Case: 2:14-cv-01458-ALM-EPD Doc #: 6 Filed: 11/10/14 Page: 1 of 5 PAGEID #: 17
IN THE UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO EASTERN DIVISION BLYS GRAD,
) ) Plaintiff, ) ) vs. ) ) ABBOTT LABORATORIES and MATRIX ) ABSENCE MANAGEMENT, ) ) Defendants. )
Case No. 2:14-cv-01458-ALM-EPD Judge Algenon L. Marbley Magistrate Judge Elizabeth Preston Deavers
ANSWER TO COMPLAINT Defendants ABBOTT LABORATORIES and MATRIX ABSENCE MANAGEMENT hereby answer Plaintiff’s complaint as follows: 1.
Defendants admit that Matrix is the claims administrator for the Abbott
Laboratories Extended Disability Plan (“EDP”) and that Plaintiff made a claim under the EDP. Defendants deny the remaining allegations of Paragraph 1. 2.
Defendants admit that Plaintiff was employed by Abbott at the time she made a
claim under the EDP, but deny that Abbott was the plan administrator of the EDP and deny the remaining allegations of Paragraph 2. 3.
Defendants admit that Plaintiff was employed by Abbott and resided in Delaware
County at the time she made a claim under the EDP. Defendants lack knowledge or information sufficient to form a belief as to the truth of the remaining allegations of Paragraph 3 and, therefore, deny same. 4.
Defendants admit that Plaintiff was eligible to apply for benefits under the EDP
and that the EDP was first amended as of January 1, 2004 and its second amendment was
Ex. M, p. 1
Case: 2:14-cv-01458-ALM-EPD Doc #: 6 Filed: 11/10/14 Page: 2 of 5 PAGEID #: 18
adopted April 27, 2006. Defendants further admit that at times Plaintiff’s EDP claim included the designation “682708,” but deny the remaining allegations of Paragraph 4. 5.
Defendants deny the allegations of Paragraph 5.
6.
Defendants admit the allegations of Paragraph 6.
7.
Defendants admit that Plaintiff has applied for EDP benefits based on certain
medical conditions. Defendants further admit that Plaintiff was initially approved for EDP benefits effective March 9, 2011, but that, following a review of the medical records in Plaintiff’s file, it was determined that Plaintiff was not totally disabled under the EDP and her claim for benefits beyond July 31, 2012 was denied. Defendants deny that Plaintiff is totally disabled under the terms of the EDP.
Defendants are without knowledge or information
sufficient to form a belief as to the truth of the remaining allegations of Paragraph 7 and, therefore, deny same. 8.
Defendants admit that Plaintiff appealed the denial of benefits described in
Paragraph 7, and that Plaintiff appealed that denial pursuant to the EDP procedures. Answering further, Defendants admit that the individual designated by the plan administrator of the EDP issued a second level denial of Plaintiff’s claim by letter dated August 16, 2013. Defendants deny the remaining allegations of Paragraph 8. 9.
Defendants deny the allegations of Paragraph 9.
10.
Defendants deny the allegations of Paragraph 10.
11.
Defendants admit the allegations of Paragraph 11.
12.
Defendants deny the allegations of Paragraph 12.
13.
Defendants deny the allegations of Paragraph 13.
14.
Defendants deny the allegations of Paragraph 14.
2
Ex. M, p. 2
Case: 2:14-cv-01458-ALM-EPD Doc #: 6 Filed: 11/10/14 Page: 3 of 5 PAGEID #: 19
15.
Defendants deny the allegations of Paragraph 15.
16.
Defendants deny the allegations of the unnumbered WHEREFORE paragraph and
further deny that Plaintiff is entitled to any relief whatsoever. FIRST ADDITIONAL AND AFFIRMATIVE DEFENSE 17.
Plaintiff fails to state a claim upon which relief may be granted because all
determinations made with regard to Plaintiff were in accordance with plan documents and were neither arbitrary nor capricious. SECOND ADDITIONAL AND AFFIRMATIVE DEFENSE 18.
Plaintiff fails to state a claim upon which relief may be granted against Abbott
Laboratories and Matrix Absence Management because they are not proper defendants under 29 U.S.C. § 1132(d)(1). WHEREFORE, Defendants pray that the Complaint be dismissed with prejudice and that this Court order such other and further relief as is just and proper. Respectfully submitted, ABBOTT LABORATORIES and MATRIX ABSENCE MANAGEMENT By:__/s/ Caroline H. Gentry______ One of Their Attorneys Caroline H. Gentry PORTER WRIGHT MORRIS & ARTHUR LLP One South Main St., Suite 1600 Dayton, Ohio 45402 T: (937) 449-6748 F: (937) 449-6820 cgentry@porterwright.com and
3
Ex. M, p. 3
Case: 2:14-cv-01458-ALM-EPD Doc #: 6 Filed: 11/10/14 Page: 4 of 5 PAGEID #: 20
Joseph J. Torres (pro hac vice admission pending) Heather S. Lehman (pro hac vice motion forthcoming) WINSTON & STRAWN LLP 35 West Wacker Drive Chicago, Illinois 60601 T: (312) 558-5600 F: (312) 558-5700 jtorres@winston.com hlehman@winston.com Attorneys for Defendants
4
Ex. M, p. 4
Case: 2:14-cv-01458-ALM-EPD Doc #: 6 Filed: 11/10/14 Page: 5 of 5 PAGEID #: 21
CERTIFICATE OF SERVICE I hereby certify that on November 10, 2014, I electronically filed the foregoing with the Clerk of Court using the CM/ECF system which will send notification of such filing to the counsel of record in this matter.
s/ Caroline H. Gentry Caroline H. Gentry
Ex. M, p. 5
Case: 5:19-cv-02285-SL Doc #: 8 Filed: 12/16/19 1 of 3. PageID #: 24
IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF OHIO EASTERN DIVISION KAREN O’KELLY,
CASE NO. 5:19-CV-02285-SL Plaintiff,
vs. THE FEDERAL RESERVE SYSTEM, et al.,
JUDGE SARA LIOI DEFENDANTS’ ANSWER TO PLAINTIFF’S COMPLAINT
Defendants. Defendants The Federal Reserve System (“Federal Reserve”), Matrix Absence Management, Inc. (“Matrix”) and Long-Term Disability Income Plan for Employees of the Federal Reserve System (the “Plan”) (collectively “defendants”) answer the Complaint of plaintiff Karen O’Kelly (“plaintiff”) in accordance with the numbered paragraphs thereof as follows: 1.
Defendants deny the allegations contained in Paragraph 1 of the Complaint except
they admit that plaintiff was formerly employed by Federal Reserve Bank of Cleveland and was provided benefits for a period of time. 2.
Defendants deny the allegations contained in Paragraph 2 of the Complaint, except
they admit that Matrix performs certain claims administration duties on behalf of the Plan. 3.
