Willitts v. Life Ins. Co. of N. Am.

JAMES ALLAN WILLITTS, SR., Plaintiff, v. LIFE INSURANCE COMPANY OF NORTH AMERICA,GDF SUEZ ENERGY NORTH AMERICA INC./ENGIE NORTH AMERICA, INC. Defendants.

Civil Action No. 1:18-cv-11908-ADB

UNITED STATES DISTRICT COURT DISTRICT OF MASSACHUSETTS

June 1, 2020

MEMORANDUM AND ORDER ON DEFENDANT'S MOTIONS FOR PARTIAL SUMMARY JUDGMENT

BURROUGHS, D.J.

Plaintiff James Willitts ("Willitts") filed this action against his former employer GDF Suez Energy North America Inc./Engie North America Inc. ("Engie") and the employee disability insurance company, Life Insurance Company of North America Inc. ("LINA" and, with Engie, the "Defendants"). [ECF No. 37]. Willitts claims that the Defendants failed to honor terms of his insurance benefits policy contract and that he was wrongfully terminated for exercising his right to enforce that policy. [Id. at 1].

Currently pending before the Court are Defendants' motions for partial summary judgment.¹ [ECF Nos. 47, 49]. For the reasons set forth below, the motions, [ECF Nos. 47, 49], are GRANTED.

I. BACKGROUND

A. Procedural Background

This case arises from three separate complaints filed by Willitts in the fall of 2018. The Court consolidated two of those cases, 18-cv-11906 and 18-cv-12252, in 18-cv-11906. See Willitts v. Engie, No. 18-cv-11906, [ECF Nos. 25, 26] (D. Mass. May 13, 2019). In that consolidated case, Willitts claimed that his employer, Engie, retaliated against him for taking medical leave by terminating his employment and telling other power generation companies not to hire him. See Willitts v. Engie, No. 18-cv-11906, [ECF No. 1] (D. Mass. Sept. 7, 2018); Willitts v. Engie, No. 18-cv-12252, [ECF No. 1] (D. Mass. Oct. 26, 2018). In the third case, 18-cv-11908, Willitts brought an ERISA claim, alleging that the Defendants denied his request to extend his short-term disability benefits beyond September 29, 2016, without conducting a full investigation into the merits of his claims. [ECF No. 1].

The Court appointed counsel in both 18-cv-11906 and 18-cv-11908. See Willitts v. Engie, No. 18-cv-11906, [ECF No. 24] (D. Mass. May 13, 2019); Willitts v. Life Ins. Co. of N.A., et al., No. 18-cv-11908, [ECF No. 33] (D. Mass. May 13, 2019). The Court then amended the scheduling order in 18-cv-11906, the non-ERISA case, so that counsel could file an amended complaint, Willitts v. Engie, No. 18-cv-11906, [ECF No. 25] (D. Mass. May 13, 2019), but did not amend the schedule in 18-cv-11908, the ERISA case.

On September 12, 2019, Willitts filed an amended complaint in 18-cv-11908, instead of 18-cv-11906 as the Court had directed. See Willitts v. CIGNA, et al., No. 18-cv-11908, [ECF Nos. 37, 38, 39] (D. Mass. Sept. 12, 2019). The Court granted Defendants' motion to strike the amended complaint in 18-cv-11908 and ordered Willitts to seek leave from the Court to file anamended complaint in 18-cv-11906, as the amended complaint filed in 18-cv-11908 would have been untimely under operative scheduling order in 18-cv-11906. [ECF No. 45]. On November 5, 2019, Willitts filed a motion asking that the Court reconsider its order and consolidate the non-ERISA case (18-cv-11906), with the ERISA case (18-cv-11908). [ECF No. 46]. The Defendants opposed. [ECF No. 53]. On November 15, 2019, before the Court ruled on that motion, the Defendants filed the instant motions for summary judgment, [ECF Nos. 47, 49], in accordance with the Court's scheduling order, [ECF No. 34]. Willitts opposed, [ECF Nos. 54, 55, 56, 57] and the Defendants filed a joint reply, [ECF No. 58].

On February 27, 2020, the Court held a status conference, [ECF No. 60], and granted the motion for reconsideration in part by consolidating the cases, [ECF No. 62]. With the agreement of the parties, the Court determined that Plaintiff's amended complaint, [ECF Nos. 37, 38, 39], would act as the operative complaint in the consolidated case. This operative complaint brings claims for breach of contract (Count I), breach of the implied covenant of good faith and fair dealing (Count II), ERISA under 29 U.S.C. § 1132 (Count III), breach of fiduciary duty as against LINA (Count IV), fraud and fraudulent inducement (Count V), intentional infliction of emotional distress (Count VI), unjust enrichment (Count VII), violation of the Massachusetts Consumer Protection Act (Count VIII), and wrongful termination/retaliation against Engie (Count IX). Also during this status conference, the Court and parties agreed that the Court would consider the pending motions for summary judgment as partial motions for summary judgment on Willitts' ERISA claim and potentially preempted state-law claims.

