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Wiley v. The Prudential Insurance Co. of America

United States District Court, District of Columbia

August 24, 2016

Jeralyn Wiley, Plaintiff,
The Prudential Insurance Company of America, et al., Defendants.


          Amit P. Mehta United States District Judge.


         In May 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.

         Defendants 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.


         Plaintiff 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. ¶ 8.

         Plaintiff 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.[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.

         By 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. Id.

         Three 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.” Id.

         Several 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.

         On 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 submitted”).

         As 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. at 18-19.

         Prudential-unasked-twice 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.

         On 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.

         Elkind, 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 ...

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