Defendants deny the allegations contained in Paragraph 3 of the Complaint.
4.
Defendants admit the allegations contained in Paragraph 4 of the Complaint.
5.
Paragraph 5 of the Complaint contains a legal conclusion to which no responsive
pleading is required. Defendants admit that this Court has subject matter jurisdiction pursuant to 12 U.S.C. § 632.
Ex. M, p. 6
Case: 5:19-cv-02285-SL Doc #: 8 Filed: 12/16/19 2 of 3. PageID #: 25
6.
Defendants deny the allegations contained in Paragraph 6 of the Complaint except
that they admit, upon information and belief, that plaintiff last worked on or about August 31, 2016. 7.
Defendants deny the allegations contained in Paragraph 7 of the Complaint except
they admit that plaintiff filed an application for disability benefits. 8.
Defendants deny the allegations contained in Paragraph 8 of the Complaint.
9.
Defendants deny the allegations contained in Paragraph 9 of the Complaint.
10.
Defendants deny the allegations contained in Paragraph 10 of the Complaint except
they admit that plaintiff was issued a letter on January 22, 2018, and that this letter speaks for itself. 11.
Defendants deny the allegations contained in Paragraph 11 of the Complaint.
12.
Defendants deny the allegations contained in Paragraph 12 of the Complaint except
they admit that plaintiff has filed the Complaint and seeks judicial review. 13.
Defendants deny the allegations contained in Paragraph 13 of the Complaint.
14.
Defendants deny the allegations contained in Paragraph 14 of the Complaint.
15.
Defendants deny the allegations contained under the “WHEREFORE” clause on
page 4 of the Complaint and specifically deny that plaintiff is entitled to any of the relief she requests. 16.
Defendants deny all allegations that have not been expressly admitted herein. FIRST DEFENSE
17.
The Complaint fails to state a claim upon which relief may be granted. SECOND DEFENSE
18.
Plaintiff’s claims are barred, in whole or in part, by plaintiff’s failure to exhaust her
internal and/or administrative remedies. THIRD DEFENSE 19.
Plaintiff has received all Plan benefits to which she is entitled. 2
Ex. M, p. 7
Case: 5:19-cv-02285-SL Doc #: 8 Filed: 12/16/19 3 of 3. PageID #: 26
FOURTH DEFENSE 20.
Plaintiff’s claims are barred, in whole or in part, by the equitable doctrines of
estoppel, judicial estoppel, and/or unclean hands. FIFTH DEFENSE 21.
Plaintiff has improperly named Matrix and Federal Reserve as defendants. SIXTH DEFENSE
22.
Plaintiff’s claims fail because she is not entitled to benefits under the terms of the
Plan and/or did not satisfy the requirements of the Plan. 23.
Defendants reserve the right to rely upon such other defenses as may become
available during discovery and reserve the right to amend their Answer accordingly. 24.
WHEREFORE, having fully answered, defendants pray that the Complaint be
dismissed with prejudice and they be granted their costs, expenses and attorney’s fees. Respectfully submitted, /s/ Gilbert Brosky Gregory V. Mersol (0030838) Gilbert Brosky (0079855) BAKER & HOSTETLER LLP Key Tower 127 Public Square, Suite 2000 Cleveland, OH 44114-1214 Telephone: (216) 621-0200 Facsimile: (216) 696-0740 gmersol@bakerlaw.com gbrosky@bakerlaw.com Attorneys for Defendants
3
Ex. M, p. 8
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 1 of 11
1 2 3 4 5 6 7 8 9 10
ALDEN J. PARKER, SBN 196808 EMail: aparker@fisherphillips.com CHRISTOPHER S. ALVAREZ, SBN 294795 EMail: calvarez@fisherphillips.com FISHER & PHILLIPS LLP 621 Capitol Mall, Suite 1400 Sacramento, California 95814 Telephone: (916) 210-0400 Facsimile: (916) 210-0401 MELISSA R. SHIMIZU, SBN 281603 EMail: mshimizu@fisherphillips.com Fisher & Phillips LLP 2050 Main Street Suite 1000 Irvine, CA 92614-8240 Telephone: (949) 851-2424 Facsimile: (949) 851-0152 Attorneys for Defendant MATRIX ABSENCE MANAGEMENT, INC.
11 12
UNITED STATES DISTRICT COURT
13
NORTHERN DISTRICT OF CALIFORNIA, SAN JOSE DIVISION
14 15
LEONARD WITANA, Plaintiff,
16 17 18 19
Case No: 5:20-cv-01860-SVK
v. MATRIX ABSENCE MANAGEMENT, INC.; RELIANCE STANDARD LIFE INSURNCE COMPANY, Defendants.
20
DEFENDANT MATRIX ABSENCE MANAGEMENT INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT Complaint Filed: March 16, 2020 Trial Date: None Set
21 22 23 24
Defendant MATRIX ABSENCE MANAGEMENT, INC. submits the following Answer and Affirmative Defenses to Plaintiff LEONARD WITANA’S Complaint (“Complaint”). JURISDICTION AND VENUE
25 26
1.
In response to Paragraph 1 of the Complaint, Defendant is without knowledge and
27
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
28
on that basis denies the allegations contained therein. Additionally, the allegations contained therein state 1 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 9
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 2 of 11
1
legal assertions, conclusions, and/or argument to which no response is required. To the extent this
2
paragraph makes any factual allegations against Defendant, Defendant denies those allegations. 2.
3
In response to Paragraph 2 of the Complaint, Defendant admits it is licensed to do
4
business in California. Defendant is without knowledge and information sufficient to form a belief as to
5
the truth of the remaining allegations contained in this paragraph, and on that basis denies the allegations
6
contained therein.
7
3.
In response to Paragraph 3 of the Complaint, the allegations contained therein state legal
8
assertions, conclusions, and/or argument to which no response is required. To the extent this paragraph
9
makes any factual allegations against Defendant, Defendant denies those allegations. II.
10 4.
11
INTRADISTRICT ASSIGNMENT
In response to Paragraph 4 of the Complaint, the allegations contained therein state legal
12
assertions, conclusions, and/or argument to which no response is required. To the extent this paragraph
13
makes any factual allegations against Defendant, Defendant denies those allegations. III.
14 15
A.
Plaintiff 5.
16
PARTIES
In response to Paragraph 5 of the Complaint, Defendant is without knowledge and
17
information sufficient to form a belief as to the truth of the allegations contained in this paragraph as it
18
is unclear to which period of time “[p]rior to stopping work” refers, and on that basis denies the
19
allegations contained therein. 6.
20
In response to Paragraph 6 of the Complaint, Defendant is without knowledge and
21
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
22
on that basis denies the allegations contained therein. Additionally, the allegations contained therein
23
state legal assertions, conclusions, and/or argument to which no response is required. To the extent this
24
paragraph makes any factual allegations against Defendant, Defendant denies those allegations. 7.
