Springer v. Cleveland Clinic Employee Health Plan Total Care
Opinion and Order. The Court affirms the decision of the Plan Administrator and grants judgment for Defendant. Judge Christopher A. Boyko on 10/26/2017. (H,CM)
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF OHIO
CLEVELAND CLINIC EMPLOYEE
HEALTH PLAN TOTAL CARE,
JUDGE CHRISTOPHER A. BOYKO
OPINION AND ORDER
CHRISTOPHER A. BOYKO, J:
This matter is before the Court on Plaintiff’s Complaint seeking to reverse the
decision of Defendant Cleveland Clinic Employee Health Plan Total Care denying Plaintiff
employee health benefits in violation of the Employee Retirement Income Security Act
(“ERISA”) 29 U.S.C. § 1002 . For the following reasons, the Court affirms the decision of
the health plan.
According to Plaintiff’s Complaint, in the Spring of 2010, Plaintiff Jason Springer, a
physician in Utah, accepted a physician position with the Cleveland Clinic in Ohio. Plaintiff
was to begin his employment with the Cleveland Clinic on July 1, 2010. Plaintiff enrolled
himself, his wife and his son, J.S., in the Cleveland Clinic’s health plan. Under the terms of
the Plan, it reads “as along as you have enrolled in the health plan within 31 days of your start
date, your coverage is effective on the first day you actively start to work.” (AR 15-1, pg.
CCEHP 000011).1 Thus, according to Plaintiff, his family were participant/beneficiaries
under the Plan on July 1, 2010.
J.S. suffers from a number of serious health conditions that require round-the-clock
healthcare. When Plaintiff accepted the Cleveland Clinic position, he arranged to have J.S
transported via air ambulance to the Cleveland Clinic. J.S.’s primary care physician signed a
Medical Letter of Necessity explaining the need for such transport services. Plaintiff’s choice
of air ambulance service, Angel Jet Services, LLC (“Angel Jet”), attempted to obtain
precertification from Defendant for the transport from Defendant’s Plan Administrator
Antares Management Solutions, Inc. (“Antares”) but Antares was unable to verify Plaintiff’s
family’s enrollment at the time service was provided.
On July 7, 2010, J.S. was transported via air ambulance to Cleveland. Shortly
thereafter, Angel Jet submitted a bill to Antares for $340,100 for J.S.’s transport. On August
31, 2010, an Antares representative informed Angel Jet the claim was approved. However, on
September 2, 2010, the claim was subsequently denied for failure to obtain precertification.
Defendant provides its own air ambulance service via a third party carrier. Based on
this relationship, the Plan offers members a steep discount on air ambulance services. On
The parties filed the Administrative Record in a previously filed, related action
captioned Angel Jet Services, LLC. v. Cleveland Clinic Employee Health Plan
Total Care, 1:12CV298. Rather than refile the Administrative Record the parties
asked to the Court if it would rely on the previously filed Administrative Record
rather than require them to refile the entire record. The Court approves the
request and refers to the record filed in the Angel Jet case.
January 27, 2011, Defendant issued Angel Jet a check for 10 percent of the billed charges.
According to Defendant, this payment reflected the amount the Plan’s exclusive air transport
service would have charged for transporting J.S.
Having exhausted all administrative appeals of the denial of the benefits owed under
the Plan, Plaintiff appeals the denial of the full amount of his Plan benefits.
