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Ratna Prabhakar v. Life Insurance Company of North

March 8, 2011


The opinion of the court was delivered by: Dora L. Irizarry, United States District Judge


Pro se plaintiff, Ratna Prabhakar, filed the instant action against defendant, Life Insurance Company of North America ("LINA"), pursuant to the Employee Retirement Income Security Act of 1974 ("ERISA") alleging that defendant improperly terminated her long term disability benefits. Defendant filed the instant motion seeking dismissal, pursuant to Fed. R. Civ. P. 12(b)(6), for failure to state a claim upon which relief may be granted. Plaintiff opposed the motion. For the reasons set forth below, defendant's motion is denied.*fn1


Plaintiff sustained injuries to her head and right leg while working at State Farm Insurance Company ("State Farm") on December 12, 1989. (Compl. ¶ 1.) As a result, plaintiff was diagnosed as permanently disabled and unable to perform any type of work in any capacity. (Compl. ¶ 2.) Plaintiff's doctor also found that there was no available treatment which would allow plaintiff to return to work. (Id.) During subsequent visits to psychiatrists, plaintiff was diagnosed with "Organic Mental Disorder secondary to concussion, affective type and Organic Mood Disorder," and symptoms of "diffuse brain dysfunction," "severe depression and anxiety" and "organic mental syndrome." (Compl. ¶ 3-4.)

Plaintiff obtained disability insurance coverage from LINA through her employment with State Farm. Plaintiff received the disability benefits from LINA from March 17, 1991 until December 12, 2003, at which time LINA ceased to provide benefits to plaintiff because "the weight of evidence in plaintiff's claim file d[id] not support [her] inability to perform [her] regular occupation or any occupation." (Compl. ¶ 6, 8.)

Plaintiff appealed LINA's decision to deny benefits to plaintiff, but LINA denied all three appeals. (Compl. ¶ 9.) LINA denied the final appeal on March 10, 2005 because it determined that it lacks medical evidence to support a finding that plaintiff is "totally disabled" from her occupation, thus plaintiff does not meet the definition of "disability" and does not qualify for long term disability benefits. (Compl., Ex. E.) Plaintiff claims that her condition has continued to decline and that she sent LINA evidence of all reports and notes indicating such decline. (Compl. ¶ 12.) Plaintiff brought this complaint on December 16, 2009 for reimbursement of all past disability payments, interest and costs, due to LINA's violation of plaintiff's long term disability contract under the State Farm group insurance plan. (See Compl. ¶ 15.)

Defendant now moves to dismiss plaintiff's complaint as time-barred pursuant to Fed. R. Civ. P. 12(b)(6), because the insurance policy includes a three-year limitations period for plaintiff to bring a legal action. As the final denial of claims occurred on March 10, 2005 and the complaint was brought four and a half years later, defendant argues that plaintiff's claims are time-barred. Plaintiff, however, alleges that the version of the policy she received from State Farm did not contain a limitations period for bringing a legal action, thus the six-year statutory limitations period applies and plaintiff's claims are timely.


I.Legal Standards

Rule 12(b)(6) of the Federal Rules of Civil Procedure states that a defendant may move, in lieu of an answer, for dismissal of a complaint for "failure to state a claim upon which relief can be granted." Fed. R. Civ. P. 12(b)(6). To determine whether dismissal pursuant to Fed. R. Civ. P. 12(b)(6) is appropriate, "a court must accept as true all [factual] allegations contained in a complaint" but need not accept "legal conclusions." Ashcroft v. Iqbal, 129 S.Ct. 1937, 1949 (2009). For this reason, "[t]hreadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice" to insulate a claim against dismissal. Id. Moreover, "[t]o survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to 'state a claim to relief that is plausible on its face.' " Id. (quoting Bell Atlantic v. Twombly, 550 U.S. 544, 570 (2007)). "[W]here the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint . . . has not shown that the pleader is entitled to relief." Id. at 1950 (internal citations and quotation marks omitted).

In reviewing plaintiff's complaint, the court is mindful that, "a pro se complaint, however inartfully pleaded, must be held to less stringent standards than formal pleadings drafted by lawyers." Erickson v. Pardus, 551 U.S. 89, 94 (2007). A district court must nevertheless dismiss an in forma pauperis action when it fails to state a claim on which relief can be granted.

28 U.S.C. § 1915(e)(2)(B)(ii) (1996).

II. Analysis

A.Statute of Limitations for ...

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