Opinion
Case No. 03-60215.
June 22, 2004
OPINION AND ORDER OF THE COURT DISMISSING PLAINTIFF'S ERISA COMPLAINT WITHOUT PREJUDICE FOR FAILURE TO EXHAUST ADMINISTRATIVE REMEDIES
I. INTRODUCTION
On October 9, 2003, Plaintiff filed a lawsuit in this Court challenging Defendant's termination of her disability benefits under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001, et seq. Now before the Court are Plaintiff's Motion to Reverse Defendant's ERISA Determination and Defendant's Fed.R.Civ.P. 58 Motion for Entry of Judgment. In its Motion for Entry of Judgment, Defendant argues, inter alia, that Plaintiff failed to exhaust administrative remedies, because she did not complete a second appeal of Defendant's termination decision. Plaintiff argues that she exhausted her administrative remedies, but does not dispute that she failed to complete her second appeal. For the reasons stated below the Court DISMISSES Plaintiff's complaint WITHOUT PREJUDICE.
Even though the ERISA statute does not contain an explicit administrative exhaustion requirement, courts have routinely held that "the administrative scheme of ERISA requires a participant to exhaust his or her administrative remedies prior to commencing suit in federal court." Miller v. Metropolitan Life Ins. Co., 925 F.2d 979, 986 (6th Cir. 1991); 29 U.S.C. § 1333(2) (requiring benefit plans to maintain internal dispute resolution procedures); 29 U.S.C. § 1133(2) (requiring benefit plan to afford reasonable opportunity to plan participant whose claim has been denied for full and fair review of decision denying claim). Typically, where a plan participant fails to exhaust administrative remedies, her federal complaint should be dismissed without prejudice. Hill v. Blue Cross and Blue Shield of Mich., 299 F. Supp.2d 742, 754 n. 10 (E.D. Mich. 2003) ("when a district court dismisses an action due to a plaintiff's failure to exhaust administrative remedies and does not dismiss it on the merits of the plaintiff's claims, the district court should dismiss the action without prejudice") (citation omitted).
A participant's failure to exhaust may be excused only "where resorting to the plan's administrative procedure would simply be futile or the remedy inadequate." Fallick v. Nationwide Mut. Ins. Co., 162 F.3d 410, 419 (6th Cir. 1998) (citation omitted). This exception will apply only where "a clear and positive indication of futility can be made." Id. (citation omitted). The plaintiff must show that "it is certain that [her] claim will be denied on appeal, not merely that [she] doubts that an appeal will result in a different decision." Id. (citation omitted).
Here, the following facts are undisputed. In a letter dated July 2, 2002, Defendant denied Plaintiff's first appeal of its decision to terminate her long-term disability benefits. (Administrative Record, p. 0066). Defendant's denial letter informed Plaintiff of her right to a second appeal. (Id.) On August 20, 2002, Plaintiff notified Defendant that she would be submitting a second appeal. (AR 0060). The parties exchanged correspondence over the next several months, and until July 9, 2003, Plaintiff's counsel informed Defendant that it would continue to send additional medical reports from Plaintiff's doctors. (AR 0035). However, October 9, 2003, before the second appeal could be completed, Plaintiff filed the present lawsuit in this Court.
Because Plaintiff does not dispute these facts, the Court rejects her unsubstantiated argument that she exhausted her administrative remedies. Clearly, Plaintiff did not exhaust her remedies because she did not complete her second appeal. Plaintiff makes no effort to justify her failure to exhaust as futile. Therefore, the Court will dismiss Plaintiff's complaint without prejudice, and will not address the merits of the parties' motions. Plaintiff may refile her complaint after she exhausts her administrative remedies.
IT IS SO ORDERED.