B. Factual Background

The following facts are based on the administrative record or are not in dispute for the purposes of summary judgment relative to the ERISA claim and related state-law claims.Willitts began working at Engie in April 2014. [ECF No. 55 at 2; ECF No. 58 at 2]. Engie sponsors a short-term disability plan, which is administered by LINA pursuant to a Claims Consulting Agreement. [ECF No. 36 at 388-400]. The short-term disability plan defines an employee as disabled if "because of a covered Injury or Sickness, [the employee is]: 1. Unable to perform all of the material duties of [his] Regular Occupation; and 2. Unable to earn 80% or more of [his] Indexed Earnings from working in [his] Regular Occupation." [ECF No. 37 ¶ 11; ECF No. 36 at 374]. The plan defines "Regular Occupation" as "[t]he occupation [the claimant] routinely perform[ed] at the time the Disability beg[an]. In evaluating Disability, the Plan will consider the duties of the occupation as it is normally performed in the general labor market in the national economy. It is not work tasks that are performed for a specific employer or at a specific location." [ECF No. 36 at 384].

On September 12, 2016, Willitts' counselor, who had been treating Willitts for depression and anxiety since 2010, requested that his primary care physician help him complete FMLA paperwork. [Id. at 79]. On that same day, Willitts applied for short-term disability benefits based on his anxiety. [Id. at 3]. Willitts never submitted a claim for long-term disability benefits. See generally [ECF No. 37].²

Willitts' primary care physician prescribed him medications to help with his anxiety symptoms on September 13, 2016. [ECF No. 36 at 75]. About a week later, Willitts reported that he was "feeling better" and that his "mood ha[d] improved tremendously." [Id. at 74]. Again, on October 24, 2016, his primary care physician noted that Willitts was "doing well from the . . . medications." [Id. at 70].

On October 28, 2016, LINA approved benefits through September 29, 2016, but determined that Willitts was not entitled to benefits beyond that date. [Id. at 81]. LINA continued to monitor Willitts' claim and requested additional medical records by November 11, 2016. [Id.].

In response to LINA's request for additional records, Willitts' primary care physician noted that Willitts had not visited him since the October 24, 2016 visit, when he was reporting improvement. [Id. at 97, 111]. On November 23, 2016, Willitts' new counselor wrote to his primary care physician and reported that Willitts' "symptoms of anxiety and depression [had] diminished, but it [wa]s apparent that when he consider[ed] he [wa]s to return to work these symptoms [were] exacerbate[d]." [Id. at 117]. His counselor recommended that he "continue his medical leave from work until after January 1^st, allowing him to adjust to returning to [a] hostile work environment by a reasonable person's standards." [Id.]. Additionally, Willitts' attorney submitted a questionnaire completed by his counselor in which the counselor explained that Willitts was unable to return to work "as a result of workplace hostility . . . ." [Id. at 125].

On February 21, 2017, LINA informed Willitts that it had reviewed the information he provided and had determined that he was not eligible for benefits beyond September 29, 2016. [Id. at 126-28]. LINA explained that it had "not received office visit notes, no specific dates oftreatment, no description or defined level of severity, frequency of symptoms or impairments or any information to support an inability to perform [his] occupation." [Id.].

In May 2017, Willitts submitted additional information to LINA including a behavioral health questionnaire and a medical request form. [Id. at 156-60]. He also submitted treatment notes from his counselor for September 2016 until April 2017. [Id. at 136-51]. LINA reviewed these records and, on June 26, 2017, informed Willitts that its determination had not changed. [Id. at 174-75].

Willitts appealed the decision on July 27, 2017. [Id. at 177]. On August 29, 2017, LINA sent a letter to Willitts to confirm that, as represented by Willitts' attorney, all additional records for consideration on appeal had been submitted. [Id. at 197-98]. LINA referred the appeal to a Behavioral Medicine Specialist (the "Specialist") and provided all the medical records it had received, including the additional information Willitts had provided in May. [Id. at 199-201]. The Specialist determined that Willitts was not disabled under the meaning of the short-term disability benefits plan. [Id.]. He explained that "[t]he treating provider's opinion is not well supported by medically acceptable clinical diagnostic techniques including mental status examinations, psychological and/or neuropsychological testing and is inconsistent with the other substantial evidence in the claim file," [id. at 199], and concluded that "there is no documentation of work tasks or activities that [Willitts] is actually unable to perform, or documentation of performance deficits at work," [id. at 200]. The Specialist noted that Willitts had expressed an interest in interviewing with different companies and found that "[t]he fact that he [wa]s seeking alternative employment [wa]s prima facie evidence that impairments and limitations do not preclude him from...