ORDER DENYING UNUM’S MOTION TO DISMISS PLAINTIFFS’ THIRD CLAIM FOR INJUNCTIVE RELIEF IN THE SECOND AMENDED COMPLAINT
This matter comes before the Court on the defendant Unum Life Insurance Company of America’s (“UNUM”) motion to dismiss, or in the alternative, to strike, the plaintiffs’ third claim for injunctive relief in the Second Amended Complaint (“SAC”).
I. Background
The plaintiffs, Brian Rawls and Lynn Carroll, allege that they were participants in separate employee welfare benefit plans and were covered under group long-term disability insurance policies issued by the defendant, UNUM, to the plaintiffs’ employers. Rawls was employed by the defendant Senn Delaney Leadership Consulting Group (“Senn Delaney”) and Carroll was employed by Sebastiani Vineyards, Inc. (“Sebastiani”). (SAC ¶¶ 6,17.)
The plaintiffs allege that they made separate claims to UNUM for long term disability insurance benefits, and the Senn Delaney Plan and Sebastiani Plan, through their claims administrator UNUM, erroneously and wrongfully denied the claims. The SAC alleges that the denial of the claims was accompanied by a letter informing the plaintiffs that any appeal must be received within 90 days. Subsequently, UNUM advised the plaintiffs that it would not consider the appeals of the denial of their claims because the appeals were not received within the 90-day period.
The plaintiffs claim that UNUM’s refusal to consider their appeals violates
UNUM Life Insurance v. Ward,
The plaintiffs also allege that the conduct of the Senn-Delaney and Sebastiani Plans, through their claims administrator UNUM, of wrongfully denying the plaintiffs’ claims for benefits, constitutes a violation of the Plans and breach of contract. (SAC ¶¶ 15, 23.) Pursuant to 29 U.S.C. ¶ 1132(a)(1)(B), the plaintiffs individually seek to recover benefits from their Plans.
*1065 II. Discussion
A. Legal Standard
Dismissal under Rule 12(b)(6) is appropriate when it is clear that no relief could be granted under any set of facts that could be proven consistent with the allegations set forth in the complaint.
Newman v. Universal Pictures,
B. Analysis
1. Plaintiffs’ Request for an Injunction Against UNUM Is Not Equivalent to a Request for Benefits
The plaintiffs have filed a claim for injunctive relief under 29 U.S.C. § 1132(a)(3), which permits a participant or beneficiary to file a claim for an injunction or “other appropriate equitable relief’ to redress violations of ERISA or of a benefit plan. Specifically, the plaintiffs seek an injunction against UNUM requiring it to:
(a) Re-open all claims that were denied on the basis that the appeal submitted on behalf of the claimant was untimely and to require UNUM to conduct a meaningful review of said claim in accordance with the requirements of ERISA and;
(b) Refrain from continuing to engage in the unlawful conduct alleged herein.
(SAC at 8; Prayer ¶ 5.)
UNUM contends that the request for an injunction is improper because it is tantamount to a claim for benefits in violation of
Everhart v. Allmerica Financial Life Insurance Company,
UNUM contends that the plaintiffs’ request for an injunction ordering UNUM to conduct an administrative review in accordance with ERISA is, in substance, a request for benefits because, if after an administrative review, UNUM determines that the claimant is entitled to benefits, then the responsible party — the plan or plan administrator — -must pay.
See e.g., Leonhardt v. Holden Bus. Forms Co.,
The plaintiffs respond that the requested injunctive relief can in no way be characterized as an action for plan benefits because it seeks relief against UNUM as the claim administrator to compel it to *1066 properly perform its plan duties, i.e. to conduct the appeal process. The injunction seeks an order requiring UNUM to reopen those appeals, which it allegedly wrongfully refused to consider, and to prohibit UNUM from engaging in this conduct in the future. The plaintiffs distinguish their request for a re-opening of the appeals process from a benefits determination on several grounds: (1) requiring a claims administrator to complete an ERISA appeals process does not equal an award of benefits because UNUM may either show prejudice in the delay or uphold its initial determination; and (2) the opportunity to complete the appeals process provides the plaintiffs with an opportunity to rebut the adverse benefit decision of a claim administrator with evidence necessary to perfect the claim.
The plaintiffs allege that this procedural step is key because if the claimant ultimately files suit, the evidence before the Court will only consist of the Administrative Record, i.e. the claim file developed by the insurance carrier. Therefore, the deprivation of the right to appeal not only implicates the loss of benefits, but the preclusion of any further evidence in the Administrative Record to rebut the carrier’s position or support the claimed disability in subsequent proceedings. In short, the preservation of the integrity of the appeal process is a valuable distinct right under ERISA that is separate from just the benefits decision. Finally, it is argued, the fact that benefits may ultimately be awarded as a consequence of the appeal of some claims is not contrary to
Everhart.
The plaintiffs also argue that actions under § 1132(a)(3) are not limited to actions only against the Plan.
