WILLIAMS v. SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

IN THE UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF NORTH CAROLINA

LATONIA WILLIAMS, )

)

Plaintiff, )

)

v. ) 1:22CV570

)

SEDGWICK CLAIMS MANAGEMENT )

SERVICES, INC. AND )

UNITEDHEALTH GROUP INC., )

)

Defendants. )

MEMORANDUM OPINION AND ORDER

LORETTA C. BIGGS, District Judge.

Plaintiff Latonia Williams, proceeding pro se,1 initiated this action against Defendants

Sedgwick Claims Management Services, Inc., and UnitedHealth Group Inc. (ECF No. 5.)

The Court construes the Complaint as alleging disability discrimination under the Americans

with Disabilities Act (“ADA”), 42 § U.S.C. 12101 et seq., and wrongful denial of benefits under

the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001 et seq. Before the

Court is Defendants’ Motion to Dismiss pursuant to Rules 12(b)(1) and 12(b)(6) of the Federal

Rules of Civil Procedure. (ECF No. 9.) For the reasons stated herein, Defendants’ motion

will be granted.

1 Williams is a pro se litigant, and the Court must construe her Complaint liberally, permitting a

potentially meritorious case to develop if one is present. Chrisp v. Univ. of N.C.-Chapel Hill, 471 F.

Supp. 3d 713, 715–16 (M.D.N.C. 2020) (citing Erickson v. Pardus, 551 U.S. 89, 94 (2007)). “However,

I. BACKGROUND

Plaintiff Williams was an employee of Defendant UnitedHealth Group Inc.

(“UnitedHealth”) beginning in November 2021. (ECF No. 5 at 2.) At some point during that

employment, Plaintiff was a “high risk patient at Duke Prenatal in Durham” and therefore

received short-term disability from February 18, 2022, to April 15, 2022. (Id.)

Plaintiff then attempted to extend her short-term disability due to continued medical

issues. (Id.) However, on June 10, 2022, Plaintiff’s claim was denied by Defendant Sedgwick

Claims Management Services, Inc. (“Sedgwick”). (Id.) Plaintiff alleges that a representative of

Sedgwick informed her that “the paperwork wasn’t sufficient enough.” (Id.) After the denial

of her short-term disability, Plaintiff took a variety of actions, including contacting the U.S.

Department of Labor and North Carolina Department of Labor. (Id. at 3.)

Plaintiff alleges several grievances stemming from the denial of her short-term

disability, including that it “threaten[s] [her] home and living arrangements with [her] baby”

(who Plaintiff describes as being born “3 months early with underlying conditions”). (Id.)

Plaintiff further states that Defendants’ actions “played a part of [Plaintiff] being evicted” and

forced her into “survival mode.” (Id. at 4.)

II. STANDARDS OF REVIEW

A. Rule 12(b)(1)

Under Rule 12(b)(1), a party may seek dismissal based on the court’s “lack of subject-

matter jurisdiction.” Fed. R. Civ. P. 12(b)(1). Subject-matter jurisdiction is a threshold issue

that relates to the court’s power to hear a case and must be decided before a determination on

the merits of the case. Constantine v. Rectors & Visitors of George Mason Univ., 411 F.3d 474, 479–

80 (4th Cir. 2005). Generally, a motion under Rule 12(b)(1) raises the question of “whether

to hear and dispose of [the] claim.” Holloway v. Pagan River Dockside Seafood, Inc., 669 F.3d 448,

452 (4th Cir. 2012). The burden of proving subject-matter jurisdiction rests with the plaintiff.

Adams v. Bain, 697 F.2d 1213, 1219 (4th Cir. 1982).

B. Rule 12(b)(6)

A motion to dismiss under Rule 12(b)(6) “challenges the legal sufficiency of a

complaint,” including whether it meets the pleading standard of Rule 8(a)(2). See Francis v.

Giacomelli, 588 F.3d 186, 192 (4th Cir. 2009). Rule 8(a)(2) requires a complaint to contain “a

short and plain statement of the claim showing that the pleader is entitled to relief,” Fed. R.

