claims, is operating under an inherent conflict of interest. Therefore, when reviewing MetLife's factual determinations and interpretations of the Kroger Plan for an abuse of discretion, the Court will apply the "sliding scale" standard and afford MetLife less deference in proportion to MetLife's apparent conflict. Estate of Bratton, 215 F.3d at 521 n. 4.

2. Review of MetLife's Reason for Denying Plaintiff's Claim

MetLife made the factual determination that Plaintiff was not actively at work when she enrolled in the dependent life benefits or at any time prior to her July 5, 2002 termination. Then, based on MetLife's interpretation of the Kroger Plan, MetLife concluded that Plaintiff's Dependent Benefits never became effective and thus Plaintiff's claim should be denied. The Kroger Plan provides the following Effective Date for Dependent Benefits:

[Y]our Dependent Benefits will become effective on the latest of:
1. the first day of the month following your Dependent Benefits Eligibility Date;

2. the effective date of your Personal Benefits; and

3. the date of your request.

(App. at 49).

The Kroger Plan provides the following Effective Date for Plaintiff's Personal Benefits:

Your Personal Benefits will become effective on the first day of the month following your Personal Benefits Eligibility Date provided you are then Actively at Work as an Employee. If you are not then Actively at Work as an Employee, your Personal Benefits will become effective on the date of your return to Active Work as an Employee. (App. at 47).

The Kroger Plan defines "Actively at Work" or "Active Work" as:

[Y]ou are performing all of the material duties of your job with the Employer where these duties are normally carried out. If you were Actively at Work on your last scheduled working day, you will be deemed Actively at Work:

1. on a scheduled non-working day;

2. provided you are not disabled.

(App. at 43).

The parties agree that Plaintiff was not actively at work when she enrolled in the dependent life insurance or at any time prior to her termination on July 5, 2002. Therefore, the Court will analyze whether, based on this factual determination, MetLife properly interpreted the Kroger Plan as barring Plaintiff's claim.

The Court finds that MetLife's interpretation of the aforementioned provisions of the Kroger Plan was legally correct and therefore not an abuse of discretion. Since Plaintiff was not actively at work at the time of enrollment, her Personal Benefits were slated to become effective on the date of her return to active work as an employee. Since Plaintiff never returned to active work as an employee, her Personal Benefits never became effective. Finally, since her Personal Benefits never became effective, her Dependent Benefits never became effective.

3. Plaintiff's Argument

Plaintiff argues that, notwithstanding the aforementioned provisions of the Kroger Plan, Plaintiff is entitled to dependent life benefits pursuant to the "Conditions Under Which Your Active Work is Deemed to Continue" provision ("deeming provision") and the "Right to Obtain a Personal Policy of Life Insurance on the Life of a Dependent" provision ("continuation coverage provision"). Plaintiff argues that, pursuant to the deeming provision, Mrs. Cooksey was deemed by Kroger to be actively at work during her leave of absence, so her dependent life benefits were in effect through her termination on July 5, 2002. Then, because Mr. Cooksey died within 31 days of the last day that the dependent life benefits were in effect, the dependent life benefits should be paid under the continuation coverage provision. MetLife contends that the deeming provision is irrelevant because it would only allow for the continuation of a benefit, not for the election of a new benefit. (Defs.' Reply at 4). MetLife further contends that the continuation coverage provision is inapplicable because there is no evidence in the administrative record that Mr. Cooksey made an application to convert his dependent life coverage. (Defs.' Reply at 4).

The deeming provision states:

If you are not Actively at Work as an Employee because of a situation set forth below, the Employer may deem you to be in Active Work as an Employee only for the purpose of continuing your employment and only for the periods specified below in order that certain of your benefits under This Plan may be continued.

All such benefits will end on:

1. the date the Employer notifies us that your benefits are not to be continued; or
2. the end of the last period for which the Employer has paid premiums to us for your benefits.
Your Sickness or Injury, Your Leave of Absence, Your Lay Off
With respect to all Personal Benefits and all Dependent Benefits, the period determined in accordance with the Employer's general practice for an Employee in your job class.
However, in the event the leave qualifies under the Family and Medical Leave Act of 1993 (FMLA), the period cannot be longer than 12 weeks in any 12 month period following the date the leave of absence begins. (App. at 74) (underlining added for emphasis).

