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Rizzo v. First Reliance Standard Life Insurance Co.

United States District Court, D. New Jersey

December 28, 2017

JODY RIZZO, Plaintiff,
v.
FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY, et al. Defendants.

          MEMORANDUM AND ORDER

          PETER G. SHERIDAN, U.S.D.J.

         This matter is before the Court on Defendant First Reliance's Motion to Dismiss Plaintiff Jody Rizzo's Complaint pursuant Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim upon which relief may be granted. (ECF No. 4). In her Complaint, Plaintiff alleges that First Reliance wrongfully denied her request for survivorship benefits under her deceased husband's insurance coverage policy.

         Background

         On January 10, 2017 Plaintiff initiated this lawsuit against Defendants First Reliance Standard Life Insurance Company (hereinafter, “First Reliance”) and Barnes and Noble, Inc. in the Superior Court of New Jersey, Ocean County. On February 3, 2017 First Reliance removed the matter to this Court based upon allegations concerning ERISA violations, and filed the present motion to dismiss.

         Plaintiff Jody Rizzo is a beneficiary of a life insurance policy issued to Angelo Rizzo, her deceased husband (hereinafter, “Decedent”), and a long term disability (LTD) policy written by First Reliance. Decedent was a manager of one of the Barnes & Noble stores and was a participant in his employer's welfare benefit plan, which included short and long term disability benefits, and Group Life benefits, all of which were insured by First Reliance. (Complaint [“Compl.”] at ¶ 8). In October 2010. Decedent purchased additional life insurance through the First Reliance, worth approximately $188, 000. (Id. at ¶ 11).

         From 2004 through 2012, Decedent suffered with cardiomyopathy, hypertension, edema, tachycardia and congestive heart failure (Id. at ¶ 13). On November 12, 2012, Decedent received medical treatment for various health conditions, such as, chest pain, shortness of breath, palpitations, dizziness, tachardia and bilateral lower extremity edema. (Id. at ¶ 15). His cardiologist prescribed eleven medications. As a result, decedent could not work, and he received short and long term disability benefits from Defendant First Reliance. (Id. at ¶ 17).

         On March 1, 2013, Decedent received a letter from First Reliance, indicating that his short term disability benefits would terminate on April 16, 2013, unless he provided an update from his physician, Dr. Riss, as to his continued inability to work. (Id. at ¶ 19). At Decedent's request, Dr. Riss completed the “Physician's Statement” wherein Dr. Riss declared that Decedent was “totally disabled, ” and it gave absolutely no indication that Decedent was capable of performing any type of work, sedentary or otherwise. (Id. at ¶¶ 23-24). In the March 1, 2013 letter, First Reliance also notified Decedent of his eligibility for a “waiver of premium” benefit under the Group Life Insurance coverage. This benefit was available to “totally disabled” individuals and entitled him to maintain life insurance coverage without paying premiums.

         On March 20, 2013, Decedent applied for both total disability benefits and the waiver of premium benefit, due to his total disability. (Id. at ¶ 25). In late March 2013, Decedent communicated with Maureen Murray, a First Reliance employee, who approved Decedent's long term disability benefits; but also requested further medical documentation in October or November 2013. (Id. at ¶¶ 26, 30).

         On October 9, 2013, First Reliance denied Decedent's waiver of premium application under the Group Life Insurance coverage. (Id. at ¶ 43). The basis for denial was First Reliance's conclusion that Decedent was not “totally disabled, ” as defined in the Group Life Policy.

         Basically, the letter stated that Decedent was not totally disabled because he could perform sedentary occupations; as such, he was not entitled to the waiver of premiums benefit. Specifically, the letter notes:

“[w]e have found that as of November 8, 2012 through November 1, 2013 you are capable of sedentary work exertion. Since you are capable of sedentary work exertion, we referred your file to our vocational department to review for viable occupations that would be commensurate with your work history. Our vocational staff found the following viable sedentary occupations that you would be eligible for: Representative Supervisor; Personal Scheduler; Customer-Complaint Clerk; Information Clerk.”

(ECF No. 4-2, “October 9th Letter, ” at 1). The letter explained to Decedent that he could request a review of this denial by submitting an appeal within 180 days of the receipt of the letter and provided instructions on how to submit such a review. (Id. at 2).

         The next day, October 10, 2013, Dr. Riss submitted another report to First Reliance indicating Decedent's disability. The Complaint states:

On October 10, 2013 Mr. Rizzo's primary care physician, Dr. Riss, completed the Defendant, First Reliance's, “ATTENDING PHYSICIAN'S STATEMENT SUPPLEMENTARY REPORT FOR CONTINUATION OF LONG TERM DISA1LITY BENEFITS”. The form specifically asks “How long was or will patient be continuously totally disabled? (unable to work).” Dr. Riss responded stating that Mr. Rizzo's Coronary Artery Disease, Diabetes, Hyperparathyroidism and Peripheral Vascular Disease made him “continuously totally disabled and (unable to work) from November 8, 2012 through the present which was then October 10, 2013.

(Compl. at ¶ 31). On November 26, 2013, Dr. Riss submitted another report, again concluding that Decedent was totally disabled. (Id. at ¶ 32).

         On February 24, 2014, Decedent died. That same day, Plaintiff contacted Melissa Conroy, a Barnes & Noble human resource representative, regarding survivor benefits. (Id. at ¶ 35). Conroy explained to Plaintiff that human resources could not discuss the policy until it was established that Plaintiff was a designated beneficiary under the policy. (Id.). On March 6, 2014, Plaintiff spoke with Christine Wild, a First Reliance Manager of Life Claims, who advised Plaintiff that she was being denied survivor benefits since Decedent did not qualify for the waiver of premium benefit. (Id. at ΒΆ 36). Wild followed up this conversation by writing to Plaintiff, ...


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