DENIZ PITSKO, оn behalf of Jacob Pitsko, a minor and Michael Pitsko, Deceased; DENIZ PITSKO, Individually, Plaintiffs v. GORDON FOOD SERVICES, INC.; THE HARTFORD; THE HARTFORD LIFE AND ACCIDENT INSURANCE CO., Defendants
No. 3:24cv1055
IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
(Judge Munley)
Filed 09/11/25
Plaintiff Deniz Pitsko brings this action under the
Before the court are two (2) motions to dismiss the Pitskos’ complaint filed by GFS and Hartford pursuant to
Background
This action arises out of three events that altered the course of the plaintiffs’ lives: Michael Pitsko’s workplace injury, the termination of his employment with GFS, and his subsequent death. At all times relevant to this action, Michael and Deniz Pitsko were husband and wife, and Jacob Pitsko was their minor son. (Doc. 1, Compl. ¶¶ 5, 27).1
GFS hired Michael Pitsko as a full-time licensed commercial driver on or around May 18, 2016. (Id. ¶ 9). Michael enrolled in GFS’s healthcare plan (“Plan”) administered by Hartford, which provided short-term disability benefits, long-term disability benefits, and family life insurance benefits. (Id. ¶ 5).
On July 16, 2017, Michael sustained a workplace injury which rendered him disabled. (Id.) Michael thereafter began receiving workers’ compensation and long-term disability benefits (“LTD” benefits) under the Plan. Beginning on or around December 2017, Michael also received Social Security Disability benefits due to the injury (“SSD benefits”). (Id.) Further, Michael’s son, Jacob Pitsko
As alleged, Michael settled his workers’ compensation claim with GFS on March 27, 2019. (Id.) Then, on March 28, 2019, Michael and GFS entered into a Separation Agreement and General Release (“Separation Agreement”), which retroactively designated November 30, 2017 as Michael’s last day of employment. (Id.) Plaintiffs allege, however, that the Separation Agreement did not terminate Michael’s ERISA benefits under the Plan, including his LTD benefits. (Id. ¶¶ 5, 9). The Pitskos further maintain that Michael’s ERISA benefits encompassed a waiver of premium benefit (“Waiver of Premium Benefit” or “Premium Waiver”) under his life insurance, pension, and disability income benefits. (Id. ¶ 5). Michael ultimately passed away on February 6, 2022 due to COVID-19 complications. (Id.) Two years later, plaintiffs initiated this action by filing the complaint.
Plaintiffs’ claims arise, inter alia, from allegations that Hartford impropеrly reduced Michael’s LTD benefits by offsetting them against Jacob’s dependent benefits over their objection. (Id. ¶¶ 5, 11). Additionally, plaintiffs allege that Hartford wrongly determined that no life insurance benefits were payable upon
Based upon the above allegations, the plaintiffs’ complaint sets forth several causes of action against thе defendants.3 Almost all of the plaintiffs’ claims are directed at both defendants. Those claims are as follows:
- Count I – Denial of ERISA benefits; failure to clarify rights to past and future benefits under the terms of the Plan, in violation of
Section 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B) , (id. ¶¶ 18–25);4 - Count II – Equitable relief under
Section 502(a)(3) of ERISA, 29 U.S.C. § 1132(a)(3) , (id. ¶¶ 26–29); - Count III – Improper offset of Michael’s LTD benefits by Jacob’s dependent benefits, (id. ¶¶ 30–33); and
- Count IV – Breach of contract under Pennsylvania law, (id. ¶¶ 34–38).
Defendants each responded to the Pitskos’ complaint by filing motions to dismiss. (Docs. 12, 14). In its motion and brief in support, GFS argues that: 1) plaintiffs’ state law claims are preempted by ERISA; 2) plaintiffs’ claim for breach of fiduciary duty under Count II are duplicative of their claims associated with the denial of benefits under Count I; 3) GFS is an improper defendant under Count III of the complaint; and 4) plaintiffs’ jury demand should be stricken. (Doc. 13, GFS Br. in Supр. at 6). Similarly, Hartford, in its motion and brief in support advances arguments regarding ERISA preemption of plaintiffs’ state law claims, the duplicative nature of Count II, and the propriety of striking the jury demand. (Doc. 15, Hartford Br. in Supp. at 6-7). Hartford further contends that it applied unambiguous policy (“Policy”) language in the following respects: 1) the offset of Michael’s LTD benefits by Jacob’s dependent benefits; and 2) the determination that Michael was not eligible for the life insurance Waiver of Premium Benefit under the Policy.5 (Id. at 6).
