The decision by U.S. District Judge Esther Salas handed a victory to Gabrielle McCauley and Sean McCauley, who sued MetLife after the insurer turned them down for benefits because of their father’s pre-existing heart condition. The insurer also refused their request for a copy of James McCauley’s policy but included it as a document in its dismissal motion to bolster its argument that the McCauley siblings’ suit was barred by the policy’s contractual two-year time limit to sue.
Rejecting MetLife’s dismissal motion, Judge Salas invoked the Third Circuit’s 1997 decision in In re Burlington Coat Factory Securities Litigation , in which the court held that a judge generally can’t consider documents outside the pleadings when considering a dismissal motion.
However, Judge Salas also noted, a court may consider a document outside of the pleadings if it’s “integral to or explicitly relied upon in the complaint,” as set forth in a New Jersey federal court’s decision in Jeffrey Rapaport M.D., P.A. v. Robin S. Weingast & Associates Inc.
But the children hadn’t reviewed the policy until after it was produced in the dismissal motion, in which the insurer argued that the suit would have had to have been filed by March 2013, and the children’s complaint “clearly states” they hadn’t had a copy, Judge Salas reasoned.
“Applying this underlying rationale to the instant matter, the court finds that it cannot rely on the alleged copy of the policy, which is the entire basis of defendant’s motion to dismiss. While the complaint is based on the allegation that plaintiffs’ father had a [Federal Employees’ Group Life Insurance] policy, defendant admits that the complaint references plaintiffs’ requests for a copy of the policy, which defendant refused to grant,” the decision said.
The incident at the root of the insurance claim happened on Dec. 26, 2010, when James McCauley was on duty at the USPS’s bulk mail center in Jersey City, New Jersey, the decision said. McCauley went outside the facility that day, in which a “blizzard-like” storm raged, and was later found facedown in the snow, dead.
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