25
In response to Paragraph 7 of the Complaint, the allegations contained therein state legal
26
assertions, conclusions, and/or argument to which no response is required. To the extent this paragraph
27
makes any factual allegations against Defendant, Defendant denies those allegations. Further, Defendant
28
/// 2 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 10
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 3 of 11
1
is without knowledge and information sufficient to form a belief as to the truth of the allegations
2
contained in this paragraph, and on that basis denies the allegations contained therein.
3
B.
Defendant 8.
4
In response to paragraph 8 of the Complaint, Defendant admits it was the claims
5
administrator for the AutoNation’s self-funded short-term disability plan and denies the remaining
6
allegations contained therein. 9.
7
In response to Paragraph 9 of the Complaint, Defendant admits Reliance Standard Life
8
Insurance Company was the long-term disability claims administrator and denies the remaining
9
allegations contained therein. 10.
10
In response to Paragraph 10 of the Complaint, Defendant admits it was the claims
11
administrator for the AutoNation’s self-funded short-term disability plan and denies the remaining
12
allegations contained therein. 11.
13
In response to Paragraph 11 of the Complaint, Defendant admits Reliance Standard Life
14
Insurance Company was the long-term disability claims administrator and denies the remaining
15
allegations contained therein. 12.
16
In response to Paragraph 12 of the Complaint, the allegations contained therein state legal
17
assertions, conclusions, and/or argument to which no response is required. To the extent this paragraph
18
makes any factual allegations against Defendant, Defendant denies those allegations. IV.
19 20
A.
Vocational Background 13.
21
FACTS
In response to Paragraph 13 of the Complaint, Defendant is without knowledge and
22
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
23
on that basis denies the allegations contained therein. 14.
24
In response to Paragraph 14 of the Complaint, Defendant is without knowledge and
25
information sufficient to form a belief as to the truth of the allegations contained in this paragraph as it
26
is unclear to which period of time “[p]rior to stopping work” refers, and on that basis denies the
27
allegations contained therein.
28
/// 3 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 11
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 4 of 11
15.
1
In response to Paragraph 15 of the Complaint, Defendant is without knowledge and
2
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
3
on that basis denies the allegations contained therein. 16.
4
In response to Paragraph 16 of the Complaint, Defendant is without knowledge and
5
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
6
on that basis denies the allegations contained therein. 17.
7
In response to Paragraph 17 of the Complaint, Defendant is without knowledge and
8
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
9
on that basis denies the allegations contained therein.
10 11
B.
Medical History 18.
In response to Paragraph 18 of the Complaint, Defendant is without knowledge and
12
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
13
on that basis denies the allegations contained therein.
14
19.
In response to Paragraph 19 of the Complaint, Defendant is without knowledge and
15
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
16
on that basis denies the allegations contained therein.
17
20.
In response to Paragraph 20 of the Complaint, Defendant is without knowledge and
18
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
19
on that basis denies the allegations contained therein.
20
21.
In response to Paragraph 21 of the Complaint, Defendant is without knowledge and
21
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
22
on that basis denies the allegations contained therein.
23
22.
In response to paragraph 22 of the Complaint, Defendant is without knowledge and
24
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
25
on that basis denies the allegations contained therein.
26
23.
In response to Paragraph 23 of the Complaint, Defendant is without knowledge and
27
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
28
on that basis denies the allegations contained therein. 4 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 12
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 5 of 11
24.
1
In response to Paragraph 24 of the Complaint, Defendant is without knowledge and
2
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
3
on that basis denies the allegations contained therein. 25.
4
In response to Paragraph 25 of the Complaint, Defendant is without knowledge and
5
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
6
on that basis denies the allegations contained therein. 26.
7
In response to Paragraph 26 of the Complaint, Defendant is without knowledge and
8
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
9
on that basis denies the allegations contained therein. 27.
10
In response to Paragraph 27 of the Complaint, Defendant is without knowledge and
11
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
12
on that basis denies the allegations contained therein. 28.
13
In response to Paragraph 28 of the Complaint, Defendant is without knowledge and
14
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
15
on that basis denies the allegations contained therein. 29.
16
In response to Paragraph 29 of the Complaint, Defendant is without knowledge and
17
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
18
on that basis denies the allegations contained therein. 30.
19
In response to Paragraph 30 of the Complaint, Defendant is without knowledge and
20
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
21
on that basis denies the allegations contained therein. 31.
22
In response to Paragraph 31 of the Complaint, Defendant is without knowledge and
23
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
24
on that basis denies the allegations contained therein. 32.
25
In response to Paragraph 32 of the Complaint, Defendant is without knowledge and
26
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
27
on that basis denies the allegations contained therein.
28
/// 5 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 13
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 6 of 11
33.
1
In response to Paragraph 33 of the Complaint, Defendant is without knowledge and
2
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
3
on that basis denies the allegations contained therein.
4
C.
5
Administration of Mr. Witana’s Claim for Benefits 34.
In response to Paragraph 34 of the Complaint, Defendant is without knowledge and
6
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
7
on that basis denies the allegations contained therein.
8 9 10
35.
In response to Paragraph 35 of the Complaint, Defendant admits Plaintiff was informed
his position was being eliminated on January 15, 2019, and his employment termination was effective January 16, 2019. Defendant denies the remaining allegations contained therein.
11
i.
STD Application with Matrix
12
36.
In response to Paragraph 36 of the Complaint, Defendant is without knowledge and
13
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
14
on that basis denies the allegations contained therein.
15
37.
In response to Paragraph 37 of the Complaint, Defendant is without knowledge and
16
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
17
on that basis denies the allegations contained therein.
18
38.
In response to Paragraph 38 of the Complaint, Defendant is without knowledge and
19
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
20
on that basis denies the allegations contained therein.
21
39.
In response to Paragraph 39 of the Complaint, Defendant admits it was determined that
22
Plaintiff was not entitled to short-term disability benefits under the voluntary disability plan as of January
23
16, 2019. Defendant denies the remaining allegations contained therein.
24 25 26
40.
In response to Paragraph 40 of the Complaint, Defendant admits Plaintiff requested
review of the denial of short-term benefits and denies the remaining allegations contained therein. 41.
In response to Paragraph 41 of the Complaint, Defendant admits it maintains the previous
27
denial of Plaintiff’s short-term benefits effective January 16, 2019. Defendant denies the remaining
28
allegations contained therein. 6 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 14
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 7 of 11
1
ii.
LTD Application with Reliance
2
42.
In response to Paragraph 42 of the Complaint, Defendant is without knowledge and
3
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
4
on that basis denies the allegations contained therein. 43.
5
In response to Paragraph 43 of the Complaint, Defendant is without knowledge and
6
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
7
on that basis denies the allegations contained therein. 44.
