Pellicier-Mercucci et al v Puerto Rico Telephone Company
Filing
16
OPINION & ORDER granting 9 Motion to Dismiss for Failure to State a Claim. Signed by Judge Jay A. Garcia-Gregory on 2/26/2014. (RJC)
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF PUERTO RICO
PELLICIER-MERCUCCI, et al.,
Plaintiffs
v.
CIVIL NO. 13-1733 (JAG)
PUERTO
D/B/A,
RICO
TELEPHONE
COMPANY,
Defendant.
OPINION & ORDER
GARCIA-GREGORY, D.J.
The complaint at bar alleges that Defendant Puerto Rico
Telephone
Company
terminated
the
Ricardo
(d/b/a
medical
Perez-Rodriguez.
Claro
benefits
The
Puerto
plan
employee’s
Rico)
belonging
unlawfully
wife
and
to
employee
daughters,
which were covered under the family plan, brought this action
claiming wrongful termination of medical insurance from June 1
through September 19, 2012, as well as consequential pain and
suffering. Defendant moved to dismiss alleging that the plan in
question was covered by the Employee Retirement Income Security
Act of 1974, 29 U.S.C. §§ 1001 et seq., and that Plaintiffs
failed to exhaust administrative remedies. Defendant also argued
that Plaintiffs’ request for damages under Article 1802 of the
13-1733 (JAG)
2
Puerto Rico Civil Code should be dismissed because it is preempted by ERISA. Plaintiffs timely opposed.
BACKGROUND
Pursuant to a collective bargaining agreement, Defendant
provides “active employee[s]” with a medical benefits plan that
covers employees and their families. (Docket No. 9-1 ¶¶ 1-3, 4).
According
to
the
terminate
complaint,
coverage
“if
the
the
plan
employee,
allows
for
Defendant
to
reason,
is
any
dismissed, laid off, resigns, passes away or is suspended for
more than 30 days.” (Id. ¶ 4).
The
plan
in
question
covered
employee
Ricardo
Perez-
Rodriguez as well as his wife and minor daughters. On June 1,
2012,
Defendant
consequently
terminated
leaving
him
Mr.
and
Perez-Rodriguez’s
his
family
without
plan,
medical
insurance. (Id. ¶ 6). Plaintiffs claim that this termination was
unjustified
because
Mr.
Perez-Rodriguez
was
still
an
“active
employee” of Defendant, and had not been dismissed, laid off, or
suspended. In an effort to resolve this problem, Mr. PerezRodriguez
initiated
a
series
of
claims
as
well
as
a
“labor
complaint” against his employer, all to no avail. (Id. ¶¶ 1314).
As
a
consequence
of
having
no
medical
insurance,
Mrs.
Pellicier-Mercucci could not obtain treatment for her cancer and
13-1733 (JAG)
3
the minor daughters were left without the vaccinations required
for school.
ANALYSIS
Defendant argues that the complaint at bar is, at bottom,
“a claim for the enforcement of rights under a medical insurance
plan
subject
dismissed
to
the
because
provisions”
Plaintiffs
of
have
ERISA,
failed
and
to
should
exhaust
be
their
administrative remedies prior to bringing this suit. Plaintiffs
appear
to
covered
should
by
be
express
concede
ERISA.
allowed
exhaustion
that
the
medical
benefits
plan
is
argue,
however,
that
this
Plaintiffs
to
proceed
requirement,
since
and
ERISA
in
does
the
not
indeed
case
have
alternative,
an
that
they made “good-faith” efforts to seek relief before resorting
to
this
forum.
Neither
argument
presented
by
Plaintiffs
is
convincing.
Plaintiffs’ first argument fails immediately; it is well
settled that ERISA requires putative plaintiffs to exhaust their
administrative remedies prior to filing suit. Madera v. Marsh
USA, Inc., 426 F.3d 56, 61 (1st Cir. 2005)(citing Terry v. Bayer
Corp., 145 F.3d 28, 40 (1st Cir. 1998). As Defendant correctly
argues, whether the exhaustion requirement is of statutory or
judicial
creation
is
entirely
immaterial.
The
requirement
is
there, and it is the Plaintiffs’ burden to meet it. Moreover,
13-1733 (JAG)
4
Plaintiffs’ suggestion that the labor complaint filed by Mr.
Perez-Rodriguez should be construed as a good-faith attempt to
satisfy the exhaustion requirement is not enough. The complaint
does not contain a single allegation supporting an inference
that the complaint filed by Mr. Perez-Rodriguez “was filed in
accordance with the plan’s claims procedure for the purpose of
obtaining reinstatement of coverage.” (Docket No. 12, p. 3). As
such, the Court cannot conclude that the procedure followed by
Mr. Perez-Rodriguez exhausted the plan’s administrative remedies
for his termination.
Still, courts have recognized several exceptions to this
requirement.
For
instance,
an
“employee
is
not
required
to
exhaust his administrative remedies […] where it would be futile
for him to do so,” or where the remedy is inadequate. Madera,
426 F.3d at 62 (citing Drinkwater v. Metro. Life Ins. Co., 846
F.2d 821, 826 (1st Cir. 1988)). On this point, Plaintiffs rely
on
the
adverse
outcome
of
the
labor
complaint
filed
by
Mr.
Perez-Rodriguez to support the notion that the administrative
procedure
however,
would
those
be
in
futile.
pursuit
“For
must
this
show
exception
that
the
to
apply,
administrative
route is futile or the remedy inadequate.” Drinkwater, 846 F.2d
at
826.
“A
blanket
assertion,
unsupported
by
any
facts,
is
insufficient to call this exception into play.” Id. Apart from
13-1733 (JAG)
5
failing to show they exhausted the plan’s remedy, Plaintiffs’
failure to explain what the “labor complaint” was or what it
entailed leaves the Court unable to conclude that the plan’s
remedies were futile or inadequate.
CONCLUSION
The Court finds that Plaintiffs did not meet their burden
of showing that they exhausted administrative remedies prior to
bringing this suit, or that they qualify for any exception to
this rule. As such, Defendant’s motion to dismiss is granted. As
this
ground
is
sufficient
to
dismiss
this
case,
the
Court
declines to enter into the merits of Defendant’s pre-emption
argument regarding Plaintiffs’ damages claim. Judgment shall be
issued accordingly.
IT IS SO ORDERED.
In San Juan, Puerto Rico, this 26th day of February, 2014.
S/ Jay A. García-Gregory
JAY A. GARCÍA-GREGORY
United States District Judge
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