United States District Court, D. New Jersey
MEMORANDUM AND ORDER
G. SHERIDAN, U.S.D.J.
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.
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.
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).
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).
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
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,
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
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).
next day, October 10, 2013, Dr. Riss submitted another report
to First Reliance indicating Decedent's disability. The
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).
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 ¶ 36). Wild followed
up this conversation by writing to Plaintiff, ...