8 9 10
In response to Paragraph 44 of the Complaint, Defendant is without knowledge and
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and on that basis denies the allegations contained therein. 45.
11
In response to Paragraph 45 of the Complaint, Defendant is without knowledge and
12
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
13
on that basis denies the allegations contained therein. 46.
14
In response to Paragraph 46 of the Complaint, Defendant is without knowledge and
15
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
16
on that basis denies the allegations contained therein. 47.
17
In response to Paragraph 47 of the Complaint, Defendant is without knowledge and
18
information sufficient to form a belief as to the truth of the allegations contained in this paragraph, and
19
on that basis denies the allegations contained therein.
20
D.
Plan Terms 48.
21
In response to Paragraph 48 of the Complaint, the allegations contained therein state legal
22
assertions, conclusions, and/or argument to which no response is required. To the extent this paragraph
23
makes any factual allegations against Defendant, Defendant denies those allegations. 49.
24
In response to Paragraph 49 of the Complaint, the allegations contained therein state legal
25
assertions, conclusions, and/or argument to which no response is required. To the extent this paragraph
26
makes any factual allegations against Defendant, Defendant denies those allegations.
27
///
28
/// 7 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 15
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 8 of 11
V.
1
CAUSE OF ACTION
2
COUNT 1:
3
[Claim for Benefits Pursuant to ERISA § 502(a)(1)(B)]
4 5 6
50.
In response to Paragraph 50 of the Complaint, Defendant re-alleges and incorporates by
reference herein its responses to the specific paragraphs re-alleged and incorporated by Plaintiff therein. 51.
In response to paragraph 51 of the Complaint, the allegations contained therein state legal
7
assertions, conclusions, and/or argument to which no response is required. To the extent this paragraph
8
makes any factual allegations against Defendant, Defendant denies those allegations.
9
52.
In response to paragraph 52 of the Complaint, Defendant denies it has violated or
10
continues to violate Plaintiff’s right to benefits. The other allegations contained therein state legal
11
assertions, conclusions, and/or argument to which no response is required. To the extent this paragraph
12
makes any factual allegations against Defendant, Defendant denies those allegations. PRAYER FOR RELIEF
13 14
53.
In response to paragraph 53 in the Prayer for Relief in Plaintiff’s Complaint, Defendant
15
denies Plaintiff is entitled to any relief sought from Defendant. Additionally, the allegations contained
16
therein state legal assertions, conclusions, and/or argument to which no response is required. To the
17
extent this paragraph makes any factual allegations against Defendant, Defendant denies those
18
allegations.
19
54.
In response to paragraph 54 in the Prayer for Relief in Plaintiff’s Complaint, Defendant
20
denies Plaintiff is entitled to any relief sought from Defendant. Additionally, the allegations contained
21
therein state legal assertions, conclusions, and/or argument to which no response is required. To the
22
extent this paragraph makes any factual allegations against Defendant, Defendant denies those
23
allegations.
24
55.
In response to paragraph 55 in the Prayer for Relief in Plaintiff’s Complaint, Defendant
25
denies Plaintiff is entitled to any relief sought from Defendant. Additionally, the allegations contained
26
therein state legal assertions, conclusions, and/or argument to which no response is required. To the
27
extent this paragraph makes any factual allegations against Defendant, Defendant denies those
28
allegations. 8 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 16
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 9 of 11
56.
1
In response to paragraph 56 in the Prayer for Relief in Plaintiff’s Complaint, Defendant
2
denies Plaintiff is entitled to any relief sought from Defendant. Additionally, the allegations contained
3
therein state legal assertions, conclusions, and/or argument to which no response is required. To the
4
extent this paragraph makes any factual allegations against Defendant, Defendant denies those
5
allegations. 57.
6
In response to paragraph 57 in the Prayer for Relief in Plaintiff’s Complaint, Defendant
7
denies Plaintiff is entitled to any relief sought from Defendant. Additionally, the allegations contained
8
therein state legal assertions, conclusions, and/or argument to which no response is required. To the
9
extent this paragraph makes any factual allegations against Defendant, Defendant denies those
10
allegations. 58.
11
In response to paragraph 58 in the Prayer for Relief in Plaintiff’s Complaint, Defendant
12
denies Plaintiff is entitled to any relief sought from Defendant. Additionally, the allegations contained
13
therein state legal assertions, conclusions, and/or argument to which no response is required. To the
14
extent this paragraph makes any factual allegations against Defendant, Defendant denies those
15
allegations. AFFIRMATIVE DEFENSES
16
Defendant asserts the following affirmative defenses and reserves the right to assert additional
17 18
affirmative defenses in accordance with applicable rules of civil procedure. FIRST AFFIRMATIVE DEFENSE
19 1.
20 21
Plaintiff’s Complaint, and each and every cause of action therein, fails to state facts
sufficient to constitute any cause of action against Defendant. SECOND AFFIRMATIVE DEFENSE
22 2.
23
Plaintiff has failed to state a claim upon which relief can be granted. THIRD AFFIRMATIVE DEFENSE
24 3.
25
At all relevant times, Defendants acted in accordance with the documents and instruments
26
governing AutoNation Benefits Company, Inc. Short Term Disability Plan.
27
///
28
/// 9 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 17
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 10 of 11
FOURTH AFFIRMATIVE DEFENSE
1 2 3
4.
Plaintiff's claims are barred because the claim determination was not arbitrary, capricious,
unreasonable, or made in bad faith. FIFTH AFFIRMATIVE DEFENSE
4 5 6
5.
Plaintiff's remedies for any alleged act or omission are limited solely to those provided
by ERISA. SIXTH AFFIRMATIVE DEFENSE
7 8
6.
Plaintiff’s claims are barred in whole or in part by the doctrine of waiver. SEVENTH AFFIRMATIVE DEFENSE
9 10
7.
Plaintiff’s claims are barred in whole or in part by the doctrine of estoppel. EIGHTH AFFIRMATIVE DEFENSE
11 12
8.
Plaintiff’s claims are barred by the doctrine of unjust enrichment. NINTH AFFIRMATIVE DEFENSE
13 14
9.
Plaintiff’s claims are barred by the applicable statute of limitations or similar time bar. TENTH AFFIRMATIVE DEFENSE
15 16 17
10.
exhaust any required administrative remedies prior to bringing this civil action. ELEVENTH AFFIRMATIVE DEFENSE
18 19 20
Plaintiff’s claims are barred for failing to satisfy administrative prerequisites and/or
11.
Plaintiff is guilty of undue delay in filing and prosecuting this suit, and accordingly, this
action is barred by the doctrine of laches. TWELFTH AFFIRMATIVE DEFENSE
21 22 23
12.
is barred in whole or in part by Plaintiff’s failure to mitigate his damages. THIRTEENTH AFFIRMATIVE DEFENSE
24 25
Any recovery on Plaintiff’s Complaint, or any purported cause of action alleged therein,
13.