Because the Pitskos assert claims under ERISA, a federal statute, the court has jurisdiction pursuant to
Legal Standard
The court tests the sufficiency of thе complaint’s allegations when considering a
Analysis
For ease of disposition, this memorandum will first address Michael’s eligibility for the Premium Waiver under the Policy. Next, the court will determine whether the Pitskos’ claims under Count II are duplicative of their claims under Count I. The court will then move to the consideration of the propriety of offsetting Jacob’s dependent benefits against Michael’s LTD benefits. Thereafter, the court will evaluate whether GFS is a proper party with respect to
1. Michael’s Eligibility for the Life Insurance Waiver of Premium Benefit
The complaint, at the outset, is not a model of clarity. Count I appears to challenge the denial of Michael’s life insurance Premium Waiver under
As a preliminary matter, the Policy designates Hartford as the claims fiduciary and рrovides that Hartford has “full discretion and authority to determine eligibility for benefits and to construe and interpret all terms and provisions of the Policy.” (Doc. 15-1, Ex. A, Policy, at ECF pp. 93, 96). On the other hand, the Policy names GFS as the plan administrator. (Id. at ECF p. 94). Additionally, the Policy provides that “[t]he Plan Administrator reserves full authority, at its sole discretion, to terminate, suspend, withdraw, reduce, amend or modify the Plan, in whole or in part, at any time, without prior notice.” (Id.)
Hartford asserts that the underlying administrative record establishes that Hartford notified Michael of his right to continue his life insurance coverage, yet Michael declined to do so. (Doc. 15, Hartford Br. in Supp. at 2 n.1; see Doc. 15-2, Ex. B, First Denial Letter, ECF pp. 3-4).7
A review of Hartford’s August 15, 2018 letter to plaintiffs’ counsel indicates that GFS advised Hartford that Michael’s life insurance coverage was discontinued for his failure to make timely premium payments. (Doc. 15-2, Ex. B, First Denial Letter, ECF p. 3). In that letter, Hartford stated that it did not receive documentation showing that Michael paid any premiums beyond October 29, 2017. (Id. at ECF p. 4). Therefore, Hartford concluded that Michael failed to pay his premiums and that his coverage lapsed as of October 29, 2017. (Id.)
The same letter, however, also references correspondence from Michael’s counsel dated January 31, 2018, asserting that Michael paid premiums from July 2017 through November 2017 but that those premiums were returned to him. (Id. at ECF p. 3). Additionally, per the letter, Michael’s counsel requested to be notified if additional premiums were due. (Id.)
Moreover, in its August 15, 2018 letter, Hartford stated that it received a notice of continuation of coverage form signed by Michael and dated January 24, 2018. (Doc. 15-2, Ex. B, First Denial Letter, ECF p. 3). Per Hartford, that form indicated that Michael requested a portability enrollment form and an LTD conversion quote. (Id.) As asserted by Hartford, its conversion unit confirmed that a quote was mailed on March 5, 2018, presumably to plaintiffs’ counsel. (Id. at ECF p. 4). However, Hartford noted that it received no response from Michael or his counsel, and therefore coverage was not converted. (Id.) Although it is unclear whether the portability enrollment form related in any way to the Waiver of Premium Benefit and the conversion of Michael’s group life insurance to an individual life insurance policy, this correspondence contributes to the underlying factual dispute.8 (See Doc. 15-4, Ex. D, Third Denial Letter, ECF p. 5).