MetLife interpreted the deeming provision as allowing Kroger to deem Plaintiff to be actively at work only for the purpose of continuing a benefit, not for the purpose of starting a benefit. In light of the recent Fifth Circuit decision of Baker v. Metropolitan Life Insurance Co., the Court finds that MetLife's interpretation of the deeming provision was legally correct and thus not an abuse of discretion. Baker v. Metro. Life Ins. Co., 364 F.3d 624 (5th Cir. 2004). In Baker, the Fifth Circuit addressed whether an employee could increase his life insurance benefits while he was deemed actively at work. Interpreting an identical "deemed to be actively at work" provision to the one in the Kroger Policy, the Fifth Circuit concluded: "[T]his provision does not allow Burlington to deem Baker to be active for the purpose of increasing his benefits under the Plan." Baker v. Metro. Life Ins. Co., 364 F.3d at 628.

Under this interpretation of the deeming provision, MetLife concluded that, even if Kroger had attempted to deem Plaintiff as actively at work during her leave of absence, Plaintiff would not be entitled to recover any dependent life benefits. In order to reach this conclusion, MetLife found that Plaintiff was not enrolled in dependent life benefits in 2001, which presumably could have been continued under the deeming provision. The record does not contain any evidence that Plaintiff was enrolled in dependent life benefits in 2001. Although the administrative record includes Confirmation Statements detailing Plaintiff's benefits for the enrollment dates 08/01/2002 — 12/31/2002 (App. at 17), 02/07/2002 — 07/31/2002 (App. at 18), and 01/01/2002 — 02/06/2002 (App. at 19), the administrative record does not include a Confirmation Statement for 2001. If Plaintiff wished to contend that dependent life benefits were continued throughout her leave of absence pursuant to the deeming provision, Plaintiff should have, prior to filing suit, submitted evidence of her 2001 dependent life benefits for inclusion in the administrative record. See Vega v. Nat'l Life Ins. Sers., 188 F.3d 287, 300 (5th Cir. 1999) ("Before filing suit, the claimant's lawyer can add additional evidence to the administrative record simply by submitting it to the administrator in a manner that gives the administrator a fair opportunity to consider it."); Audino v. Raytheon Co. Short Term Disability Plan, No. Civ. A. 3:03-CV-0777-N, 2004 WL 1152028, at * (N.D. Tex. May 21, 2004) (Godbey, J.) ("Under ERISA, Audino [the plaintiff] bears the burden of submitting evidence that supports her claim for benefits under the Plan."). Therefore, the Court finds that MetLife did not abuse its discretion in finding that Plaintiff was not enrolled in dependent life benefits in 2001.

The Court notes that, even if the documents attached to Plaintiff's Motion for Leave of Court to Supplement the Administrative Record had been properly submitted to MetLife prior to Plaintiff's filing suit and were thus properly part of the administrative record, those documents would serve only to buttress MetLife's factual determination that Plaintiff was not enrolled in dependent life benefits in 2001. The Kroger Benefits brochure identifies dependent life insurance as a "new" offering. (App. to Pl.'s Resp. at 81).

Because MetLife did not abuse its discretion in interpreting the deeming provision as only applying to the continuation of benefits, and because MetLife did not abuse its discretion in determining that Plaintiff was not enrolled in dependent life benefits in 2001, MetLife did not abuse its discretion in finding that the deeming provision is irrelevant to whether Plaintiff's claim for dependent life benefits should be granted. In light of this finding, the Court further finds that MetLife did not abuse its discretion in finding that the continuation coverage provision is irrelevant. The continuation coverage provision states:

A. Application

We will issue a personal policy of life insurance without disability or accidental death benefits to a Dependent if that Dependent applies for it in writing during the Application Period. The Application Period is the 31 day period after the date the Life Benefits on that Dependent end because:
1. your employment ends or you are no longer in a class which remains eligible for Dependent Life Benefits; or

. . .

C. If the Dependent Dies During the Application Period
If the Dependent dies during the Application Period, we will pay a death benefit. The payment of the death benefit will be in the same manner as if the Life Benefits on that Dependent had been in effect on the date of that Dependent's death. The amount of the death benefit will be the highest amount of life insurance, pursuant to item B(4) or B(5) for which a personal policy could have been issued. This death benefit will be paid even if the Dependent did not apply for a personal policy.

(App. at 60-61).