Everhart,
UNUM relies on
Leonhardt,
in which the plaintiff sought to enjoin the defendants (her employer, the plan, the plan administrator) from denying coverage for her proposed autologous bone marrow transplant. The court found that the requested injunction was substantively a request for “benefits due” under § 1132(a)(1)(B), and therefore, only the Plan was the proper subject of the plaintiffs proposed injunction. Similarly, UNUM cites
Hall v. Lhaco, Inc.,
UNUM argues that what the plaintiffs seek, “in the end,” is benefits on behalf of the class. 1 However, at this stage in the proceedings, the Court is persuaded that the integrity of the appeal process (which the plaintiffs allegedly seek to enforce through the SAC) is a valuable distinct right under ERISA that is separate from just the benefits decision. Therefore, the Court finds that the plaintiffs’ requested injunctive relief against UNUM is not simply equivalent to a request for benefits. 2 *1067 The plaintiffs seek equitable relief against UNUM, and their request is not violative of Everhart.
a. No Injunction For Benefits Is Available Under Section 1132(a)(3)
Next, UNUM contends, setting aside that the class may not obtain benefits from UNUM, an injunction from benefits is not available under § 1132(a)(3).
Mertens v. Hewitt
Assocs.,
The plaintiffs contend that an action for equitable relief may be brought against a plan fiduciary, and this action is expressly sanctioned by
Varity Corporation v. Howe,
The Court finds that the plaintiffs’ request for an injunction is not a request for monetary relief, and that the defendants’ authorities are inapposite for that reason. For example, in
Mertens,
the Supreme Court stated that: “[ajlthough they often dance around the word, what petitioners in fact seek is nothing other than compensatory
damages
—monetary relief for all losses their plan sustained as a result of the alleged breach of fiduciary duties.”
b. Plaintiffs Have No Adequate Remedy At Law
Finally, UNUM argues, the plaintiffs have an available remedy at law — i.e. to file a suit for benefits under § 1132(a)(1) against the plan (as the named plaintiffs in this case have already done). Therefore, the plaintiffs are precluded from bringing suit under section 1132(a)(3).
Varity Corp.,
The plaintiffs argue that they have no adequate remedy at law. The plaintiffs argue that UNUM’s denial of their opportunity to appeal has caused them to lose valuable rights because they are now unable to rebut the initial administrative decision denying their claims. As discussed above, the inability to submit- additional evidence in the Administrative Record means that their subsequent civil action for benefits will also be compromised because the trial evidence in an ERISA benefits action is limited to the insurer’s administrative record.
Kearney v. Standard Ins. Co.,
The Court finds that there is no adequate remedy at law to cure this defect and the plaintiffs’ request for injunctive relief is therefore proper at this stage.
*1068 2. The Class Allegations
The SAC names the plans in which the plaintiffs Brian Rawls and Lynn Carroll were participants and from which they seek additional benefits (the Senn Delaney and Sebastiani Plans). However, the SAC does not name any of the plans of the other purported class members. Therefore, UNUM argues, the plaintiffs’ claim for benefits on behalf of the class against UNUM is improper under Everhart and should be dismissed.
In this action, the plaintiffs seek to represent the following class of people:
[I]ndividuals who were insured under ERISA plans who were or are funded by UNUM Group Long Term Disability Policies, in which UNUM acted as a claim fiduciary and who reside in a state which has adopted the common law insurance doctrine of Notice/Prejudice as it relates to the submission of Proofs of Claim or Proofs of Loss, whose Long Term Disability Claims were denied by UNUM, and whose on going claims or appeals were rejected by UNUM on the ground that they were not submitted within the time period prescribed by UNUM.
(SAC ¶ 28.)
UNUM argues that the plaintiffs lack standing to seek additional benefits on behalf of participants or beneficiaries of plans in which they are not also a participant or beneficiary.
Lee v. Prudential Ins. Co. of Am.,
A civil action may be brought—
(1) by a participant or beneficiary—
... (B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan.
29 U.S.C. § 1132(a)(1)(B).
The plaintiffs respond that they are not seeking benefits against plans other than their own. Instead, the plaintiffs seek “other equitable relief’ under § 1132(a)(3), which provides, in relevant part:
A civil action may be brought—
(3) 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 obtain other appropriate equitable relief (i) to redress such violations....
29 U.S.C. § 1132(a)(3).
According to the plaintiffs, there is no limiting language in § 1132(a)(3) which restricts a participant in bringing an action for “other equitable relief’ to challenge general claims practices. Therefore, the standing restrictions of § 1132(a)(1)(B) have no application to an action brought under 1132(a)(3).
See e.g., Fallick v. Nationwide Mut. Ins. Cor.,
The Court finds that the SAC alleges that the plaintiff class has sustained the requisite injury (denial of appeal rights by UNUM as the claim administrator on grounds that the appeals were not timely submitted), and that there is no limitation under § 1132(a)(3) requiring plaintiffs to *1069 sue for equitable relief against only their Plans.
III. Conclusion
For the reasons stated above, the Court denies the motion to dismiss the SAC.
IT IS SO ORDERED.
Notes
. UNUM disputes that the plaintiffs’ argument that the full and complete administrative record generated by the appeal process is valuable to the plaintiffs, and distinct from a request for benefits. UNUM argues that the proper remedy if a request for review is improperly rejected is to remand the claim for adjudication on the merits, at which time the administrative record can be supplemented.
See, e.g., White v. Jacobs Eng’g Group Long Term Disability Benefit Plan,
. UNUM argues that the ERISA regulations specifically provide that the purpose of an *1067 administrative review is to make a benefits determination.