Derosia et al v. HMO Louisiana, Inc. et al

Filing 19

RULING granting HMO Louisiana, Inc.'s 16 Motion Adopting Defendants Motion for Summary Judgment on the Merits. A separate final judgment will be entered. Signed by Magistrate Judge Stephen C. Riedlinger on 9/29/2014. (SMG)

UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF LOUISIANA

JEFFREY J. DEROSIA AND
WIFE CATINA MARIE DEROSIA
CIVIL ACTION
VERSUS
NUMBER 12-632-SCR
HMO LOUISIANA, INC. (A/K/A
BLUE CROSS AND BLUE SHIELD
LOUISIANA)
RULING ON MOTION FOR SUMMARY JUDGMENT
Before the court is HMO Louisiana, Inc.’s Motion Adopting
Defendant’s Motion for Summary Judgment on the Merits.
document number 16.

Record

Plaintiffs filed a response to the court’s

earlier order to file memoranda addressing the whether summary
judgment for HMO Louisiana, Inc. should be granted.1

Plaintiffs

filed this same memorandum again after the summary judgment motion
was filed.2
Summary judgment is only proper when the moving party, in a
properly supported motion, demonstrates that there is no genuine
issue of material fact and that the party is entitled to judgment
as a matter of law.

Rule 56(c), Fed.R.Civ.P.; Anderson v. Liberty

Lobby, Inc., 477 U.S. 242, 247, 106 S.Ct. 2505, 2510 (1986).

If

the moving party carries its burden under Rule 56(c), the opposing
party must direct the court’s attention to specific evidence in the

1

Record document number 14, Order; record document number 15,
Plaintiff’s Memorandum in Opposition to Summary Judgment.
2

Record document number 18.

record which demonstrates that it can satisfy a reasonable jury
that it is entitled to verdict in its favor.
252, 106 S.Ct. at 2512.
metaphysical

doubt

as

Anderson, 477 U.S. at

This burden is not satisfied by some
to

the

material

facts,

conclusory

allegations, unsubstantiated assertions or only a scintilla of
evidence.

Little v. Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir.

1994)(en banc); Boudreaux v. Swift Transp. Co., Inc., 402 F.3d 536,
540 (5th Cir. 2005).
The court previously granted Defendant’s Motion for Summary
Judgment on the Merits filed by defendant Louisiana Health Services
& Indemnity Company d/b/a Blue Cross and Blue Shield of Louisiana
(“Blue

Cross”).3

Defendant

HMO

Louisiana

moved

for

summary

judgment on the ground previously asserted by defendant Blue Cross,
and also argued that it was incorrectly named as a defendant
because the plaintiffs were never covered by any insurance plan or
policy issued by HMO Louisiana.
On this latter ground, the summary judgment record establishes
that HMO Louisiana is entitled to summary judgment.

The affidavit

of Anita Stewart, the Manager of Group Accounts in the Membership
3

Record document number 9, motion; record document number 11,
Ruling on Motion for Summary Judgment. In that ruling the court
determined that the medical services for which the plaintiffs seek
recovery in this action are excluded from coverage, even if they
were medically necessary at the time they were provided, under
Article XIX, sections A and B(9) of the GroupCare Group Health
Benefit Plan.
Consequently, defendant Blue Cross correctly
interpreted the applicable plan provisions and properly denied
payment for the services. Because the plaintiffs are a participant
and a beneficiary of an ERISA-covered plan who brought claims for
benefits under the plan, their state law claims are preempted.
2

& Billing Department of defendant Blue Cross, establishes that the
plaintiffs were only covered under the group policy issued to
Jeffery

Derosia’s

employer,

Grand

Isle

Shipyards.

Stewart

explained that she is also responsible for maintenance and custody
of the insurance contracts for persons covered by HMO Louisiana,
and that the plaintiffs were never covered by any policy issued by
HMO Louisiana.
Plaintiffs offered no summary judgment evidence to contradict
Stewart’s affidavit, or any evidence to create a dispute as to
whether they were covered by any insurance policy issued by HMO
Louisiana at the time the medical care was provided to plaintiff
Catina Marie Derosia.
In these circumstances, summary judgment for defendant HMO
Louisiana is warranted, based on the undisputed fact that the
plaintiffs

were

never

covered

under

a

policy

issued

by

HMO

Louisiana.4
Accordingly, HMO Louisiana, Inc.’s Motion Adopting Defendant’s
Motion for Summary Judgment on the Merits is granted.

A separate

final judgment will be entered.
Baton Rouge, Louisiana, September 29, 2014.

STEPHEN C. RIEDLINGER
UNITED STATES MAGISTRATE JUDGE

4

Summary judgment on this ground makes is unnecessary to
address the issue on which summary judgment was previously granted
in favor of Blue Cross.
3