Hartford asserts that it properly denied Michael’s Premium Waiver under the Policy’s unambiguous language. (Doc. 15, Hartford Br. in Supp. at 11). To support its position, Hartford cites the Policy provisions. According to the Policy, “Waiver of Premium is a provision which allows You [Michael] to continue Your and Your Dependent’s Life Insurance coverage without paying premium, while You are Disabled and qualify for Waiver of Premium.” (Doc. 15-1, Ex. A, Policy, at ECF p. 47). “To qualify for Waiver of Premium” an insured must, inter alia, “be Disabled and provide Proof of Loss that You have been Disabled for 6 consecutive month(s), starting on the date You wеre last Actively at Work [.]” (Id.) However, coverage ends “the date Your Employer terminates Your employment”—which in this case for Michael, was November 30, 2017—or “the date the premium payment is due but not paid”—which, according to Hartford, was October 29, 2017. (Id. at ECF p. 45).9
To successfully challenge a plan’s denial of benefits under
When applying the more deferential abuse-of-discretion standard, courts analyze the administrator’s interpretation under a two-step framework. At thе first step, the court considers whether the plan’s language is ambiguous, i.e., “subject to reasonable alternative interpretations.” Bergamatto v. Bd. of Trs. of the NYSA-ILA Pension Fund, 933 F.3d 257, 264 (3d Cir. 2019) (quoting Bill Gray Enters., Inc. Emp. Health & Welfare Plan v. Gourley, 248 F.3d 206, 218 (3d Cir. 2001) (citation omitted)). If the plan’s language is unambiguous, the court will not disturb the administrator’s interpretation so long as it is “ ‘reasonably consistent’ with the plan’s text.” Id. (quoting Dowling v. Pension Plan for Salaried Emps. of Union Pac. Corp. & Affiliates, 871 F.3d 239, 245 (3d Cir. 2017)). If, however, the plan’s terms are ambiguous, the court must take an additional step and evaluate whether the administrator’s interpretation of the plan was reasonable. Id. In this regard, the Third Circuit Court of Appeals has set forth a five-factor test for
As discussed above, Hartford’s denial of the Premium Waiver turns on the factual dispute as to whether Michael paid his life insurance premiums through November 2017. At this juncture, the cоurt need not determine whether the Policy’s language governing the Waiver of Premium Benefit is ambiguous, nor need it reach the merits of the denial itself, as a motion for summary judgment is the more appropriate vehicle for resolving this issue. Even Hartford acknowledges that plaintiffs’ allegations in the complaint raise a factual issue that cannot be resolved on a motion to dismiss. Therefore, Hartford’s motion to dismiss Count I of the complaint as it relates to the Premium Waiver will be denied.
2. The Duplicative Nature of Plaintiffs’ Claims Under Section 502(a)(3) of ERISA
Defendants argue that plaintiffs’ claim for breach of fiduciary duty under
Count II of the complaint consists of allegations in its breach of fiduciary duty claim under
- Improper supervision and administration of the Plan, (Id. ¶ 28);
- Failure to properly represent the benefits that Michael was entitled to receive, (Id.);
- Failure to provide plan information and timely notices as requested, (Id.);
- Improper deduction of Jacob’s dependent benefits, (Id. ¶29);
Improper denial of benefits under the Plan, (Id.);
The court is not persuadеd that dismissal is appropriate at this stage of the litigation. In Varity, the United States Supreme Court interpreted
Although Varity emphasized that
Here plaintiffs’ breach of fiduciary duty claim may rest on defendants’ alleged misrepresentations regarding Plan information, which prevented the Pitskos from taking the steps necessary to continue Michael’s life insurance coverаge under the Plan. These allegations are distinct from the Pitskos’ claim for wrongful denial of benefits.
Whether Counts I and II are ultimately duplicative, and whether relief under
GFS argues that it is an improper defendant under Count III of the complaint. (Doc. 13, GFS Br. in Supp. at 14). As previously stated, Count III relates to the propriety of the offset of Jacob’s dependent benefits against Michael’s LTD benefits. (Doc. 1, Compl. ¶¶ 30-33). Plaintiffs admit that “the Pitskos have not pled any facts showing or even suggesting that Gordon Food Services somehow became a functional or even
Hartford asserts that the Policy’s language unambiguously requires Hartford to consider Jacob’s dependent benefits when calculating Michael’s LTD benefits. (Doc. 15, Hartford Br. in Supp. at 9-10). Specifically, Hartford contends that when calculating Michael’s LTD benefits, it was required to reduce Jacob’s dependent benefits from Michael’s gross monthly LTD benefits. (Id. at 10). Plaintiffs counter that the consideration of Jacob’s dependent benefits by Hartford when calculating Michael’s LTD benefits was improper. (Doc. 23, Second Br. in Opp. at 15).17
The recovery of plaintiffs’ benefits, the enforcement of their rights, and the clarification of their rights for future benefits are governed by the terms of the ERISA plan. Heimeshoff v. Hartford Life & Acc. Ins. Co., 571 U.S. 99, 108 (2013) (citing
To address plaintiffs’ allegations, the court must review the Policy terms governing the calculation of Michael’s gross monthly LTD benеfit. The Policy provides that Michael’s monthly LTD benefit is calculated by multiplying his pre-disability earnings by the benefit percentage and subtracting from that any “Other Income Benefits.” (Doc. 15, Hartford Br. in Supp. at 5; Doc. 15-1, Ex. A, Policy, at ECF p.16). The Policy provides in relevant part that:
Other Income Benefits means the amount of any benefit for loss of income, provided to You or Your family, as a result of the period of Disability for which You are claiming benefits under The Policy. This includes any such benefits for which You or Your family are eligible or that are paid to You, or Your family or to a third party on Your behalf, pursuant to any . . . 5) disability benefits under: a) the United States Social Security Act or alternative plan offered by a state or municipal government . . . that You, Your spouse and/or children, are eligible to receive because of Your Disability . . . .
