United States District Court, District of Columbia
MEMORANDUM OPINION AND ORDER
P. Mehta United States District Judge.
2015, Plaintiff Jeralyn Wiley, who was then an employee of
Defendant Ernst & Young U.S. LLP, applied for short-term
and long-term disability benefits under her employer's
disability plans. Defendant Prudential Insurance Company of
America, the claims administrator, approved Plaintiff's
application for short-term disability benefits, but only
through June 9, 2015. Six months later, on December 14, 2015,
Plaintiff timely filed an appeal of Prudential's
decision. Instead of processing the appeal, however,
Prudential repeatedly set new deadlines-each time on its own
initiative-giving Plaintiff extra time in which to submit
additional documents to support her appeal. When Prudential
still had not ruled on her appeal as of late February 2016,
Plaintiff filed suit against Prudential, alleging a violation
of the Employee Retirement Insurance Security Act (ERISA), 29
U.S.C. §§ 1001 et seq.
have moved to dismiss this action on the ground that
Plaintiff failed to exhaust her administrative remedies
before filing suit. Specifically, Defendants argue that
because Prudential has not yet ruled on Plaintiff's
appeal, Plaintiff filed this action prematurely. The court,
however, does not agree. Prudential granted itself extensions
of time that neither were requested by Plaintiff nor
permitted under the applicable ERISA regulations. As a
result, Prudential did not timely rule on Plaintiff's
appeal. The court therefore finds that Plaintiff's ERISA
claim has been exhausted and that her suit is properly before
this court. Accordingly, the court denies Defendants'
Motion to Dismiss.
Jeralyn Wiley formerly worked at Defendant Ernst & Young
U.S. LLP. Compl., ECF No. 1, ¶ 13. During her time
there, Ernst & Young sponsored both short-term disability
and long-term disability plans (collectively,
“Plans”) for its employees. Id.
¶¶ 6-11; see generally Defs.'
Statement of P. & A. in Supp. of their Mot. to Dismiss,
ECF No. 7-1 [hereinafter Defs.' Mot.], Ex. A, ECF No. 7-3
[hereinafter Ex. A]; see generally Defs.' Mot.,
Ex. B, ECF No. 7-4 [hereinafter Ex. B]. Defendant Prudential
Insurance Company of America was the claims administrator for
both Plans. Compl. ¶¶ 7-8; see generally
Exs. A-B. As such, it had the authority to determine an
employee's eligibility for disability benefits. Compl.
was a participant under both Plans. Id. ¶ 6;
Defs.' Mot. at 5. She suffers from a series of
conditions, including, but not limited to, fibromyalgia, limb
paresthesia, and myositis. Compl. ¶ 12; Defs.' Mot.
at 5. In May 2015, Plaintiff applied for short-term
disability benefits. Defs.' Mot., Ex. C, ECF No. 7-5
[hereinafter Ex. C], at 1. On June 17, 2015, Prudential
retroactively approved Plaintiff for benefits through June 9,
2015, but denied her any benefits beyond that date.
Id. Prudential further informed Plaintiff that she
had 180 days from her receipt of the denial letter to file an
appeal. Id. at 2.
letter dated June 26, 2015, Plaintiff asked Prudential to
“review” the “denial of [her] claim for
ongoing benefits.” Id. at 4. “However,
” she added, “I request that [Prudential] not
complete its review of this denial until such time as I have
been afforded the opportunity to supplement the
record.” Id. She asked Prudential to
“advise [me] of the last date by which [Prudential]
will accept additional materials prior to commencing its
review of my claim, ” but stated that, “[w]hile I
fully intend to supplement my record on appeal, if you have
not received additional materials by such date, please
proceed to complete your review.” Id.
Plaintiff further requested that Prudential disclose to her a
host of documents relevant to her benefits determination.
weeks later, on July 17, 2015, Prudential responded to
Plaintiff: “Your letter indicates that the appeal is
not complete at this time and that you intend on submitting
additional documentation for our evaluation of your appeal.
As such, we have not initiated our appeal review at this
time.” Id. at 7. Prudential advised Plaintiff
that her “complete appeal must be received by
Prudential no later than December 14, 2015.”
months later, Plaintiff retained Scott B. Elkind as her
counsel. Comp. ¶ 17. On November 17, 2015, Elkind wrote
to Prudential requesting certain documents relating to
Prudential's benefits determination, including the claim
file. Ex. C at 10-11. He also requested a minimum 60-day
extension of time, starting from the date he received the
claim file, in which to review the documents and then
supplement Plaintiff's appeal. Id. at 12.
December 1, 2015, Prudential denied Elkind's requested
extension. Id. at 15. It advised Elkind: “The
information in [the] file indicates that the 180 day appeal
timeframe expires on or about December 14, 2015. As a result,
[Plaintiff's] complete appeal submission must be received
by that date. We will proceed with our review of the appeal
at that time based on the information that has been
submitted.” Id.; see also Id. at
13-14 (letter from Prudential to Elkind dated November 23,
2015, identifying December 14, 2015, as the deadline and the
date by which Prudential would proceed with its “review
of the appeal . . . based on the information that has been
Prudential had directed, on December 14, 2015, Elkind timely
submitted certain- concededly not all-documents in support of
his client's appeal. Compl. ¶ 18 (stating that
Plaintiff's appeal included “additional medical,
functional and vocational evidence, but lacked certain
materials due to the hard deadline Prudential gave
Plaintiff”); Pl.'s Opp'n to Defs.' Mot. to
Dismiss, ECF No. 8 [hereinafter Pl.'s Opp'n], Ex. 1,
ECF No. 8-1 [hereinafter Ex. 1], at 4 (letter showing that
Elkind submitted nearly 300 documents on Plaintiff's
behalf). Several days later, on December 17, 2015, Prudential
informed Elkind that it would not review Plaintiff's
appeal until December 28, 2015, because it had not previously
calculated into the deadline a 14-day grace period allowed
for mailing delays. Ex. C at 16. Elkind immediately
questioned Prudential's two-week delay in commencing its
review of Plaintiff's appeal. See Id. at 17. He
nevertheless submitted additional documents on December 18,
2015, and stated that he would provide Prudential “with
documents as they are received by [me].” Id.
more extended the time in which Plaintiff could submit
additional records in support of her appeal. On December 29,
2015, Prudential told Elkind: “You have reported you
will be submitting additional information in support of Ms.
Wiley's appeal. Please ensure this information is
provided to us within 45 days or by February 10, 2016.”
Id. at 21. Elkind continued to provide additional
materials through February 2, 2016. Id. at 23,
26-31. He also continued to object to Prudential's delay
in commencing review of Plaintiff's application.
Id. at 24, 33.
February 10, 2016, Prudential again informed Elkind that it
was extending Plaintiff's deadline “to remit
additional required information”-though the letter did
not provide further specifics-by an additional 45 days, to
March 26, 2016. Id. at 32. Prudential told Elkind
that “[a]ll time frames for the review of Ms.
Wiley's claim will be tolled until the earlier of the
receipt of the additional information or the end of the
additional 45 day period allowed for you to supply such
information. At the time we resume our review, an extension
of up to 45 days will be taken to complete our appeal review
of Ms. Wiley's claim.” Id.
that same day, objected to Prudential's 45-day extension.
Id. at 33. He wrote: “The appeal in this case
was filed on 12/14/15. Your request is beyond the 45 day
deadline permitted under ERISA for such a request.”
Id. On February ...