Candelario v. Metro. Life Ins. Co.

861 F.Supp.2d 23

Luis CANDELARIO, Plaintiff,

v.METROPOLITAN LIFE INSURANCE COMPANY (METLIFE), Wyeth Pharmaceuticals Company, Defendants.

Civ. No. 10–1463(PG).

United States District Court, D. Puerto Rico.

May 22, 2012.

Pedro J. Landrau–Lopez, San Juan, PR, for Plaintiff.

Frank Gotay–Barquet, Gotay & Perez, P.S.C., San Juan, PR, for Defendants.

OPINION AND ORDER

JUAN M. PEREZ–GIMENEZ, Senior District Judge.

Defendants Metropolitan Life Insurance Company (“MetLife”) and Wyeth Pharmaceutical Company (“Wyeth”) seek reconsideration from the Court's previous Opinion and Order (Docket No. 26) denying their motion for summary judgment (Docket No. 13). In their motion for reconsideration (Docket No. 27), Defendants aver the Court committed three distinct manifest errors of law in determining that material issues of fact persisted which precluded dismissal of Plaintiff Luis Candelario's complaint on period of limitations grounds. Namely, Defendants argue the Court stumbled in determining that: (1) an explanation surrounding how final eligibility determinations for plan benefits was needed; (2) Defendants were the plan administrators and breached regulatory disclosure requirements; and (3) that Plaintiff had made a prima facie showing of “equitable estoppel.” The Court will DENY the motion as to points one and two, but for the following reasons, will GRANT the motion as to point three. After careful deliberation, the Court ultimately determines that Plaintiff's suit is time-barred and that summary judgment should be granted in Defendants' favor.

I. BACKGROUND

The Court recounts the following factual narrative which it has gathered from the parties' filings and the record as a whole. These facts are the ones the Court deems relevant for the purposes of resolving Defendants' motion for reconsideration.

Plaintiff was an employee of Wyeth. Said company maintained an employee welfare plan for its employees that is regulated by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et seq. This plan provides for the payment of LTD benefits to participants who become disabled, as that term is defined by the plan, and meet all other requirements. LTD benefits are provided through a group insurance policy issued by MetLife. Plaintiff alleges that on February of 1999, he suffered an accident that physically and mentally incapacitated him. Around that time, Plaintiff requested LTD benefits under the group policy.¹ On September 27, 2000 MetLife issued a decision denying coverage to Plaintiff under the terms of the plan. Plaintiff apparently appealed this decision on November 17, 2000 but MetLife decided to uphold it, notifying Plaintiff via letter dated January 16, 2001. Plaintiff contends that this decision was “arbitrary, unfounded, and in violation of the terms of the policy and the law.” ( Compl. ¶ 10). The letter failed to apprise Plaintiff of his right to seek judicial review of MetLife's decision.

Nearly nine years later, around November of 2009, Plaintiff wrote a letter to MetLife's offices in San Juan and Oriskany, New York seeking to obtain a copy of his LTD benefits claim before MetLife. On November 5, 2009 Plaintiff received a response from Ms. Laura D. Smith, an “LTD Unit Leader” at MetLife Disability, who informed Plaintiff that his claim was closed in 1999 and that the period of retention for said claim had been exhausted. As such, Smith informed Plaintiff that his claim file had been destroyed and that it was now impossible for MetLife to provide him with a copy of it.

On May 27, 2010, Plaintiff filed the instant action under ERISA § 502(a)(1)(B) seeking to recover the LTD benefits he claims he was due under the group policy. (Docket No. 1). On August 31, 2010 Defendants filed a motion for summary judgment positing that said policy has a three-year contractual limitations period for legal actions to recover LTD benefits and that the limitations period commenced on January 1, 2000 and concluded on January 1, 2003. (Docket No. 13). Plaintiff opposed the motion and retorted that Defendants never provided him with a copy of the plan, the Summary Plan Description (SPD), or any other document regarding his rights, appeal procedures and/or time limitation periods under the plan. (Docket No. 14). As such, Plaintiff argued Defendants should be equitably estopped from relying on the contractual limitations period as a defense or in the alternative, that the contractual limitations period should be tolled due to Defendants' failure to furnish him with the required disclosures.² In its Opinion and Order the Court denied Defendants' motion for summary judgment, ruling that Plaintiff had made a prima facie showing of equitable estoppel. (Docket No. 26).