(Doc. 15-1, Policy, Ex. A at ECF p. 24).
A court reviewing a plan аdministrator’s interpretation of an ERISA plan must first begin by determining if the terms of the plan are ambiguous. Bill Gray Enters., 248 F.3d at 218. As previously mentioned, a term is ambiguous “if it is subject to reasonable alternative interpretations.” Id. However, where the
In their opposition, plaintiffs vaguely contend that the Policy is ambiguous. (Doc. 23, Second Br. in Opp. at 15).18 The court disagrees with plaintiffs’ contentions.
“Benefit offsets are common features of LTD plans. There is an almost even split among Fortune 500 company LTD plans between those which provide for offsets of only the employee’s Social Security disability benefits and those which also provide for the offset of family Social Security disability benefits.” In re
However, the offset of dependent benefits from LTD benefits is proper under one condition, that is when the language of the ERISA plan or policy expressly provides for that offset. In re Unisys, 97 F.3d at 716; Lamb v. Connecticut Gen. Life Ins. Co., 643 F.2d 108, 109 n.1, 111-12 (3d Cir. 1981). “Because of the twofold nature of Social Security disability awards—primary and dependent—LTD plans must specify whether one or both kinds of awards are to be offset from plan benefits.” In re Unisys, 97 F.3d at 716.19 Thus, to the extent the policy expressly authorizes such offsets, the reduction of benefits payable to a participant under the policy may properly encompass not only the participant’s own Social Security benefits but also those received by his dependents. Lamb, 643 F.2d at 111-12.
The language of the Policy here is substantially similar to the ERISA policy language at issue in other cases. See Lamb v. Connecticut Gen. Life Ins. Co., 509 F. Supp. 560, 562 (D.N.J. 1980), aff’d, 643 F.2d 108 (3d Cir. 1981); see also Patchell, 2018 WL 1524531, at *3. It is also comparable to plans the Third
Additionally, plaintiffs assert that the “Other Income Bеnefits” are not described in the core document of the handbook itself.21 (Id.) Contrary to this assertion, “Other Income Benefits” are defined on page 23 of both documents, and the definitions are identical. (See Doc. 15-1, Ex. A, Policy, at ECF p. 24; Doc. 23-1, Ex. B, Handbook, at ECF p. 31).
Plaintiffs also contend that the offsets of dependent benefits are improper here because such benefits belong solely to the dependents and not to their
Lastly, plaintiffs submit that the offset of Michael’s LTD benefits by Jacob’s dependent benefits violates public policy set by the Social Security Act. (Doc. 23, Second Br. in Opp. at 15). Plaintiffs’ argument is unpersuasive. The Third Circuit Court of Appeals has held that “there is nothing in [Section] 402(d)(1) [of the Social Security Act] to suggest that it prevents an employer from bargaining for an insurance contract to cover its employees that offsets Social Security benefits received for the support of dependents against the disability payments to be made under the policy.” Lamb, 643 F.2d at 112.
In sum, Hartford has properly offset Jacob’s dependent benefits when calculating Michael’s LTD benefits, as required by the Poliсy’s unambiguous language. Hence, Hartford’s motion to dismiss Count III of the complaint will be granted.
Hartford and GFS argue that plaintiffs’ state law breach of contract claims are preempted by ERISA. (Doc. 13, GFS Br. in Supp. at 7-11; Doc. 15, Hartford Br. in Supp. at 14-17).
Section 514 of ERISA provides that ERISA “shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan” covered by ERISA.
For instance, claims for breach of contract, breach of fiduciary duty, and fraud in the inducement based on alleged improper processing of long-term disability benefits under an employee benefit plan “undoubtedly meet the criteria for pre-emption under § 514(a) [.]” Pryzbowski v. U.S. Healthcare, Inc., 245 F.3d 266,
The Third Circuit Court of Appeals has noted in Pane that breach of contract claims under state law and ERISA cannot co-exist for purposes of enforcement of an ERISA plan. Pane v. RCA Corp., 868 F.2d 631, 635 (3d Cir. 1989). The Court of Appeals added “to the extent that these state law claims would support an award of punitive damages, the claim fоr such relief is also preempted.” Id. at 635.