Civ. P. 8(a)(2), thereby “giv[ing] the defendant fair notice of what the . . . claim is and the

grounds upon which it rests,” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 545 (2007) (quoting

Conley v. Gibson, 355 U.S. 41, 47 (1957)). To survive a Rule 12(b)(6) 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.’” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Twombly, 550

U.S. at 570). In assessing a claim’s plausibility, a court must draw all reasonable inferences in

the plaintiff’s favor. Vitol, S.A. v. Primerose Shipping Co., 708 F.3d 527, 539 (4th Cir. 2013). A

claim is plausible when the complaint alleges facts that allow the court “to draw the reasonable

inference that the defendant is liable for the misconduct alleged.” Iqbal, 556 U.S. at 678.

However, “mere conclusory and speculative allegations” are insufficient, Painter’s Mill Grille,

LLC v. Brown, 716 F.3d 342, 350 (4th Cir. 2013), and a court “need not accept as true

unwarranted inferences, unreasonable conclusions, or arguments,” Vitol, 708 F.3d at 548

(quoting Jordan v. Alt. Res. Corp., 458 F.3d 332, 338 (4th Cir. 2006)).

III. DISCUSSION

A. ADA Claim

Defendants argue that the Complaint “fails to demonstrate how Defendants

purportedly violated the law or otherwise engaged in conduct supporting [Plaintiff’s] claims.”

(ECF No. 10 at 6.) Defendants maintain that Plaintiff “failed to allege facts sufficient to state

all the elements of any legally cognizable claim, including those that may arise under ERISA

or the ADA,” thus the Complaint must be dismissed. (Id.) Defendants last contend that the

“Complaint also fails to allege that Plaintiff complied with the administrative prerequisites to

filing suit under the ADA.” (Id.) Specifically, Defendants argue that the Complaint “does not

allege that Plaintiff filed an EEOC charge, or otherwise exhausted her administrative remedies

by demonstrating that she was issued a right to sue letter as required to bring an ADA claim.”

(Id. at 7.)

In her response, Plaintiff does not respond to any of these arguments directly. (ECF

No. 13.) Instead, Plaintiff relists the various hardships she allegedly experiences as a result of

the denial of her short-term disability benefits, (id. at 4–5), and reiterates the various agencies

and representatives she has contacted about her issues, (id. at 6).

To raise an ADA claim in federal court, a plaintiff must first exhaust her administrative

remedies by filing a timely charge with the EEOC. See McCullough v. Branch Banking & Tr. Co.,

35 F.3d 127, 131 (4th Cir. 1994). To qualify as timely, a charge must be filed by the plaintiff

within 180 days of the alleged discriminatory incident. 42 U.S.C. § 2000e–5(e)(1); J.S. ex rel.

Duck v. Isle of Wight Cnty. Sch. Bd., 402 F.3d 468, 475 n.12 (4th Cir. 2005). Here, Plaintiff

Williams makes no allegations that she exhausted her administrative remedies regarding her

ADA claim. There is no indication in the Complaint that Plaintiff ever filed a charge with the

EEOC or was issued a notice of right to sue. Accordingly, this Court must dismiss Plaintiff’s

ADA claim.

As an alternative grounds for dismissal, the Court likewise finds that Plaintiff fails to

plausibly state an ADA discrimination claim. To establish a claim for disability discrimination,

a plaintiff must show “(1) that she has a disability, (2) that she is a ‘qualified individual’ for the

employment in question, and (3) that [her employer] discharged her (or took other adverse

employment action) because of her disability.” Jacobs v. N.C. Admin. Off. of the Cts., 780 F.3d

562, 572 (4th Cir. 2015) (quoting EEOC v. Stowe–Pharr Mills, Inc., 216 F.3d 373, 377 (4th Cir.

2000)). To survive a motion to dismiss, Plaintiff must therefore “plead facts that permit the

court to reasonably infer each element of the prima facie case.” Schmitz v. Alamance-Burlington

Bd. of Educ., No. 18-CV-910, 2020 WL 924545, at *4 (M.D.N.C. Feb. 26, 2020).

Here, it is not clear from the Complaint what Plaintiff alleges as her disability or medical

condition. Plaintiff only alleges that she was a “high risk patient at Duke Prenatal in Durham,”

(ECF No. 5 at 2), and experienced “continued pain,” (id.). From these facts alone, the Court

cannot infer a disability under the ADA. See 42 U.S.C. § 12102(1)(A) (defining a disability as

“a physical or mental impairment that substantially limits one or more major life activities”).