Plaintiff did not exercise ordinary care on his own behalf, and his own acts and omissions
26
proximately caused and/or contributed to the loss, injury, damage, or detriment alleged by Plaintiff, and
27
Plaintiff’s recovery from Defendant, if any, should be reduced in proportion to the percentage of
28
Plaintiff’s negligence or fault. 10 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 18
Case 5:20-cv-01860-SVK Document 13 Filed 05/08/20 Page 11 of 11
FOURTEENTH AFFIRMATIVE DEFENSE
1 2 3
14.
Plaintiff could have avoided the alleged harm and/or damages alleged in the Complaint
with reasonable effort but failed to do so. FIFTEENTH AFFIRMATIVE DEFENSE
4 5
15.
Plaintiff’s purported claims are barred in that Plaintiff has assumed all risks. SIXTEENTH AFFIRMATIVE DEFENSE
6 7
16.
Defendant expressly reserves its right to amend its answer and to assert additional
8
affirmative defenses, and to supplement, alter, or change its answer and separate defenses upon the
9
revelation of more definitive facts by Plaintiff and/or upon Defendant’s further undertaking of discovery
10
and investigation of this matter.
11
WHEREFORE, Defendant prays for judgment as follows:
12
1.
That Plaintiff take nothing by the Complaint on file herein;
13
2.
That Plaintiff’s Complaint herein be dismissed in its entirety with prejudice;
14
3.
That Defendant recover their costs of suit herein, including their reasonable attorney’s
15
fees; and
16
4.
That the Court award such and further relief as it deems appropriate.
17 18 Dated: May 8, 2020
FISHER & PHILLIPS LLP
19 /s/ Christopher S. Alvarez By: ____________________________________ ALDEN J. PARKER CHRISTOPHER S. ALVAREZ MELISSA R. SHIMIZU
20 21 22
Attorneys for Defendant MATRIX ABSENCE MANAGEMENT, INC.
23 24 25 26 27 28
11 DEFENDANT MATRIX ABSENCE MANAGEMENT, INC.’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT FP 37783608.1
Ex. M, p. 19
Case 3:15-cv-00495-MHL Document 6 Filed 10/16/15 Page 1 of 9 PageID# 25
IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF VIRGINIA Richmond Division
LISA T. DAVIDSON,
) ) Plaintiff, ) v. ) ) MATRIX ABSENCE MANAGEMENT, ) INC., ) ) Defendant. ) ____________________________________)
Civil Action No. 3:15-CV-00495-MHL
DEFENDANT’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT Defendant, Matrix Absence Management, Inc. (“Defendant”), hereby responds to the Complaint filed by Plaintiff Lisa Davidson (“Plaintiff”) and states as follows: FIRST DEFENSE Defendant responds to the individually numbered paragraphs of the Complaint as follows: Nature of the Case 1.
Defendant admits that Plaintiff seeks relief pursuant to the Employee Retirement
Income Security Act of 1974, as amended (“ERISA”), 29 U.S.C. § 1001 et seq. However, Defendant specifically denies that Plaintiff is entitled to any such relief. Any remaining allegations in Paragraph 1 of the Complaint are denied. Parties 2.
Defendant lacks information sufficient to form a belief as to the truthfulness of the
allegations regarding Plaintiff’s residence contained in Paragraph 2 of the Complaint, and therefore denies the same. Defendant denies the allegations contained in the second sentence of Paragraph 2 as pled. Any remaining allegations in Paragraph 2 of the Complaint are denied.
LEGAL02/35895648v3
Ex. M, p. 20
Case 3:15-cv-00495-MHL Document 6 Filed 10/16/15 Page 2 of 9 PageID# 26
3.
Defendant admits that Plaintiff was, from time to time, a participant in the Long
Term Disability Income Plan for Employees of the Federal Reserve System (the “Plan”). Defendant admits only that it provides certain claim administrative services with respect to the Plan. Any remaining allegations in Paragraph 3 of the Complaint are denied. 4.
Defendant admits that it is a Delaware corporation that is authorized to conduct
business in the state of Virginia.
Defendant further admits that it provides certain claim
administrative services with respect to the Plan. However, Defendant specifically denies that it is the plan administrator. Any remaining allegations contained in Paragraph 4 of the Complaint are denied. 5.
Defendant admits that the Plan provides long term disability benefits for eligible
employees of the Federal Reserve System. Defendant specifically denies that it is the plan sponsor or plan administrator with respect to the Plan. Further, Defendant specifically denies that it funds or insures the Plan. Any remaining allegations contained in Paragraph 5 of the Complaint are denied. 6.
Defendant admits that it provides claim administrative services with respect to the
Plan. However, Defendant specifically denies that it is the plan sponsor or plan administrator with respect to the Plan. Further, Defendant specifically denies that it funds or insures the Plan. Any remaining allegations contained in Paragraph 6 of the Complaint are denied.
2 LEGAL02/35895648v3
Ex. M, p. 21
Case 3:15-cv-00495-MHL Document 6 Filed 10/16/15 Page 3 of 9 PageID# 27
Venue Defendant does not contest venue in this District at this time. Any remaining allegations contained in the unnumbered paragraph titled “Venue” of the Complaint are denied. Facts 7.
Defendant denies the allegations contained in the first sentence of Paragraph 7 as
pled. Plaintiff’s job description and duties are reflected in written documents, which speak for themselves. Defendant denies the allegations in Paragraph 7 of the Complaint to the extent that they are inconsistent with or misrepresent the contents of those documents. The remaining allegations contained in Paragraph 7 of the Complaint are denied. 8.
The allegations in Paragraph 8 of the Complaint purport to paraphrase provisions
of written documents, which speak for themselves. Defendant denies that Plaintiff has accurately or completely summarized the terms of those documents. Any remaining allegations contained in Paragraph 8 of the Complaint are denied. 9.
Defendant admits that Plaintiff was awarded disability benefits from the Social
Security Administration. However, Defendant specifically denies that Plaintiff is disabled under the terms of the Plan. The remaining allegations contained in Paragraph 9 of the Complaint are denied. 10.
Defendant admits that Plaintiff received disability benefits under the Plan from time
to time. Further, Defendant admits that Plaintiff’s claim for disability benefits was terminated on or around September 26, 2014. The decisions regarding Plaintiff’s claim for disability benefits are reflected in written documents, which speak for themselves. Defendant denies the allegations in Paragraph 10 of the Complaint to the extent that they are inconsistent with or misrepresent the
3 LEGAL02/35895648v3
Ex. M, p. 22
Case 3:15-cv-00495-MHL Document 6 Filed 10/16/15 Page 4 of 9 PageID# 28
contents of those documents. Any remaining allegations contained in Paragraph 10 of the Complaint are denied. 11.