Defendants timely filed a motion for reconsideration, arguing the Court erred in determining that: (1) an explanation surrounding how final eligibility determinations for plan benefits was needed; (2) Defendants were the plan administrators and breached regulatory disclosure requirements; and (3) that Plaintiff had made a prima facie showing of “equitable estoppel.” (Docket No. 27). Plaintiff opposed the motion (Docket No. 30) and also filed an informative motion containing the recent First Circuit opinion in Ortega Candelaria v. Orthobiologics LLC, 661 F.3d 675, 679 (1st Cir.2011)( Docket No. 31). Defendants filed a reply thereto. (Docket No. 37). After reviewing these submissions and the pertinent law, the Court will DENY the motion as to claims of error one and two, but will GRANT the same as to claim three. For the reasons that follow, and in light of the First Circuit's opinion in Ortega Candelaria, the Court will revisit its ruling determining that Plaintiff has advanced enough facts to make a prima facie showing of equitable estoppel or equitable tolling.

II. STANDARD OF REVIEW

Rule 59(e) of the Federal Rules of Civil Procedure preserves the district court's right to alter or amend a judgment after it is issued. Fed.R.Civ.P. 59(e). Motions to alter or amend an order or a judgment are appropriate where they involve reconsideration of matters properly encompassed in the decision on the merits. See White v. New Hampshire Department of Employment, 455 U.S. 445, 451, 102 S.Ct. 1162, 71 L.Ed.2d 325 (1982). The case law acknowledges the following four grounds that justify altering or amending an order or a judgment: (1) to incorporate an intervening change in law; (2) to reflect new evidence not available at the time of trial; (3) to correct a clear legal error; and (4) to prevent a manifest injustice. See Landrau–Romero v. Banco Popular De Puerto Rico, 212 F.3d 607 (1st Cir.2000); Zimmerman v. City of Oakland, 255 F.3d 734 (9th Cir.2001); and Servants of Paraclete v. Does, 204 F.3d 1005 (10th Cir.2000). Thus, for example, a Rule 59(e) motion is “appropriate where the court has misapprehended the facts, a party's position, or the controlling law.” Id. at 1012;See also Continental Casualty Co. v. Howard, 775 F.2d 876 (7th Cir.1985), cert. denied, 475 U.S. 1122, 106 S.Ct. 1641, 90 L.Ed.2d 186 (1986).

III. DISCUSSION

In his opposition to Defendants' motion for summary judgment as well as his opposition to Defendants' motion for reconsideration, Plaintiff interchangeably invokes the doctrines of equitable estoppel and equitable tolling against Defendants. He invariably suggests that the three-year period of limitations should not be enforced against him as Defendants failed to furnish him with any information reflecting his right to appeal the adverse determination taken against his LTD benefits claim in 2001. Defendants, on their part, argue that neither doctrine is applicable, and point to Plaintiff's failure to identify any definite misrepresentation on their part meant to entice him to miss the filing deadline. They also point to Plaintiff's lack of diligence in prosecuting his claims, as his lawsuit comes more than seven years after the contractual limitations period expired.

The Court will thus analyze the issues to determine whether Plaintiff is entitled to equitable estoppel or equitable tolling. Since the First Circuit has repeatedly noted that the doctrines of equitable estoppel and equitable tolling are distinct, albeit closely related, the Court will evaluate them separately. See Vistamar, Inc. v. Fagundo–Fagundo, 430 F.3d 66, 71 (1st Cir.2005); and Benítez–Pons v. Com. of Puerto Rico, 136 F.3d 54, 61 (1st Cir.1998).

A. Equitable Estoppel

A plaintiff who knows of his cause of action but reasonably relies on a defendant's conduct or statements in failing to bring suit may be entitled to equitable estoppel. Ramírez–Carlo v. United States, 496 F.3d 41, 48 (1st Cir.2007). In order to make a showing of equitable estoppel the party seeking the estoppel must establish that: (1) the party to be estopped made a “definite misrepresentation of fact to another person having reason to believe that the other [would] rely upon it”; (2) the party seeking estoppel relied on the misrepresentations to its detriment; and (3) the “reliance [was] reasonable in that the party claiming the estoppel did not know nor should it have known that its adversary's conduct was misleading.” Id. at 49 (citing Heckler v. Community Health Services, 467 U.S. 51, 59, 104 S.Ct. 2218, 81 L.Ed.2d 42 (1984)). A plaintiff must present evidence showing that the defendant had an “improper purpose” or “constructive knowledge of the deceptive nature of his conduct in the form of some definite, unequivocal behavior fairly calculated to mask the truth or to lull an unsuspecting person into a false sense of security.” Ortega Candelaria, 661 F.3d 675, 679 (1st Cir.2011)(citing Vera v. McHugh, 622 F.3d 17, 30 (1st Cir.2010))(internal quotations omitted).

In this case, nothing in the record supports the assertion that Defendants made a “definite misrepresentation of fact” or engaged in unequivocal, intentionally deceptive conduct aimed at dissuading Plaintiff from filing within the three-year...