It is similarly unclear whether Plaintiff was discharged or suffered any adverse employment

action. The Complaint focuses primarily on the alleged struggles Plaintiff has experienced

because of her short-term disability being denied and other generalized grievances. (ECF No.

5 at 3–4.) In sum, Plaintiff has failed to provide sufficient allegations from which the Court

can infer that any of the elements of an ADA discrimination claim are satisfied. The Court

finds that Plaintiff’s Complaint fails under Rule 12(b)(6) for failure to state a claim, and

Plaintiff’s ADA claim must be dismissed.

B. ERISA Claim

In response to Plaintiff’s purported ERISA claim, Defendants also argue that Plaintiff

has “failed to plead sufficient facts to establish any legally cognizable claim” and that the

Complaint “fails to demonstrate how Defendants purportedly violated the law or otherwise

engaged in conduct supporting her claims.” (ECF No. 10 at 6.) Additionally, Defendants

argue that Plaintiff’s failure to exhaust her administrative remedies warrants dismissal. (Id. at

7.) Defendants note that “[w]hile the Complaint references a denial of short-term disability

benefits and subsequent appeal of the same . . . it does not allege that she received any final

decision or otherwise exhausted plan remedies prior to filing suit.” (Id.) Further, “based on

the documentation attached to the Complaint, it appears that Plaintiff’s appeal is currently

pending.” (Id.)

In general, an ERISA plan participant “must both pursue and exhaust plan remedies

before gaining access to the federal courts.” Gayle v. United Parcel Serv., Inc., 401 F.3d 222, 226

(4th Cir. 2005); see also Makar v. Health Care Corp. of Mid–Atl. (CareFirst), 872 F.2d 80, 82 (4th

Cir. 1989) (“This exhaustion requirement rests upon the Act’s text and structure as well as the

strong federal interest encouraging private resolution of ERISA disputes.”). A failure to

exhaust administrative remedies may be excused if any attempt to pursue those remedies

would be futile. This exception, however, is narrow and before the exhaustion requirement

may be waived on this basis, the plan participant must make a “clear and positive” showing of

futility. Kunda v. C.R. Bard, Inc., 671 F.3d 464, 471–72 (4th Cir. 2011).

Under ERISA, however, the exhaustion of administrative remedies is considered an

affirmative defense, making a Rule 12(b)(6) motion the improper vehicle for Defendants’

challenge. See, e.g., Rogers v. UnitedHealth Grp., Inc., 144 F. Supp. 3d 792, 802–03 (D.S.C. 2015).

This Court cannot base its dismissal of an ERISA claim at this stage on an affirmative defense.

“The burden of establishing an affirmative defense rests with the defendant, and ‘a motion to

dismiss filed under [Rule] 12(b)(6) . . . generally cannot reach the merits of an affirmative

defense.’” Taylor v. Oak Forest Health & Rehab., LLC, No. 11-CV-471, 2013 WL 4505386, at

*3 (M.D.N.C. Aug. 22, 2013) (quoting Goodman v. Praxair, Inc., 494 F.3d 458, 464 (4th Cir.

2007) (en banc)). Thus, the Court cannot grant Defendants’ motion on these grounds.

Nonetheless, the Court finds that because Plaintiff has failed to state a claim, dismissal

is still appropriate. Apart from mentioning the denial of short-term disability, the Complaint

does not explicitly reference ERISA or specify any statutory provision in which Plaintiff brings

her claim. The Court construes the Complaint, at best, as a wrongful denial of benefits claim

related to 29 U.S.C. § 1132(a)(1)(B). That said, Plaintiff’s Complaint is wholly deficient with

respect to such a claim. The Complaint is devoid of any allegations that the benefit in question

is covered by ERISA or that Plaintiff is a participant or a beneficiary under an ERISA plan,

let alone that the determination of Plaintiff’s claim for benefits was wrongful. Accordingly,

Williams has failed to plausibly state any claim for relief under ERISA and her claims must

and will be dismissed.

For the reasons stated herein, the Court enters the following:

ORDER

IT IS THEREFORE ORDERED that Defendants’ Motion to Dismiss, (ECF No.

9), is GRANTED. This action is hereby DISMISSED, and a Judgment in favor of

Defendants will be filed contemporaneously with this Memorandum Opinion and Order.

This, the 1st day of March 2023.

/s/ Loretta C. Biggs