Ravannack v. United HealthCare Insurance Company
ORDER AND REASONS denying 78 Motion for Contempt. Signed by Judge Jane Triche Milazzo. (ecm)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF LOUISIANA
UNITED HEALTHCARE INS. CO.
ORDER AND REASONS
Before the Court Plaintiff Jocel Ravannack’s Motion for Contempt (Doc.
78). For the following reasons, this Motion is DENIED.
This case is an ERISA appeal. Plaintiff’s minor child LB was treated for
bipolar disorder at Sandhill Child Development Center from June 4, 2013
through some time in 2015. Plaintiff is insured under the terms of a policy
issued by Defendant United Healthcare Insurance Company (the “Policy”).
United has declined coverage for services provided at Sandhill. A brief review
of the history of this dispute is helpful here.
LB is diagnosed as “Bipolar disorder mixed, severe, non-psychotic.” The
parties agree that this diagnosis is classified as a “Serious Mental Illness” per
the terms of the Policy. Plaintiffs aver that the minor’s condition required
treatment at a Residential Treatment Facility. From March 13, 2013 through
June 3, 2013 this treatment was provided at Meridell Achievement Center.
His treatment was then “stepped down” to Sandhill Child Development Center,
where he was treated from June 4, 2013 through May of 2015. United has not
paid claims for services rendered at Sandhill.
United claims that, at the outset of litigation, it was only aware of claims
made for treatment at Sandhill from June 4, 2013 to December 31, 2013. As
to those claims, United represented that they were denied because medical
records had not been timely furnished by Sandhill. As to the claims for 2014
and 2015, Plaintiff represented that those claims were filed via fax. Defendant
responded that the number to which the claims were sent “is not a number at
which United receives claims.” To resolve this dispute, the Court ordered
limited discovery relative to the fax number.
The parties ultimately
determined that the fax number was associated with United, but that it had
nevertheless never processed the claims for 2014 and 2015.
Due to the incomplete nature of the administrative record, on January
24, 2017 the Court remanded this matter to United Healthcare for a full
determination of all claims. Plaintiff now files the instant motion, averring
that Defendant should be held in contempt for failure to comply with this
Court’s order. Defendant opposes.
“A federal court can find a party in civil contempt when the party
‘violates a definite and specific order of the Court requiring him to perform or
refrain from performing a particular act or acts with knowledge of the Court’s
order.’”1 The movant in a civil contempt proceeding carries the burden of
producing clear and convincing evidence showing that: (1) that a court order
was in effect, (2) that the court order required certain conduct of the
respondent, and (3) the respondent failed to comply with the court order.2 The
evidence must be “clear, direct and weighty and convincing” enough to allow
the fact finder “to come to a clear conviction, without hesitancy, of the truth of
the precise facts of the case.”3 In civil contempt proceedings, the respondent’s
action need not be willful, as long as the respondent “actually failed to comply
with the court’s order.”4
LAW AND ANALYSIS
The Court previously found that United had failed to comply with
ERISA’s notice provisions for all claims that are the subject of this suit.
Finding these violations to be procedural in nature, the Court remanded the
matter to United for further development of the administrative record and a
full determination of the claims at issue. In the instant Motion, Plaintiff avers
that United has not complied with this order, in that it did not provide a
Bd. of Supervisors of the La. State Univ. and Agric. and Mech. Coll. v. Smack
Apparel Co., 574 F.Supp.2d 601, 604 (quoting SEC v. First Fin. Grp., 659 F.2d 660, 669 (5th
2 Whitcraft v. Brown, no. 08–10174, 2009 WL 1492833, *2 (5th Cir.2009) (citing
Martin v. Trinity Indus., Inc., 959 F.2d 45, 47 (5th Cir.1992)).
3 Test Masters Educ. Servs, Inc. v. Singh, 428 F.3d 559, 581–82 (5th Cir.1999).
4 Am. Airlines v. Allied Pilots Ass’n, 228 F.3d 574, 581 (5th Cir .2000).
determination of benefits within 60 days.
United responds in opposition,
averring that it had in fact issued a determination letter on April 21, 2017.
Though it concedes that this letter was issued after the deadline imposed by
ERISA, it avers that there is no authority for the relief sought by Plaintiff,
namely, full payment of the claims and attorney’s fees. This Court agrees.
“[A]n administrator's failure to comply with the procedures mandated by
ERISA generally does not give rise to a substantive remedy.” 5 The record
reflects that, following this Court’s remand order, Defendant communicated
with Plaintiff’s counsel to determine if any additional documentation would be
submitted in support of the disputed claims. After Plaintiff’s counsel provided
none, United proceeded to review the claims.
Following a “review of the
available documentation and all information received to date,” United again
determined that the level of care received at Sandhill was inappropriate and
denied the claim.6
Plaintiff asserts that United’s medical reviewer did not review the
entire administrative record. This statement is unsupported by the record
before the Court. United’s determination letter indicates that its medical
reviewer reviewed all available documentation. This presumably includes the
medical records previously provided by Plaintiff. Regardless, Plaintiff has not
submitted sufficient evidence to support a finding of contempt in this regard.
Plaintiff also complains that United did not communicate with the
insured to request more information before denying the claims. This statement
is misleading, as the record reveals that prior to processing the claims, counsel
Goldman v. Hartford Life & Acc. Ins. Co., No. CIV.A. 03-0759, 2006 WL 861016, at
*3 (E.D. La. Mar. 30, 2006).
6 Doc. 83-1.
for United asked if there was any additional documentation to support the
The Court finds that there is no basis upon which to hold United in
contempt at this time. The Court’s previous order did not specifically direct
Defendant to complete its review in any defined period of time. Additionally,
“ERISA does not require strict compliance with its procedural requirements,
mandating only that plan administrators ‘substantially comply’ with the
statute and accompanying regulations.”7 Technical violations of ERISA may
be excused when the violation does “not raise serious doubts as to whether the
result reached was the product of an arbitrary decision or the plan
administrator’s whim.”8 The Court ordered Defendant to review Plaintiff’s
claim anew, and it appears that Defendant has now complied with this order.
Plaintiff is now in a position to take advantage of United’s appeals process to
allow for complete development of the administrative record. In any event,
Plaintiff has provided this Court with no authority indicating that failure to
comply with ERISA’s deadlines should inure to her benefit in the form a full
award of her claim without any review whatsoever. Accordingly, this Motion
Baptist Mem'l Hosp.--DeSoto Inc. v. Crain Auto. Inc., 392 F. App'x 288, 293 (5th
8 Goldman v. Hartford Life & Acc. Ins. Co., 417 F. Supp. 2d 788, 799 (E.D. La. 2006).
For the foregoing reasons, Plaintiff’s Motion for Contempt is DENIED.
New Orleans, Louisiana this 17th day of July, 2017.
JANE TRICHE MILAZZO
UNITED STATES DISTRICT JUDGE
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