Plaintiffs and defendants agree in part on this issue. In the complaint, plaintiffs allege that defendants breached their contractual obligation to implement the Plan in accordance with ERISA. (Doc. 1, Compl. ¶ 37). To that end, plaintiffs expressly base their breach of contract claims on the administration and implementation of Michael’s benefits under the Plan. (Id.) Nevertheless, plaintiffs eventually do concede that ERISA provides the exclusive remedy for plan participants seeking to enforce their rights under such a plan and admit that their state law breach of contract claims are preempted by ERISA. (Doc. 16, First Br. in Opp. at 11-13; Doc. 23, Second Br. in Opp. at 4, 24-25). However, plaintiffs’ concession on this issue excludes state law breach of
The breach of contract claims related to Jacob ultimately turn on the propriety of offsetting his dependent benefits against Michael’s LTD benefits. (Doc. 16, First Br. in Opp. at 12; Doc. 23, Second Br. in Opp. at 4, 25). Given that the offset of Jacob’s dependent benefits was proper under the terms of the Policy, plaintiffs have no viable state law claims remaining. Consequently, defendants’ motions to dismiss Count IV will be granted.
6. Jury Demand
Defendants also move to strike plaintiffs’ jury demand on the ground that ERISA actions are equitable in nature, specifically when brought under Section 502(a)(1)(B). (Doc. 13, GFS Br. in Supp. at 15-17; Doc. 15, Hartford Br. in Supp. at 17). Per defendants, it is well settled in the Third Circuit that parties in ERISA actions have no right to a jury trial. (Doc. 13, GFS Br. in Supp. at 16; Doc. 15, Hartford Br. in Supp. at 17) (citing among others Pane, 868 F.2d at 636-37; Turner v. CF & I Steel Corp., 770 F.2d 43, 46 (3d Cir.1985)). The court agrees with the defendants. See
Plaintiffs admit that they are not entitled to a jury trial on their ERISA claims and that the jury demand as to those claims should be stricken. (Doc. 16, First Br. in Opp. at 21; Doc. 23, Second Br. in Opp. at 15). They nevertheless maintain that Jacob’s breach of contract claims are triable by a jury because they are independent from the ERISA claims. (Doc. 16, First Br. in Opp. at 21; Doc. 23, Second Br. in Opp. at 15). Bеcause the breach of contract claims on Jacob’s behalf will be dismissed, defendants’ motions to strike will be granted and plaintiffs’ request for jury trial will be stricken from the complaint.
Conclusion
For the reasons set forth above, the motions to dismiss filed by GFS and Hartford, (Docs. 12, 14), will be granted in part and denied in part. The motions to dismiss will be granted as to Counts III and IV of the complaint. The claims related to the offset of Jacob’s dependent benefits against Michael’s LTD
Date: 9/11/25
JUDGE JULIA K. MUNLEY
United States District Court
Notes
Additionally, Hartford attached a copy of the Policy and denial letters to its brief in support of its motion, (Doc. 15-1, Ex. A, Policy), First Denial Letter, (Doc. 15-2, Ex. B, First Denial Letter), Second Denial Letter, (Doc. 15-3, Ex. C, Second Denial Letter), Third Denial Letter, (Doc. 15-4, Ex. D, Third Denial Letter). A court may also “consider an undisputedly authentic document that a defendant attaches as an exhibit to a motion to dismiss if the plaintiff’s claims are based on the document.” Citisteel USA, Inc. v. Gen. Elec. Co., 78 F. App’x 832, 835 (3d Cir. 2003) (quoting Pension Ben. Guar. Corp., 998 F.2d at 1196). Furthermore, where a document is integral to or explicitly relied upon in the complaint, it may be considered without converting а motion to dismiss for failure to state a claim into one for summary judgment under
The Policy is integral to the complaint because it forms the basis for plaintiffs’ claims. Likewise, the denial letters are integral to the complaint as plaintiffs’ claims are predicated on the denial of the Waiver of Premium Benefit and on plaintiffs’ assertions that defendants failed to provide
A civil action may be brought--by a participant, beneficiary, or fiduciary (A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to оbtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan [.]
The Second Circuit Court of Appeals, in Devlin v. Empire Blue Cross & Blue Shield, 274 F.3d 76, 89 (2d Cir. 2001), rejected the majority’s strict view. The Second Circuit Court of Appeals has held that a
Id. at 712. The Court of Appeals concluded that the language of the earlier version of the policy “specifically provided for dependent offsets.” Id. at 716. It is important to note that the case involved a revised version of the policy, which provided only that long-term disability benefits “you receive may be adjusted if you receive . . . disability income from other sources.” Id. at 715. According to the Third Circuit Court of Appeals, the revised policy’s language was unambiguous, and therefore did not permit dependent benefits offsets. Id. at 717.The amount of disability or retirement benefits under the United States Social Security Act, The Canada Pension Plan, or thе Quebec Pension Plan, or any similar plan or act, as follows:
- disability benefits for which:
- you are eligible, and
- your spouse, child or children are eligible because of your disability [.]