The allegations contained in Paragraph 11 of the Complaint are denied.
12.
The allegations contained in Paragraph 12 of the Complaint are denied.
13.
The allegations contained in Paragraph 13 of the Complaint are denied.
14.
The allegations contained in Paragraph 14 of the Complaint are denied.
15.
Defendant admits that Plaintiff’s claim for disability benefits was terminated on or
around September 26, 2014.
The remaining allegations contained in Paragraph 15 of the
Complaint are denied. 16.
The allegations contained in Paragraph 16 of the Complaint are denied.
17.
Defendant admits Plaintiff appealed the termination of her claim for disability
benefits. Any remaining allegations contained in Paragraph 17 of the Complaint are denied. 18.
The allegations contained in Paragraph 18 of the Complaint are denied.
19.
The allegations contained in Paragraph 19 of the Complaint are denied.
20.
The allegations contained in Paragraph 20 of the Complaint are denied.
21.
Defendant admits that Plaintiff exhausted her administrative remedies with respect
to her claim for disability benefits. Any remaining allegations contained in Paragraph 21 of the Complaint are denied. 22.
The allegations contained in Paragraph 22 of the Complaint are denied.
23.
Defendant admits that the Plan requires participants to apply for Social Security
disability benefits. Further, Defendant admits that Plaintiff was awarded disability benefits from the Social Security Administration. However, the Plan terms and Plaintiff’s Social Security award are reflected in written documents, which speak for themselves. Defendant denies the allegations
4 LEGAL02/35895648v3
Ex. M, p. 23
Case 3:15-cv-00495-MHL Document 6 Filed 10/16/15 Page 5 of 9 PageID# 29
in Paragraph 23 of the Complaint to the extent that they are inconsistent with or misrepresent the contents of those documents. Any remaining allegations contained in Paragraph 23 of the Complaint are denied. 24.
The allegations contained in Paragraph 24 of the Complaint are denied.
25.
The allegations contained in Paragraph 25 of the Complaint are denied. Count I Denial of Disability Benefits
26.
Defendant incorporates by reference its prior responses to the allegations in
Paragraphs 1 through 25 of the Complaint. 27.
The allegations contained in Paragraph 27 of the Complaint are denied.
28.
The allegations contained in Paragraph 28 of the Complaint are denied.
29.
The allegations contained in Paragraph 29 of the Complaint are denied.
30.
The allegations contained in Paragraph 30 of the Complaint are denied. Count II Breach of ERISA Fiduciary Duties
31.
Defendant incorporates by reference its prior responses to the allegations in
Paragraphs 1 through 30 of the Complaint. 32.
The allegations contained in Paragraph 32 of the Complaint are denied.
33.
The allegations contained in Paragraph 33 of the Complaint are denied.
34.
The allegations contained in Paragraph 34 of the Complaint are denied.
35.
The allegations contained in Paragraph 35 of the Complaint are denied.
36.
Defendant admits that the Plan allows the Medical Board to examine any Totally
Disabled Participant and any Participant who has applied for benefits under the Plan. However,
5 LEGAL02/35895648v3
Ex. M, p. 24
Case 3:15-cv-00495-MHL Document 6 Filed 10/16/15 Page 6 of 9 PageID# 30
the Plan terms are reflected in written documents, which speak for themselves. Defendant denies the allegations in Paragraph 36 of the Complaint to the extent that they are inconsistent with or misrepresent the contents of those documents. The remaining allegations contained in Paragraph 36 of the Complaint are denied. 37.
Defendant admits that the Plan requires participants to apply for Social Security
disability benefits. However, the Plan terms are reflected in written documents, which speak for themselves. Defendant denies the allegations in Paragraph 37 of the Complaint to the extent that they are inconsistent with or misrepresent the contents of those documents. Any remaining allegations contained in Paragraph 37 of the Complaint are denied. 38.
The allegations contained in Paragraph 38 of the Complaint are denied. Count III Failure to Provide Documents Under ERISA
39.
Defendant incorporates by reference its prior responses to the allegations in
Paragraphs 1 through 38 of the Complaint. 40.
Defendant admits that ERISA § 502(c), 29 U.S.C. § 1132(c), allows the Court to
exercise discretion as to whether to award limited penalties when a plan administrator fails or refuses to comply with a request for information which such administrator is required by that subchapter of ERISA to furnish to a participant or beneficiary. Any remaining allegations contained in Paragraph 40 of the Complaint are denied. 41.
Defendant admits that Plaintiff requested certain documents from Defendant.
However, Plaintiff’s requests are reflected in written documents, which speak for themselves. Defendant denies the allegations in Paragraph 41 of the Complaint to the extent that they are
6 LEGAL02/35895648v3
Ex. M, p. 25
Case 3:15-cv-00495-MHL Document 6 Filed 10/16/15 Page 7 of 9 PageID# 31
inconsistent with or misrepresent the contents of those documents. The remaining allegations contained in Paragraph 41 of the Complaint are denied. 42.
The allegations contained in Paragraph 42 of the Complaint are denied.
43.
The allegations contained in Paragraph 43 of the Complaint are denied.
Answering the allegations contained in the “Wherefore” paragraph and sub-paragraphs AF following Paragraph 43 the Complaint, Defendant denies that Plaintiff is entitled to any judgment or relief. Any allegations not specifically admitted herein are hereby denied. SECOND DEFENSE Plaintiff’s claims, in whole or in part, fail to state a claim upon which relief can be granted. THIRD DEFENSE Plaintiff’s claims are barred as a result of her failure to satisfy the Plan’s terms. FOURTH DEFENSE Any benefits due under the Plan are subject to offset, integration or other deductions or adjustments in accordance with the Plan terms. FIFTH DEFENSE Plaintiff is limited to the evidence and arguments presented during the administrative process. SIXTH DEFENSE There is no vesting of benefits under the Plan, and thus Plaintiff may not recover the benefits for any future period of disability, but rather must provide periodic proof of any alleged continuing disability.