According to Defendant, Plaintiff lacks constitutional standing to assert his ERISA
claim because he does not allege that Angel Jet has sought to recover its unreimbursed fees
from Plaintiff. Without this allegation, Defendant contends Plaintiff has failed to allege an
injury arising from the Plan’s 10 percent payment. Furthermore, the same issues that formed
the central dispute in Angel Jet apply here -i.e.- whether it was arbitrary and capricious of the
Plan to deny coverage for non-emergency medical transport of J. S. when Plaintiff failed to
obtain preauthorization. Because the transport of J. S. was not an emergency situation, there
was no necessity on the part of Plaintiff to transport J. S. via air ambulance without first
Standard of Review
The first issue the Court must address is whether the Plan confers upon the Plan
Administrator the discretion to determine eligibility and construe the terms of the Plan. In
determining the appropriate standard of review, the United States Supreme Court held the
“denial of benefits challenged under § 1132(a)(1)(B) is to be reviewed under a de novo
standard unless the benefit plan gives the administrator or fiduciary discretionary authority to
determine eligibility for benefits or to construe the terms of the plan.” Firestone Tire &
Rubber Co. v. Bruch, 489 U.S. 101, 115, 109 S. Ct. 948, 956–57, 103 L. Ed. 2d 80 (1989)
The Court applies the arbitrary and capricious standard of review where a policy cloaks the
plan administrator with the discretionary authority to determine eligibility and construe the
terms of a policy. DeLisle v. Sun Life Assurance Co. of Canada, 558 F. 3d 440 (6th Cir. 2009)
(Citing Firestone Tire & Rubber Co. v. Burch, 489 U.S. 101, 115 (1989)). The arbitrary and
capricious standard is the most deferential form of judicial review. Admin. Comm. of Sea Ray
Employees Stock Ownership and Profit Sharing Plan v. Robinson, 164 F. 3d 981, 989 (6th
Cir. 1999). The administrator’s decision should be upheld if it is “the result of a deliberate,
principled reasoning process” and “supported by substantial evidence.” Glenn v. Metro. Life
Ins. Co., 461 F. 3d 660, 666 (6th Cir. 2006), aff’d, 128 S. Ct. 2343 (2008). In other words,
“when it is possible to offer a reasoned explanation, based on the evidence, for a particular
outcome, that outcome is not arbitrary or capricious.” Davis v. Kentucky Finance Cos.
Retirement Plan, 887 F.2d 689, 693 (6th Cir.1989). “In applying the arbitrary and capricious
standard in ERISA actions, a court is limited to reviewing the evidence contained within the
administrative record.” Kouns v. Hartford Life & Acc. Ins. Co, 780 F. Supp. 2d 578, 584–85
(N.D. Ohio 2011) citing Wilkins v. Baptist Healthcare System, Inc., 150 F.3d 609, 615 (6th
Cir.1998). “A court should utilize the arbitrary and capricious standard even when a conflict
of interest exists.” Kouns, 780 F.Supp.2d at 584 citing Metro. Life Ins. Co. v. Glenn, 554 U.S.
105 (2008). “The Supreme Court has held that a conflict of interest exists for ERISA
purposes where the plan administrator evaluates and pays benefit claims, even where the
administrator is an insurance company and not the beneficiary's employer.” Kouns, 780
F.Supp.2d at 584 citing Glenn, 554 U.S. at 111, 128 S.Ct. 2343. Courts will weigh a potential
conflict of interest as a factor in determining whether the decision to deny benefits was
arbitrary and capricious. Glenn, 554 U.S. at 117, 128 S.Ct. 2343; Firestone, 489 U.S. at 115,
109 S.Ct. 948. A possible conflict of interest due to the administrator’s dual role is “but one
factor among many that a reviewing judge must take into account.” Glenn, 128 S. Ct. at 2351.
Here, the Cleveland Clinic Employee Health Plan Total Care expressly identifies
Antares as its third party administrator. The Plan reads:
Antares Management Solutions (Antares) functions as the Third-Party
Administrator (TPA) for Cleveland Clinic Employee Health Plan (EHP) Total
Care. In this role, they are responsible for:
1. Member eligibility verification
2. Benefit coverage determinations
3. Processing claims and claims appeals
4. Issuing statements of Explanation of Benefits (EOB)
5. Coordinating benefits if a member is covered by more than one health plan
6. Subrogation processing
7. Workers’ Compensation coordination
(AR 15-1 pg. CCEHP 000017).
The Plan confers upon Antares the discretion to construe the terms of the Plan and
determine eligibility. The Plan provides an appeals process wherein a beneficiary may appeal
an adverse decision to the Plan Advisory Committee for a final and binding determination.
(See AR 15-1 pg. CCEHP 000068)
Role of Cleveland Clinic Employee Health Plan Total Care Advisory
If it is determined that the appeal cannot be resolved through the TPA,
Cleveland Clinic Employee Health Plan (EHP) Total Care, or Compensation/
Benefit review process, the case will be forwarded to the Health Plan Advisory
Committee (HPAC) for Third Level Appeal Review. Physician members of the
Cleveland Clinic Employee Health Plan Total Care Advisory Committee must
hold a current, active, unrestricted license to practice and be Board Certified.
Committee members include EHP Total Care Chief Medical Officer, Senior
Director, Legal Counsel, Senior Director Compensation and Benefits, Cleveland
Clinic Medical Director, Director of Health and Welfare Benefits, Director of
Retirement/Voluntary Benefit Plans, Director, EHP Medical Management, EHP Total
Care Pharmacy Director, and Behavioral Health representatives. Appeal decisions
made by Cleveland Clinic Employee Health Plan Total Care or the HPAC are final
and binding. If you are dissatisfied with an appeal decision, refer to Section Six, page
65, "A Statement of Your Rights Under ERISA."