If Plaintiff had been enrolled in dependent life benefits in 2001 and those benefits had been continued through her termination date of July 5, 2002 pursuant to the deeming provision, the "If the Dependent Dies During the Application Period" portion of the continuation coverage provision would arguably have entitled Plaintiff to recover her dependent life benefits because Mr. Cooksey died within 31 days after Plaintiff's termination, regardless of whether Mr. Cooksey made an application to convert his dependent life coverage. However, because MetLife determined that Plaintiff was not enrolled in dependent life benefits in 2001 that were subject to continuation under the deeming provision, the continuation coverage provision would only provide Plaintiff with dependent life benefits for Mr. Cooksey's death if Mr. Cooksey had converted his dependent life coverage. Because there is no evidence in the administrative record that Mr. Cooksey applied to convert his dependent life coverage, MetLife did not abuse its discretion in finding that Plaintiff was not entitled to dependent life benefits under the continuation coverage provision.

Plaintiff further argues that Defendants should be estopped from denying Plaintiff's claim on the basis that she was not actively at work. Plaintiff asserts that her estoppel claim is supported by her receipt of the Kroger Benefits brochure that does not reference the "active" requirement, her allegation that she never received a copy of the Kroger Plan, and her alleged November 2001 telephone conversation with two MetLife representatives who assured her that her life insurance coverage would continue. The Court denies Plaintiff's estoppel claim because Plaintiff has not pled a claim for estoppel. On May 7, 2004, the Court denied Plaintiff's Motion for Leave of Court to File Plaintiff's First Amended Complaint to add an estoppel claim because it was untimely under the Court's Scheduling Order and because Plaintiff did not show "good cause" under Federal Rule of Civil Procedure 16(b) for the modification of the Scheduling Order. The Court further notes that, even if Plaintiff had properly asserted a claim for estoppel, summary judgment on that claim would nonetheless be appropriate. Assuming that a claim for equitable estoppel is cognizable under ERISA, Plaintiff has failed to show a material misrepresentation or reasonable reliance thereon. See Weir v. Fed. Asset Disposition Ass'n, 123 F.3d 281, 290 (5th Cir. 1997) (expressing doubt about whether a claim for estoppel is cognizable under ERISA and explaining that, if such an action is cognizable, an ERISA beneficiary must establish "a material misrepresentation, reasonable and detrimental reliance upon the representation, and extraordinary circumstances"). First, as the Court noted earlier in this Order, the Kroger Benefits brochure does not conflict with the Kroger Policy or contain any misrepresentations. Second, relying on the Kroger Benefits brochure to explain entitlement to benefits would be wholly unreasonable because the brochure purports only to explain an employee's enrollment options and does not contain any details about entitlement to benefits. Even if Plaintiff did not receive a copy of the Kroger Policy, her reliance on the Kroger Benefits brochure to explain her entitlement to benefits would be unreasonable in light of the brochure's explicit reference to "formal plan documents." Third, even if the MetLife employees misrepresented that Plaintiff's life insurance benefits were effective, an ERISA equitable estoppel cause of action cannot be premised on oral communications. See Weir, 123 F.3d at 289 ("An estoppel cause of action is not cognizable under ERISA in suits seeking to enforce rights to benefits based on purported oral modifications of plan terms.").

III. CONCLUSION

Therefore, the Court grants Defendants' Motion for Summary Judgment. This case is removed from the trial calendar. The Court will enter a Final Judgment for Defendants simultaneously with the entry of this Order.

SO ORDERED.


Summaries of

Cooksey v. Metropolitan Life Insurance Company

United States District Court, N.D. Texas, Dallas Division
Jun 17, 2004
No. 3:02-CV-2583-M (N.D. Tex. Jun. 17, 2004)

holding plaintiff's employer was not a proper defendant under ERISA

Summary of this case from Greenbaum v. Sedgwick Claims Mgmt. Servs., Inc.

holding that § 502(B) provides sole remedy for claim for continuation coverage of ERISA plan

Summary of this case from Schimek v. United Healthcare Group

dismissing an entity under § 1132(B) because it was not responsible for paying benefits under the terms of the plan

Summary of this case from Bernstein v. Citigroup Inc.
Case details for

Cooksey v. Metropolitan Life Insurance Company

Case Details

Full title:JONLEN COOKSEY, Individually and as Representative or Executrix of the…

Court:United States District Court, N.D. Texas, Dallas Division

Date published: Jun 17, 2004

Citations

No. 3:02-CV-2583-M (N.D. Tex. Jun. 17, 2004)

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