7 LEGAL02/35895648v3
Ex. M, p. 26
Case 3:15-cv-00495-MHL Document 6 Filed 10/16/15 Page 8 of 9 PageID# 32
SEVENTH DEFENSE Defendant is not a proper party to this suit because it does not insure, or otherwise fund, the benefits Plaintiff seeks and is not otherwise liable for such benefits. Matrix has no obligation to fund benefits. EIGHTH DEFENSE Plaintiff has failed to join a necessary or indispensable party. One or more entities within the Federal Reserve System self-fund the benefits Plaintiff seek and is or are necessary and/or indispensable parties to this action. WHEREFORE, having fully answered the Complaint, Defendant requests that the Court dismiss the same and enter an order awarding Defendant’s costs, attorney fees, and such other relief as the Court deems proper. This 16th day of October, 2015. Respectfully submitted, ________/s/ Marianne Roach Casserly Virginia Bar No. 45254 Counsel to Matrix Absence Management, Inc. ALSTON & BIRD LLP 950 F Street, NW Washington, DC 20004 Telephone: (202) 756-3379 Facsimile: (202) 654-4989 marianne.casserly@alston.com
8 LEGAL02/35895648v3
Ex. M, p. 27
Case 3:15-cv-00495-MHL Document 6 Filed 10/16/15 Page 9 of 9 PageID# 33
CERTIFICATE OF SERVICE This is to certify the foregoing DEFENDANT’S ANSWER AND AFFIRMATIVE DEFENSES TO PLAINTIFF’S COMPLAINT was filed using the CM/ECF system, which will automatically provide notice to the following attorneys of record by electronic means: John B. Mann John B Mann PC 2201 Libbie Ave Suite 200 Richmond, VA 23230 (804) 673-6600 Fax: 804-673-6604 Email: jmann@canfieldbaer.com This 16th day of October, 2015. Respectfully submitted, ________/s/ Marianne Roach Casserly Virginia Bar No. 45254 Counsel to Matrix Absence Management, Inc. ALSTON & BIRD LLP 950 F Street, NW Washington, DC 20004 Telephone: (202) 756-3379 Facsimile: (202) 654-4989 marianne.casserly@alston.com
9 LEGAL02/35895648v3
Ex. M, p. 28
Case 1:14-cv-00002-IMK Document 6 Filed 04/15/14 Page 1 of 9 PageID #: 26
IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF WEST VIRGINIA AT CLARKSBURG DEBORAH A. DOOLEY, Plaintiff, CIVIL ACTION No. 1:14-cv-2 (Judge Irene M. Keeley)
v.
MATRIX ABSENCE MANAGEMENT, INC. Defendant.
ANSWER, AFFIRMATIVE AND OTHER DEFENSES OF MATRIX ABSENCE MANAGEMENT, INC. COMES NOW Defendant Matrix Absence Management, Inc. (“Matrix” or “Defendant”), by counsel, and for its answer to Plaintiff’s Complaint hereby states as follows: GENERAL ALLEGATIONS A.
JURISDICTION 1.
Matrix admits the allegations contained in Paragraph A.(1) of the Complaint that
Plaintiff’s claim for short term disability (“STD”) benefits arise under an “employee welfare benefits plan” subject to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001, et seq. Matrix further admits the allegations contained in Paragraph A.(1) of the Complaint that Plaintiff’s employer, Mylan Pharmaceuticals, Inc. (“Mylan”), provides a short term disability plan (the “STD Plan”) pursuant to ERISA for covered employees who are otherwise eligible. Finally, Matrix admits the allegations contained in Paragraph A.(1) of the Complaint that jurisdiction is proper in this Court. 2.
Matrix admits the allegations contained in Paragraph A.(2) of the Complaint.
Ex. M, p. 29
Case 1:14-cv-00002-IMK Document 6 Filed 04/15/14 Page 2 of 9 PageID #: 27
B.
PARTIES. 3.
Upon information and belief, Matrix admits the allegations contained in
Paragraph B.(3). 4.
Matrix admits the allegations contained in Paragraph B.(4) of the Complaint that
it is the third party claim administrator for the STD Plan.
Matrix admits the allegations
contained in Paragraph B.(4) of the Complaint that it does business in the State of West Virginia, including Monongalia County, West Virginia. Matrix admits that the service of process address contained in Paragraph B.(4) is correct. C.
FACTUAL BACKGROUND. 5.
Paragraph C.(5) of the Complaint purports to summarize and/or explain Plaintiff’s
claims and allegations, and, as such, no response is required. However, Matrix denies that it is liable to Plaintiff for any claim asserted in the Complaint, or that the averments or claims set forth therein are accurate or viable. 6.
Matrix admits the allegations contained in Paragraph C.(6) of the Complaint.
7.
Matrix admits the allegations contained in Paragraph C.(7) of the Complaint.
8.
Matrix admits the allegations contained in Paragraph C.(8) of the Complaint.
9.
Matrix lacks knowledge or information sufficient to form a belief as to the truth of
the allegations contained in Paragraph C.(9) of the Complaint. 10.
Matrix admits that it denied Plaintiff’s claim for STD benefits as set forth in
Paragraph C.(10) of the Complaint.
Matrix denies the remaining allegations contained in
Paragraph C.(10) of the Complaint. 11.
Matrix admits the allegations contained in Paragraph C.(11) of the Complaint that
it denied Plaintiff’s appeal for STD benefits. As to the remainder of the allegations contained in Paragraph C.(11) of the Complaint, Matrix denies the same. 2
Ex. M, p. 30
Case 1:14-cv-00002-IMK Document 6 Filed 04/15/14 Page 3 of 9 PageID #: 28
12.
Matrix admits the allegations contained in Paragraph C.(12) of the Complaint to
the extent that it requested additional information to process Plaintiff’s claim. Matrix denies the remaining allegations contained in Paragraph C.(12) of the Complaint to the extent they attempt to aver that Matrix deviated from standard claim practice or that the information requested was somehow inappropriate. 13.
Matrix admits the allegations contained in Paragraph C.(13) of the Complaint that
it denied Plaintiff’s appeal for STD benefits on May 24, 2013. Matrix denies the remaining allegations contained in Paragraph C.(13) of the Complaint. 14.
Matrix admits the allegations contained in Paragraph C.(14) of the Complaint. FIRST CAUSE OF ACTION
[FOR RECOVERY OF PLAN BENEFITS, AGAINST DEFENDANT MATRIX PURSUANT TO 29 U.S.C. § 1132(a)(1)(B)] 15.
Defendant reincorporates and realleges its averments in response to Paragraphs
A.(1) through C.(14) of the Complaint as if fully set forth verbatim herein. 16.
Matrix denies the allegations contained in Paragraph (16) of the Complaint. By
way of further explanation, Plaintiff is only entitled to STD benefits if she meets the terms and conditions of the STD Plan. Inasmuch as Plaintiff failed to do so, Matrix was not obligated to provide Plaintiff with benefits of any kind. 17.
Matrix denies the allegations contained in Paragraph (17) of the Complaint.
18.
Matrix denies the allegations contained in Paragraph (18) of the Complaint.
19.
Matrix denies the allegations contained in Paragraph (19) of the Complaint.
20.
Matrix denies the allegations contained in Paragraph (20) of the Complaint.
21.
Matrix denies the allegations contained in Paragraph (21) of the Complaint.
3
Ex. M, p. 31
Case 1:14-cv-00002-IMK Document 6 Filed 04/15/14 Page 4 of 9 PageID #: 29
SECOND CAUSE OF ACTION [FOR AN AWARD OF ATTORNEYS’ FEES AND COSTS AGAINST ALL DEFENDANTS, PURSUANT TO 29 U.S.C. § 1132(g)(1)] 22.
