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Valle v. Cigna Group Life Insurance/Life Insurance Company of North America


March 25, 2009


The opinion of the court was delivered by: William J. Martini Judge


Dear Counsel:

This matter comes before the Court on Defendant Life Insurance Company of North America's ("LINA")*fn1 motion to dismiss Plaintiff William Valle's complaint pursuant to Fed. R. Civ. P. 12(b)(6). There was no oral argument. Fed. R. Civ. P. 78. For the reasons stated below, Defendant's motion to dismiss is GRANTED.


Until July 7, 1992, Plaintiff William Valle was employed by the New Jersey-based Kessler Rehabilitation Institute ("Kessler"). As a benefit of his employment, Valle was covered under a group long-term disability policy issued by LINA. On the last day of his employment at Kessler, Valle filed a claim for disability benefits with LINA and "received for a time long term disability benefits as a New Jersey resident at a rate of $500.00 per month." Compl. ¶ 1.

On January 24, 2002, LINA terminated Valle's benefits, stating that "[c]ontinued requests for a physical assessment have not been provided and therefore it is reasonable to state there is no evidence of an impairment in functional status." Certification of E. Evans Wohlforth ("Wohlforth Cert.") Ex. D.*fn2 LINA reconfirmed its decision to terminate Valle's benefits in a letter dated March 6, 2002. See Wohlforth Cert. Ex. E. Valle then appealed the termination decision on April 3, 2002. See Certification of Steven F. Berardi ("Berardi Cert.") Ex. D. On June 27, 2002, LINA informed Valle that his appeal was still under review.*fn3 See Berardi Cert. Ex. E.

On October 22, 2004, Valle filed a complaint in the Superior Court of New Jersey demanding payment of his benefits, as well as punitive damages. This complaint was dismissed on May 21, 2005 by the New Jersey state court for lack of prosecution. See Berardi Cert. Ex. C. The notice of dismissal, however, was sent to the wrong law firm.*fn4

See id.

On August 7, 2008, Valle filed the instant complaint, which is virtually identical to his first, in the Superior Court of New Jersey. See Wohlforth Cert. Ex. B. LINA removed this complaint to this Court on September 4, 2008. LINA now brings a motion to dismiss the complaint pursuant to Fed. R. Civ. P. 12(b)(6).


Before the Court now is Defendant's motion to dismiss the August 7, 2008 complaint, which was properly removed from the Superior Court of New Jersey.

A. Motion to Dismiss Standard

When deciding a motion to dismiss under Fed. R. Civ. P. 12(b), all allegations in the complaint must be taken as true and viewed in the light most favorable to the plaintiff. See Warth v. Seldin, 422 U.S. 490, 501, 95 S.Ct. 2197, 45 L.Ed.2d 343 (1975); Trump Hotels & Casino Resorts, Inc., v. Mirage Resorts Inc., 140 F.3d 478, 483 (3d Cir.1998). If, after viewing the allegations in the complaint in the light most favorable to the plaintiff, it appears that no relief could be granted "under any set of facts that could be proved consistent with the allegations," a court may dismiss a complaint for failure to state a claim. Hishon v. King & Spalding, 467 U.S. 69, 73, 104 S.Ct. 2229, 81 L.Ed.2d 59 (1984).

B. Statute of Limitations

As noted above, Plaintiff Valle was covered by his former employer's group long-term disability policy, issued by LINA. Valle therefore received disability payments pursuant to terms of this policy. Under the terms of this policy, "[n]o action will be brought at all [under the policy] unless brought within 3 years ... after the time within which proof of loss is required by the policy." See Wohlforth Cert. Ex. C. In defining "proof of loss," the policy states that "[u]pon request, written proof of continued Disability and of regular attendance of physician must be given to the Insurance Company within 30 days of such request." Id.

Defendant represents that it demanded "proof of loss" -- here, evidence of Valle's continued disability -- on August 30, 2001. See Def.'s Br. in Supp. of Mot. to Dismiss at 5; see also Wohlforth Cert. Exs. D, E (January 24, 2002 and March 6, 2002 letters from LINA referencing the August 30, 2001 request). Using this August 30, 2001 date as the time at which "proof of loss" was requested, Plaintiff was required to demonstrate "proof of loss" within thirty days and then bring the instant complaint within three years, i.e. before September 30, 2004.*fn5 Instead, the instant complaint -- which is the only complaint before this Court -- was brought nearly seven years later on August 7, 2008. This complaint is clearly untimely under the policy.

Plaintiff attempts to get around this procedural bar by ignoring the complaint he filed in 2008 and arguing that his first state court complaint, filed in 2004, is still viable. Plaintiff contends that this 2004 complaint was dismissed improperly and that this 2004 complaint, if restored, provides a basis for recovery of his terminated benefits. See Pl.'s Br. 2.

While this argument may have some facial appeal, it overlooks one salient point -- the 2004 state court complaint was not removed. As such, this 2004 complaint is not before this Court.*fn6 Only one complaint is before the Court now, and the issue is whether this complaint, filed on August 7, 2008, is timely under the terms of the policy. As discussed supra, the complaint is not timely. Accordingly, Defendant's motion to dismiss is GRANTED.


For the foregoing reasons, Defendant's motion to dismiss is GRANTED. An order follows this Letter Opinion.


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