Constantini v. Hartford Life and Accident Insurance Company

Background

Nuky Constantini brought an action against Hartford Life and Accident Insurance Company seeking disability-income benefits under Section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 (ERISA). Constantini alleged that she became disabled after serious injuries in a January 2018 motor-vehicle accident and that Hartford improperly refused to pay benefits under an employee welfare-benefit plan covering employees of Allstate Insurance Company.

Constantini filed a long-term-disability benefits claim in April 2018. Hartford denied the claim in May 2018, stating that certain medical records had not been supplied for review. Constantini maintained that all necessary records had been provided and that her medical conditions qualified her for coverage. She filed the lawsuit in state court on July 21, 2021, and Hartford removed it to federal court on August 13, 2021.

Motion to Dismiss

Hartford moved to dismiss the First Amended Complaint under Federal Rule of Civil Procedure 12(b)(6), which allows dismissal when a complaint does not state a legally sufficient claim. Hartford argued that Constantini had failed to exhaust the plan’s administrative remedies before filing suit.

The plan required a participant to appeal a wholly or partly denied claim within 180 days and to complete that appeal process before bringing an action in court. Constantini did not dispute that the plan required exhaustion and conceded in her opposition memorandum that she had not appealed Hartford’s denial.

Although exhaustion is generally an affirmative defense, the court held that it could consider the defense on a motion to dismiss because Constantini admitted that she had not exhausted the available appeal process. The court also considered the plan and the denial letter because they were incorporated into, or integral to, the complaint.

Court’s Analysis

The court rejected Constantini’s argument that she was excused from exhausting the plan’s procedures because she did not receive a copy of the plan until after starting the lawsuit. The court stated that lack of awareness of claim procedures does not excuse the ERISA exhaustion requirement and found that the denial letter gave Constantini notice of the appeal requirement.

The court also rejected Constantini’s argument that the denial letter’s statement that she “may submit an appeal” did not make an appeal mandatory. Relying on prior decisions, the court held that this language was sufficient to establish an exhaustion requirement. The letter further stated that she would have the right to bring a civil action under ERISA if the claim decision were upheld on appeal.

Finally, the court rejected Constantini’s argument that pursuing an appeal would have been futile. The court explained that futility requires a clear and positive showing that the administrative process would not provide relief. Constantini’s assertion that the appeal would have been denied for the same reason as the initial claim was considered conclusory and insufficient.

Leave to Amend and Disposition

The court considered whether Constantini should be allowed to amend the complaint again. Because she admitted that she had not exhausted the administrative remedies and the time to do so had passed, the court concluded that any further amendment would be futile.

The court granted Hartford’s motion to dismiss. It directed the clerk to terminate all outstanding motions and close the case. The opinion does not state that the dismissal was with or without prejudice.