Thus, the Plan confers upon Antares the discretion to determine eligibility and
construe the terms of the Plan, then, on appeal, the Plan Advisory Committee has final
authority over all eligibility issues.2 Therefore, the Court sees no reason to depart from its
prior holding in Angel Jet that the Plan Administrator has discretionary authority and that the
arbitrary and capricious standard applies in spite of the conflicting representations to the
The Court has been hampered by the conflicting statements in the pleadings and
the record as to the identity of the Plan Administrator. Plaintiff’s Complaint
alleges “the Plan is administered by Antares Management Solutions, Inc.
(“Antares”). Both the Cleveland Clinic and Antares are Plan Administrators and
Fiduciaries.” (Complaint at para.6). Defendant’s Answer states “Defendant
admits Antares Management Solutions, Inc. “Antares” is a third party
administrator for the CCF Plan. Defendant denies the remaining allegations in
paragraph 6 of Plaintiff’s Complaint.” (Answer at para. 6). In its Response Brief,
Defendant states “Cleveland Clinic is the administrator of the Plan.” (Defendant
Response Brief ECF # 11 pg 3). In a letter dated October 11, 2011, from Ann
Zellmer to Amanda Crutchfield, Zellmer writes “I write to you as counsel for the
Cleveland Clinic Foundation (“CCF”), in its capacity as Plan Administrator of the
Cleveland Clinic Employee Health Care Plan.” (AR 17-28). These
representations stand in stark contrast to the plain language of the Plan which
reads “Cleveland Clinic Employee Health Plan (EHP) Total Care is partnered
with Antares Management Solutions (Antares) to administer your health plan
benefits accurately and efficiently. Antares provides claims processing for all
members who receive healthcare services.” (AR 15-1 pg CCEHP000008). The
parties do not point the Court to any provision in the Plan document itself
describing the Cleveland Clinic Foundation as the Plan Administrator.
contrary. (See footnote 2). The Court must consider the provisions expressly described in
the Plan itself to determine the identity of the Plan Administrator and the discretionary
authority granted that Administrator. As described above, the Plan clearly appoints Antares
as administrator with discretionary authority to determine eligibillity. Final authority on
appeal resides with the Health Plan Advisory Committee. In a case wherein the subject Plan
was similarly structured with a Third Party Administrator and a Plan Administrative Review
appeals panel the Sixth Circuit in University Hospitals of Cleveland v. Emerson Electric Co.
202 F.3d 839 (6th Cir. 2000) applied the arbitrary and capricious standard. This Court does
the same, albeit with a more discerning eye due to Defendant’s admission in the previously
filed Angel Jet case that the Plan operates under a conflict of interest (Angel Jet, Case No. 12298 at ECF # 19 pg. 2) (“Defendant readily stipulates that it, like most ERISA plans, operates
under a structural conflict of interest, because it both determines claim eligibility and pays
benefits.”). However, this conflict of interest does not change the standard of review. See
Zenadocchio v. BAE Sys. Unfunded Welfare Ben. Plan, 936 F. Supp. 2d 868, 885 (S.D. Ohio
2013) (“The conflict of interest does not alter the standard of review, but is weighed as but
one factor in determining whether there is an abuse of discretion.”).
However, even were the Court to apply the de novo standard of review the outcome
would not change because issues of standing and construction of the unambiguous Plan terms
ultimately decide this case.
Under ERISA, 29 U.S.C. § 1132, the following persons may bring a civil action.
(a) Persons empowered to bring a civil action
A civil action may be brought-(1) by a participant or beneficiary-(A) for the relief provided for in subsection (c) of this section, or
(B) to recover benefits due to him under the terms of his plan, to enforce his
rights under the terms of the plan, or to clarify his rights to future benefits
under the terms of the plan;
There is no dispute Plaintiff is a plan participant. Defendant challenges Plaintiff’s
constitutional standing to assert an ERISA claim because the administrative record
demonstrates J. S. received air ambulance service, Defendant paid the usual and customary
amount to Angel Jet and Plaintiff has not alleged he had to pay or is liable for the unpaid
Plaintiff contends the Complaint clearly alleges Plaintiff was denied benefits under the
Plan. (Complaint para. 37). According to Plaintiff, Angel Jet charged Plaintiff $340,100
which he directed to be processed through the Plan. The Plan failed to pay the full amount
but instead issued payment of only 10 percent of the charged costs. This was done in spite of
the plain language of the Plan wherein it expressly states it will pay “100% for transportationincluding professional ambulance, air ambulance, or regularly scheduled airline...” (AR 15-1
pg. CCEHP 000035).