Defendant reincorporates and realleges its averments in response to Paragraphs
A.(1) through (21) of the Complaint as if set forth verbatim herein. 23.
Matrix admits the allegations contained in Paragraph (23) of the Complaint.
24.
Matrix denies the allegations contained in Paragraph (24) of the Complaint. THIRD CAUSE OF ACTION
[VIOLATION OF WEST VIRGINIA UNFAIR TRADE PRACTICES ACT AND COMMON LAW BAD FAITH] 25.
Defendant reincorporates and realleges its averments in response to Paragraphs
A.(1) through (24) of the Complaint as if set forth verbatim herein. 26.
Matrix denies the allegations contained in Paragraph (26) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 27.
Matrix denies the allegations contained in Paragraph (27) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 28.
Matrix denies the allegations contained in Paragraph (28) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 29.
Matrix denies the allegations contained in Paragraph (29) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable.
4
Ex. M, p. 32
Case 1:14-cv-00002-IMK Document 6 Filed 04/15/14 Page 5 of 9 PageID #: 30
30.
Matrix denies the allegations contained in Paragraph (30) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 31.
Matrix denies the allegations contained in Paragraph (31) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 32.
Matrix denies the allegations contained in Paragraph (32) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 33.
Matrix denies the allegations contained in Paragraph (33) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 34.
Matrix denies the allegations contained in Paragraph (34) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 35.
Matrix denies the allegations contained in Paragraph (35) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 36.
Matrix denies the allegations contained in Paragraph (36) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 37.
Matrix denies the allegations contained in Paragraph (37) of the Complaint,
including subparts (a)-(i). The claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 5
Ex. M, p. 33
Case 1:14-cv-00002-IMK Document 6 Filed 04/15/14 Page 6 of 9 PageID #: 31
38.
Matrix denies the allegations contained in Paragraph (38) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 39.
Matrix denies the allegations contained in Paragraph (39) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 40.
Matrix denies the allegations contained in Paragraph (40) of the Complaint. The
claims asserted in the Third Cause of Action are completely preempted by ERISA, and, as such, are not viable. 41.
Matrix denies the allegations contained in the ad damnum clause of the
Complaint, and further denies that Plaintiff is entitled to any of the relief sought therein or anywhere in the Complaint. 42.
Matrix denies any allegation not expressly admitted herein. AFFIRMATIVE AND OTHER DEFENSES
Matrix asserts the following affirmative and other defenses: 1.
The Complaint fails to state a claim or cause of action upon which equitable relief
can be granted against Defendant. 2.
If Plaintiff is entitled to any relief as a result of this action, her relief is limited to
that which is provided under ERISA, together with the terms of the STD Plan, and such relief does not include an award of damages or future benefits. 3.
The decision to deny STD benefits to Plaintiff was pursuant to and consistent with
the terms of the STD Plan and relied upon the information available at the time of the decision. 4.
Plaintiff does not meet the eligibility requirements of the STD Plan.
6
Ex. M, p. 34
Case 1:14-cv-00002-IMK Document 6 Filed 04/15/14 Page 7 of 9 PageID #: 32
5.
Plaintiff’s claim is barred, in whole or in part, because Matrix at all times acted in
good faith and in the interest of the STD Plan’s participants and beneficiaries. 6.
Plaintiff is precluded from recovering anything under than the terms of the STD
Plan, ERISA and federal common law. 7.
Denial of Plaintiff’s claims for STD benefits should be upheld because Matrix’s
decision was not arbitrary and capricious and/or an abuse of discretion. 8.
If the Plaintiff is entitled to any STD benefits, any such payment must be reduced
and/or offset in accordance with the terms of the STD Plan. 9.
If the Court determines that the decision to deny benefits alleged in the Complaint
was incorrect, Plaintiff’s claims for STD benefits available beyond the date of that decision must be remanded to the STD Plan’s claim administrator for determination as to whether she continues to meet the STD Plan requirements for ongoing benefits after that date. 10.
Plaintiff has not shown any degree of success on the merits of this case, and, as
such, consideration of award of attorneys’ fees and costs is both premature and speculative. 11.
Matrix reserves the right to assert additional affirmative defenses, cross claims
and counterclaims in the event that discovery reveals that any such defenses are appropriate. 12.
Plaintiff’s Third Cause of Action is completely preempted by ERISA, and, as
such, should be dismissed. WHEREFORE, Defendant, Matrix Absence Management, Inc., respectfully requests that this Court enter judgment in its favor and against Plaintiff on her claims, award Defendant it’s attorneys’ fees and costs to cover the defense of this litigation pursuant to 29 U.S.C. § 1132(g), and grant Defendant such other and further relief as the Court deems just and proper.
7
Ex. M, p. 35
Case 1:14-cv-00002-IMK Document 6 Filed 04/15/14 Page 8 of 9 PageID #: 33
MATRIX ABSENCE MANAGEMENT, INC. /s/ Grant P. H. Shuman Grant P.H. Shuman (WV State Bar # 8856) Spilman Thomas & Battle, PLLC 300 Kanawha Boulevard, East (Zip 25301) PO Box 273 Charleston, WV 25321-0273 (304) 340-3800 (304) 340-3801 (facsimile) Email: gshuman@spilmanlaw.com Larissa C. Dean (WV State Bar #10383) Spilman Thomas & Battle, PLLC 48 Donley Street, Suite 800 PO Box 615 Morgantown, WV 26508-0615 (304) 291-7924 (304) 291-7979 (facsimile) Email: ldean@spilmanlaw.com
8
Ex. M, p. 36
Case 1:14-cv-00002-IMK Document 6 Filed 04/15/14 Page 9 of 9 PageID #: 34
IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF WEST VIRGINIA AT CLARKSBURG DEBORAH A. DOOLEY, Plaintiff, CIVIL ACTION No. 1:14-cv-2 (Judge Irene M. Keeley)
v.
MATRIX ABSENCE MANAGEMENT, INC. Defendant.
CERTIFICATE OF SERVICE I, Grant P. H. Shuman, counsel for Matrix Absence Management, Inc., hereby certify that on April 15, 2014, I electronically filed the foregoing Answer, Affirmative and Other Defenses of Matrix Absence Management, Inc. with the Clerk of the Court using the CM/ECF system, which will send notification of such filing to the following:
Erika Klie Kolenich (WV State Bar # 9880) Christina Joann Rumbach (WV State Bar # 10550) Klie Law Offices, PLLC 85 W. Main Street Buckhannon, WV 26201 ehklie@klielawoffices.com crumback@klielawoffices.com
/s/ Grant P. H. Shuman Grant P.H. Shuman (WV State Bar # 8856)
Ex. M, p. 37
