- 1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 Jerry T Collen, et al., No. CV-19-05692-PHX-MTL 10 Plaintiffs, ORDER 11 v. 12 UnitedHealthCare Insurance Company, et al., 13 Defendants. 14 15 Plaintiff Elizabeth Collen and her husband, Jerry, (collectively the “Collens”) have 16 sued their employer-sponsored healthcare insurer United Healthcare Insurance Company 17 (“United”). It is alleged in the Amended Complaint (Doc. 7) that United wrongfully denied 18 coverage for healthcare services. The Amended Complaint asserts two claims for relief: 19 (1) “Violation of ERISA: Improper Denial of Rights and Breach of Fiduciary Duty” and 20 (2) “Misrepresentation and Detrimental Reliance.” (Id. at 4.) The Employee Retirement 21 Income Security Act of 1974 (“ERISA”) governs employer-sponsored benefits such as the 22 healthcare plan at issue in this case. United moves to dismiss based on ERISA preemption 23 and pleading insufficiencies. (Doc. 9.) The Court will grant the Motion. 24 I. 25 The Motion seeks dismissal of the Collens’ ERISA-based claim for relief under Bell 26 Atlantic Corp. v. Twombly, 550 U.S. 544 (2009), because it fails to “raise a right to relief 27 above the speculative level.” Id. at 555. The Court agrees. ERISA § 502(a) provides 28 exclusive civil remedies for plaintiffs. The Amended Complaint, however, does not assert 1 critical facts to provide United with notice of the ERISA claim. This includes asserting 2 plan provisions that the Collens contend that United violated. In their Response brief, the 3 Collens admit that their Amended Complaint lacks this detail because they did not have 4 the “plans or documents” from which to assert their claim. (Doc. 12 at 2.) The Collens’ 5 ERISA-based claim for relief will be dismissed with leave to assert a proper civil remedy 6 under § 502(a).* 7 The Collens assert an ERISA-based claim for breach of fiduciary duty and United 8 argues that it fails as a matter of law. “The claim for fiduciary breach gives a remedy for 9 injuries to the ERISA plan as a whole, but not for injuries suffered by individual 10 participants as a result of a fiduciary breach.” Wise v. Verizon Communications, Inc., 600 11 F.3d 1180, 1189 (9th Cir. 2010). A breach of fiduciary duty claim, moreover, must assert 12 that “the fiduciary injured the benefit plan or otherwise jeopardized the entire plan or put 13 at risk plan assets.” Id. (citation and internal quotation marks omitted). This lawsuit arises 14 from what the Collens contend was a wrongful denial of benefits to Ms. Collen. They do 15 not assert a breach of fiduciary duties to the plan itself. The Court agrees with United on 16 the merits of its argument and this aspect of the ERISA claim will be dismissed also. 17 II. 18 A. 19 In order to promote uniformity among the states, Congress intended the civil 20 remedies provided for in § 502(a) of ERISA to be the exclusive remedies for disputes 21 concerning of the denial of benefits. Aetna Health Inc. v. Davila, 542 U.S. 200, 208-09 22 (2004). This principle derives from two ERISA sections, the comprehensive remedial 23 scheme in § 502(a) itself and in the § 514(a) preemption provision. 29 U.S.C. 24 §§ 1132(a)(1)(B), 1144(a). Such is the language of these provisions that the United States 25 Supreme Court has held “any state-law cause of action that duplicates, supplements, or 26 * What is perplexing about the Collens’ explanation is that, prior to filing its Motion to 27 Dismiss, United’s counsel offered them the opportunity to amend their complaint to include this necessary detail. See LRCiv. 12.1(c). Plaintiffs’ counsel appears to have refused that 28 offer. (Doc. 16-1 at 5-6.) Had Plaintiffs’ counsel taken that offer seriously and amended their complaint, that would have saved a great deal of client resources and judicial effort. 1 supplants the ERISA civil enforcement remedy conflicts with the clear congressional intent 2 to make the ERISA remedy exclusive and is therefore pre-empted.” Davila, 542 U.S. at 3 209. The Collens’ second claim for relief, misrepresentation and detrimental reliance, is 4 pleaded as a state-law cause of action. This claim is premised on the argument that United 5 failed to cover procedures that the Collens contend should be covered under the plan. This 6 claim impermissibly “duplicates, supplements, or supplants the ERISA civil enforcement 7 remedy.” Id. It will therefore be dismissed as preempted under ERISA. 8 B. 9 While ERISA preemption is unforgiving to state-law claims for relief, there is a 10 narrow exception where independent state-law claims against the insurer may be asserted. 11 Marin General Hosp. v. Modesto & Empire Traction Co., 581 F.3d 941 (9th Cir. 2009). 12 These include circumstances where an independent contract, be it written or oral, exists 13 between the insurer and the insured or a healthcare provider. Id.; see also Emergency 14 Group of Ariz. Professional Corp. v. United Healthcare Inc., --- F. Supp. 3d. ---, 2020 WL 15 1451464 (D. Ariz. Mar. 25, 2020). The pleading allegations indicate that United promised 16 to provide additional coverage for Ms. Collen that was not fulfilled. (Doc. 7 at ¶¶ 18, 20- 17 21.) The Amended Complaint does not make clear whether United promised additional 18 coverage that was not ultimately provided to Ms. Collen. Mindful of counsel’s obligations 19 under Rule 11 of the Federal Rules of Civil Procedure, the Court will grant leave to amend 20 allowing Plaintiffs an opportunity to assert any such state-law claim for relief arising from 21 an independent obligation undertaken by United that was, ultimately, not provided. 22 III. 23 Accordingly, 24 IT IS ORDERED that the Motion to Dismiss Amended Complaint (Doc. 9) is 25 GRANTED. 26 IT IS FURTHER ORDERED that Plaintiffs’ request for an award of costs and 27 fees is DENIED. (Part of Doc. 12.) 28 /// 1 IT IS FURTHER ORDERED that Plaintiffs shall have 14 days from the date of 2|| this Order to file a Second Amended Complaint. The Clerk of the Court shall not enter 3 || judgment at this time. Should Plaintiffs fail to file a Second Amended Complaint within this time period, the Clerk of the Court shall enter judgment of dismissal with prejudice. 5 Dated this 22nd day of June, 2020. 6 ’ Wichal T. Hburde 8 Michael T. Liburdi 9 United States District Judge 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -4-
Document Info
Docket Number: 2:19-cv-05692
Filed Date: 6/22/2020
Precedential Status: Precedential
Modified Date: 6/19/2024