“Article III limits the judicial power of the United States ... and ‘Article III standing ...
enforces the Constitution's case-or-controversy requirement.’ ” Hein v. Freedom From
Religion Found., Inc., 551 U.S. 587, 597–98, (2007) (quoting Elk Grove Unified Sch. Dist. v.
Newdow, 542 U.S. 1, 11 (2004)). In order to assert constitutional standing a plaintiff must
have “‘such a personal stake in the outcome of the controversy’ as to warrant [their]
invocation of federal-court jurisdiction and to justify exercise of the court's remedial powers
on [their] behalf.” Warth v. Seldin, 422 U.S. 490, 498–99 (1975) (quoting Baker v. Carr, 369
U.S. 186, 204 (1962)). Plaintiff bears the burden of establishing standing. Lujan v.
Defenders of Wildlife, 504 U.S. 555, 561 (1992).
In this administrative appeal, there is no allegation in the Complaint nor is there any
evidence in the administrative record demonstrating that Plaintiff suffered an actual injury.
Actual injury is a mandatory prerequisite for a claimant seeking redress for ERISA violations
in order to establish constitutional standing. In a recent case directly addressing this issue, the
Sixth Circuit in Soehnlen v. Fleet Owners Ins. Fund, 844 F.3d 576, 581–82 (6th Cir. 2016),
analyzed constitutional standing in the context of an ERISA action. The Sixth Circuit held
that “with respect to claims arising under ERISA, plaintiffs are not absolved from showing
that the elements of Article III are met.” Id citing Loren v. Blue Cross & Blue Shield of Mich.,
505 F.3d 598, 606–07 (6th Cir. 2007). “To satisfy Article III's standing requirements, a
plaintiff must show: ‘(1) [he] has suffered an ‘injury-in-fact’ that is (a) concrete and
particularized and (b) actual or imminent, not conjectural or hypothetical; (2) the injury is
fairly traceable to the challenged action of the defendant; and (3) it is likely, as opposed to
merely speculative, that the injury will be redressed by a favorable decision.’” Soehnlen, 844
F.3d at 581 quoting Loren, 505 F.3d at 606–07 (quoting Friends of the Earth, Inc. v. Laidlaw
Envtl. Servs., 528 U.S. 167, 180–81(2000)). “ As the Supreme Court recently affirmed in
Spokeo, Inc. v. Robins, an injury-in-fact contains the two distinct elements of particularization
and concreteness.” Soehnlen, 844 F.3d at 581 citing ––– U.S. ––––, 136 S.Ct. 1540, 1548–50,
194 L.Ed.2d 635 (2016). “For an injury to be particularized, ‘it must affect the plaintiff in a
personal and individual way.’” Soehnlen at 581-82 quoting Spokeo at 1548; see also Valley
Forge Christian Coll. v. Americans United for Separation of Church & State, Inc., 454 U.S.
464, 472, 102 S.Ct. 752, 70 L.Ed.2d 700 (1982) (standing requires that the plaintiff
“personally has suffered some actual or threatened injury”).
The Sixth Circuit in Soehnlen continued:
While “particularization is necessary to establish injury in fact[,] ... it is
not sufficient.” Spokeo, 136 S.Ct. at 1548. A plaintiff must also show that he
suffered a concrete injury, defined as a “de facto” injury, meaning that the
injury “must actually exist.” Id.
Pointing specifically to Spokeo, Plaintiffs contend that the Supreme
Court has radically altered the landscape for pleading injury-in-fact.
Consequently, they believe that by merely alleging a violation of ERISA
rights, they satisfy their obligation under Article III. We disagree on both
points. While we recognize that the Supreme Court acknowledged that nontangible injuries, including violations of statutory rights, may satisfy the
constitutional showing of an injury-in-fact, we also take the Court at its word
when it cautions that “Congress' role in identifying and elevating intangible
harms does not mean that a plaintiff automatically satisfies the injury-in-fact
requirement whenever a statute grants a person a statutory right and purports to
authorize that person to sue to vindicate that right.” Id. “Article III standing
requires a concrete injury even in the context of a statutory violation.” Id.
