United States District Court, D. Maine
COLON L. CARTER, Plaintiff
AETNA LIFE INSURANCE COMPANY, Defendant
DECISION AND ORDER ON PLAINTIFF'S MOTION TO
C. Nivison U.S. Magistrate Judge
Colon L. Carter alleges Defendant Aetna Life Insurance
Company has unlawfully denied Plaintiff's claim for
benefits under the long term disability insurance policy
Defendant issued to and through Plaintiff's employer,
Bath Iron Works. Plaintiff asserts the policy is governed by
the Employee Retirement Income Security Act (ERISA).
matter is before the Court on Plaintiff's Motion to Amend
the Complaint. (ECF No. 16.) Through the motion, Plaintiff
seeks leave to amend the pleadings to assert that
Plaintiff's claim is governed by a de novo standard of
full-time employee of Bath Iron Works, Plaintiff was insured
under a long term disability (LTD) policy issued by Defendant
to Bath Iron Works. (Complaint ¶ 6.) Plaintiff alleges
that he qualified for LTD insurance benefits under the policy
beginning on or about January 11, 2016. (Id.
¶¶ 19 - 28, 31.) Defendant denied Plaintiff's
claim for benefits. (Id. ¶ 10.) Plaintiff
contends Defendant's denial of benefits “was
arbitrary and capricious.” (Id. ¶ 30.)
Court issued a scheduling order on December 12, 2017, which
order established January 8, 2018, as the deadline for filing
the administrative record, and February 22, 2018, as the
deadline for the amendment of the pleadings. (ECF No. 9.) On
the parties' joint motion, the Court extended the
deadline for the filing of motions for judgment on the record
to March 22, 2018. (ECF No. 13.) After Plaintiff filed the
motion to amend on March 20, 2018, the Court deferred the
deadline to file motions for judgment until after the Court
resolves the motion to amend. (ECF No. 18.)
asserts that a de novo review of the denial of his claim for
benefits is warranted because Defendant did not have
discretion under the applicable policy or plan. Defendant
opposes the motion to amend based on Plaintiff's failure
to file a proposed amended complaint, Plaintiff's failure
to demonstrate good cause for the amendment at this stage of
the proceedings, and the futility of the proposed amendment.
(ECF No. 20.)
15(a)(1) of the Federal Rules of Civil Procedure permits a
litigant to amend a pleading “as a matter of
course” subject to certain time constraints. However,
when a party seeks to amend a complaint more than 21 days
after the filing of a responsive pleading, the other
party's consent or leave of court is required in order to
amend the complaint. Fed.R.Civ.P. 15(a)(2). In such a case,
the court is to grant leave to amend “freely”
when “justice so requires.” Id.; see
also Foman v. Davis, 371 U.S. 178, 182 (1962) (“In
the absence of any apparent or declared reason-such as undue
delay, bad faith or dilatory motive on the part of the
movant, repeated failure to cure deficiencies by amendments
previously allowed, undue prejudice to the opposing party by
virtue of allowance of the amendment, futility of amendment,
etc.-the leave sought should, as the rules require, be
standard is elevated when the motion to amend is filed after
the court's scheduling order deadline for amendment of
pleadings. A motion to amend that is filed beyond the
deadline established in a scheduling order requires an
amendment of the scheduling order. To obtain an amendment of
the scheduling order, a party must demonstrate good cause.
Johnson v. Spencer Press of Maine, Inc., 211 F.R.D.
27, 30 (D. Me. 2002); El-Hajj v. Fortis Benefits Ins.
Co., 156 F.Supp.2d 27, 34 (D. Me. 2001); Fed.R.Civ.P.
16(b)(4). A court's decision on good cause “focuses
on the diligence (or lack thereof) of the moving party more
than it does on any prejudice to the party-opponent.”
Steir v. Girl Scouts of the USA, 383 F.3d 7, 12 (1st
Cir. 2004). “Particularly disfavored are motions to
amend whose timing prejudices the opposing party by
‘requiring a re-opening of discovery with additional
costs, a significant postponement of the trial, and a likely
major alteration in trial tactics and strategy.'”
Id. (quoting Acosta-Mestre v. Hilton Int'l
of P.R., Inc., 156 F.3d 49, 52 (1st Cir. 1998)).
Ultimately, a court has discretion whether to grant a motion
to amend, and that discretion should be exercised on the
basis of the particular facts and circumstances of the case.
standard of review in an ERISA claim is based in part on a
review of the plan and thus is necessarily included in a
court's assessment of the merits of a claim:
In ERISA cases, an inquiring court must peruse the plan
documents in order to determine the standard of judicial
review applicable to a claims administrator's denial of
benefits. See Firestone Tire & Rubber Co. v.
Bruch, 489 U.S. 101, 115 (1989). A challenge to a denial
of benefits is to be reviewed de novo “unless the
benefit plan gives the administrator or fiduciary
discretionary authority to determine eligibility for benefits
or to construe the terms of the plan.” Id. But
where the plan documents grant the claims administrator full
discretionary authority, the decision is reviewed for abuse
of discretion. See Id. at 111; Colby v. Union
Sec. Ins. Co. & Mgmt. Co. for Merrimack Anesthesia
Assocs. LTD Plan, 705 F.3d 58, 61 (1st Cir. 2013).
McDonough v. Aetna Life Ins. Co., 783 F.3d 374, 379
(1st Cir. 2015) (observing that even the deferential standard
“is not without some bite, ” particularly where
the defendant “suffers from a structural conflict of
interest”). The First Circuit has explained that the de
novo review standard is the “default” standard,
unless the court determines otherwise in the course of its
review of the claim. Rodriguez-Lopez v. Triple-S Vida,
Inc., 850 F.3d 14, 20 (1st Cir. 2017).
Court's view, because the standard of review is derived
in part from an assessment of the plan documents, which the
Court will review as part of its assessment of the merits of
the claim, the Court would typically determine the applicable
standard of review as part of its analysis of the merits of
the claim. Indeed, the parties will presumably address the
applicable standard of the review in their motions for
judgment. Plaintiff's motion, therefore, is unnecessary.
That is, an amendment to the complaint is not required ...