Therefore, even if we assume the injury is sufficiently particularized, Plaintiffs
must still show that the deprivation of a right created by statute is accompanied
by “some concrete interest that is affected by the deprivation.” Id. (quoting
Summers v. Earth Island Inst., 555 U.S. 488, 496, 129 S.Ct. 1142, 173 L.Ed.2d
1 (2009)). A “concrete” intangible injury based on a statutory violation must
constitute a “risk of real harm” to the plaintiff. Id.
Id at 582.
In the case at bar, there is nothing indicating Plaintiff has or will suffer a concrete
injury. In his Reply, Plaintiff contends Angel Jet charged him $340,100 “which he directed
to be processed through his health insurance with the Plan.” (ECF # 12 pg.1). He directs the
Court to ECF 15, Exhibit 15, pg 000111 in the record as support for this statement. Exhibit
15 is not a bill from Angel Jet to Plaintiff, rather, it is a customer service log entry dated
August 31, 2010, from Angel Jet to Antares inquiring about the Angel Jet claim status. Under
the status notes it reads “status. Advised that this was processed 8/26/10. We will be paying
$340,100.00 no check number yet.” It is entirely silent on any charges from Angel Jet to
Plaintiff. Plaintiff does not point the Court to any evidence in the administrative record
demonstrating that Plaintiff is liable for the balance of the Angel Jet claim nor has Plaintiff
alleged that Angel Jet has sought reimbursement from him. In fact, his Reply indicates that
Angel Jet has not sought reimbursement. “At that point, the only thing that was stopping
Angel from seeking to collect from Dr. Springer personally was an agreement assigning Dr.
Springer’s rights to pursue the Plan to Angel.” (Reply at pg.2). It was this alleged assignment
that Angel Jet relied on in Angel Jet when asserting its claim for payment against the Plan as
the authorized representative of Plaintiff. The Court determined that assignment conferred
upon Angel Jet no rights under the Plan because it only assigned Plaintiff’s spouse’s rights to
an unrelated Blue Cross plan.
Here, it is undisputed that J. S. was transported by air ambulance. It is also
undisputed that the Plan reimbursed Angel Jet $34,451.75 based on what the comparable air
ambulance cost would have been had Plaintiff used the Plan’s air ambulance provider. There
is no dispute that Defendant issued the above payment to Angel Jet. There is nothing in the
record demonstrating that Angel Jet rejected the payment.
In light of the above, the Court finds Plaintiff has failed to establish constitutional
standing as he has not and cannot show a concrete injury. He received air ambulance service.
Defendant Plan paid what they determined was covered under the Plan. Angel Jet accepted
that payment and has not sought reimbursement from Plaintiff. Therefore, the Court finds
Plaintiff’s appeal fails for lack of constitutional standing.
The Terms of the Plan
Even assuming arguendo Plaintiff could establish standing, the Plan’s refusal to pay
100% of Angel Jet’s billed fees was not arbitrary and capricious. In the administrative record
the evidence shows Plaintiff became a Plan participant on July 1, 2010. J. S. was transported
via air ambulance on July 7, 2010. Plaintiff’s had been planning to transport Plaintiff’s son
for more than thirty days prior to the actual transport. This is evidenced by the Medical Letter
of Necessity dated June 3, 2010, which describes how the family plans on moving to Ohio.
(AR 15-2). This is further evidenced by Plaintiff’s wife’s Appointment of Authorized
Representative letter signed June 8, 2010, subrogating her rights under her health plan to
Angel Jet. (AR 15-3). This timeline is important because the question of whether J.S.’s air
transportation was an emergency situation plays a significant role in the benefits
Plaintiff contends the Plan authorizes 100% coverage for air transportation. Plaintiff
cites to page 28 of the Plan wherein it reads:
Emergency transport to an emergency room is always covered. However, if a
member becomes sick or injured while away from the Cleveland area and must
be admitted to a hospital anywhere in the United States or Canada, EHP Total
Care will pay 100% for transportation-- including professional ambulance, air
ambulance, or regularly scheduled airline (limit: one trip during any one
accident or illness) -- if transported from such other hospital to the nearest
Cleveland Clinic Hospital (Florida or Ohio) for treatment. This type
of transportation to a Cleveland Clinic Hospital must meet the
precertification process of the EHP Medical Management Department.
(AR 15-1 pg. CCEHP 000035).
There is no question that J. S required medical air ambulance transport, however, there
is nothing indicating it was an emergency situation. Rather, the record indicates that the air
transport was planned at least one month in advance of Plaintiff’s first day of work with the
Cleveland Clinic and coincided with Plaintiff’s move to Cleveland. All other transportation
requires precertification. There is no dispute Plaintiff never obtained precertification. The
record further notes that Angel Jet’s initial contact with the Plan occurred on July 2, 2010,
only one day after Plaintiff enrolled. The record reflects Angel Jet’s inquiry into Plaintiff’s
eligibility and benefits. It does not reflect an attempt to obtain preauthorization for the air
ambulance services prior to the date of the flight.
The Plan makes it clear that coverage starts the day of enrollment subject to certain
conditions, however, it clearly states it may take up to 15 business days to process the
paperwork (AR 15-1 pg. CCEPH000011). The record does not reflect that Angel Jet
attempted to obtain or otherwise requested a copy of the Plan in order to determine coverage
prior to its providing air ambulance service to J. S. There is no dispute Angel Jet did not
receive preauthorization to transport J.S. to Cleveland from the Plan and there is nothing in
the record indicating any reliance by Angel Jet prior July 7, 2010, on any Plan provision upon
which it could reasonably have presumed coverage for its services. Instead, the Plan
expressly excludes coverage where precertification is required and is not obtained even if it
applies to a covered benefit. (AR 15 pg. CCEHP 000062).
Furthermore, although Plaintiff argues preauthorization was an impossibility given
that the Plan was unable to verify Plaintiff’s status as a member prior to July 7, 2010, it does
not explain why J.S. had to be transported via air ambulance on July 7, 2010.
Having considered all the relevant provisions of the Plan, the determination to pay
only $34,451.75 was not arbitrary or capricious in that the express, unambiguous Plan
provisions required precertification and none was obtained. Therefore, the Plan was well
within its authority to preclude coverage absent precertification. Furthermore, the record does
not evidence any attempt by Angel Jet to obtain preauthorization, nor does it support a finding
that the transportation of J.S. on July 7, 2010 was an emergency.
From the Antares original Explanation of Benefits (AR 15-18) to the denial of benefits
by the EHP on October 11, 2011, Defendant has consistently denied the full benefit for failure
to obtain preauthorization for the flight as required under the Plan. The Plan authorized
payment based on the amount its own air ambulance provider would have charged for the
same transportation. (AR 17-31).
Therefore, for the foregoing reasons, the Plan’s denial of benefits to Angel Jet and
Plaintiff was not arbitrary or capricious as the Plan required precertification which was not
sought nor obtained for a non-emergency transport.
Failure to Provide Plan Documents
Count II of Plaintiff’s Complaint alleges the Plan failed to produce Plan documents
within thirty days as required by ERISA. Angel Jet first requested Plan documents in a letter
dated November 3, 2010. Angel Jet further requested “any documents, contracts, guidelines,
or procedures that establish rate schedules for the Cleveland Clinic-owned air transport
service” on February 25, 2011. According to Defendant, the applicable statute of limitation
period for such an action is one year. Plaintiff did not bring this claim until January of 2015,
almost four years after its latest request. Defendant further asserts that under 29 U.S.C.
§1132(c)(1)(B) penalties may be imposed by a Court for the untimely disclosure of
documents as required by 29 U.S.C. §1024, not 29 CFR 2560.503-1 as Plaintiff alleges.
Furthermore, the statute only permits the imposition of such penalties against Plan
Administrators, not Plans. Since Plaintiff has failed to name the Cleveland Clinic as a
Defendant, Defendant contends the Court cannot impose such penalties.
Plaintiff, on Reply, offers no defense to these arguments but instead asks the Court to
permit it to amend its Complaint to include the Cleveland Clinic as a Defendant.
The Court finds that the applicable statute of limitations for an action for statutory
penalties under 29 USC § 1132(c)(1)(B) is one year. See Kumar v. Higgins, 91 F. Supp.2d
1119, 1124 (N.D. Ohio 2000). Thus, Plaintiff’s action is well outside the applicable
limitation period and his claim is denied. Because the limitation period forecloses this claim
regardless of the whom Plaintiff named as Defendant, the Court denies Plaintiff’s request to
amend his Complaint to name the Cleveland Clinic.
Therefore, for the foregoing reasons, the Court affirms the decision of the Plan
Administrator and grants judgment for Defendant.
IT IS SO ORDERED.
s/ Christopher A. Boyko
CHRISTOPHER A. BOYKO
United States District Judge
Dated: October 26, 2017
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