Fresenius Medical Care Holdings, Inc. et al v. Wellmont Health System, Inc. et al
Filing
34
MEMORANDUM OPINION AND ORDER re 14 MOTION to Dismiss Plaintiff's Complaint filed by MCA Administrators, Inc. For the reasons set forth herein, the motion to dismiss filed by the defendant, MCA, pursuant to Rule 12(b) of the Federal Rules of Civil Procedure, [Doc. 14], is GRANTED. As such, the plaintiffs claims against MCA are hereby DISMISSED. Signed by District Judge J Ronnie Greer on 9/30/2011. (RLC, )
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF TENNESSEE
GREENEVILLE
FRESNIUS MEDICAL CARE
HOLDINGS, INC., d/b/a FRESNIUS
MEDICAL CARE NORTH AMERICA,
ET AL
V.
WELLMONT HEALTH SYSTEM,
INC., ET AL
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NO. 2:11-CV-4
MEMORANDUM OPINION AND ORDER
This matter is brought for alleged violations of section 502(a)(1)(B) of the
Employee Retirement Income Security Act (“ERISA”), 29 United States Code §
1132(a)(1)(B) (2009), and various pendent state law claims. Pending before the Court
is the motion of MCA Administrators, Inc. (hereinafter referred to as “defendant”) to
dismiss the plaintiffs’ Complaint pursuant to Rule 12(b)(6) of the Federal Rules of
Civil Procedure, [Doc. 14]. The plaintiffs’ have responded to the motion. For the
reasons which follow, the Motion of Defendant, MCA Administrators, Inc., to
Dismiss plaintiffs’ Complaint will be GRANTED.
Plaintiffs allege in their Complaint that they are entitled to receive certain
benefits pursuant to assignment of benefits agreements executed by various plan
participants. Plaintiffs further allege that such benefits were denied, and the defendant
was substantially involved in the denial of said benefits. Plaintiffs attached to their
Complaint as exhibits a copy of the Plan Information, [Att. 8], and a letter from
Wellmont Health Systems denying the plaintiffs’ appeal and determination of benefits,
[Att. 7]. The Plan Information references the defendant as the plan’s third-party
administrator.
The final denial letter references the defendant as the claims
administrator. The letter indicates that the defendant participated in an analysis of the
plaintiffs’ claim for benefits and “[a]fter review of that analysis and discussions with
MCA, the Plan elected not to pay . . . .” The letter further indicates that the Senior
Vice President of Human Resources for Wellmont Health System reviewed the claims
adjudication process and found the process was properly conducted.
I. Rule 12(b)(6) Standard of Review
Dismissal pursuant to Federal Rule of Civil Procedure 12(b)(6) eliminates a
pleading or portion thereof that fails to state a claim upon which relief can be granted.
Fed. R. Civ. P. 12(b)(6). Moreover, Federal Rule of Civil Procedure 8(a)(2) requires
the complaint to contain a “short plain statement of the claim showing that the pleader
is entitled to relief.” Fed. R. Civ. P. 8(a)(2). A motion to dismiss under Rule 12(b)(6)
requires the Court to construe the allegations in the complaint in the light most
favorable to the plaintiff and accept all the complaint’s factual allegations as true.
Meador v. Cabinet for Human Res., 902 F.2d 474, 475 (6th Cir. 1990). The Court may
not grant a motion to dismiss based upon a disbelief of a complaint’s factual
allegations. Lawler v. Marshall, 898 F.2d 1196, 1199 (6th Cir. 1990). The Court must
liberally construe the complaint in favor of the party opposing the motion. Miller v.
Currie, 50 F.3d 373, 377 (6th Cir. 1995). However, the plaintiff must allege facts that,
if accepted as true, are sufficient “to raise a right to relief above the speculative level,”
Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007), and to “state a claim to
relief that is plausible on its face,” id. at 570; see also Ashcroft v. Iqbal, – U.S. –, 129
S.Ct. 1937, 1949-50 (2009). “A claim has facial plausibility when the plaintiff pleads
factual content that allows the court to draw the reasonable inference that the
defendant is liable for the misconduct alleged.” Iqbal, 129 S.Ct. at 1949. This Court
need not “accept as true a legal conclusion couched as a factual allegation.’” Twombly,
550 U.S. at 555 (quoting Papasan v. Allain, 478 U.S. 265, 286 (1986)); see also Iqbal,
129 S.Ct. at 1949.
Moreover, a plaintiff is not entitled to utilize the discovery process once a
complaint has been filed to obtain the factual information requisite to state a claim
with facial plausibility, “even when the information needed to establish a claim . . . is
solely within the purview of the defendant or a third party.” New Albany Tractor, Inc.
v. Louisville Tractor, Inc., 10-5100, 2011 WL 2448909 (6th Cir. June, 21, 2011)
(quoting Iqbal, 129 S.Ct. at 1954)). However, this Court may consider documents
central to the plaintiffs’ claims to which the complaint refers and incorporates as
exhibits. Amini v. Oberlin College, 259 F.3d 493, 502 (6th Cir. 2001).
III. Pendent State Law Claims
The defendant’s motion to dismiss requests this Court dismiss the breach of
contract, fraud and promissory fraud claims alleged in the Complaint for failure to
state a claim upon which relief may be granted. The plaintiffs’ Response in
Opposition to the Motion to Dismiss states that the plaintiffs’ do not allege these
claims against the defendant and, as such, the defendant’s motion is rendered moot as
to the pendent state law claims.
IV. ERISA Benefits Claim
Title 29 United States Code section 1132(a)(1)(B) allows a participant or
beneficiary of a qualified ERISA employee welfare benefit plan to bring a cause of
action 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. Such cause of action may be brought against the plan itself or any other
party that is “shown to control administration of the plan.”1 Daniel v. Eaton Corp.,
839 F.2d 263, 266 (6th Cir. 1988), cert. denied, 488 U.S. 826 (1988). Under ERISA,
1
In defendant’s Brief, [Doc. 15], and in plaintiffs’ Response in Opposition, [Doc. 26],
both parties acknowledge that there is a split among the circuits regarding the proper party
defendants to an ERISA claim for benefits. However, this Court is bound by well-established
Sixth Circuit precedent providing for a cause of action against any party found to exercise
discretionary authority or control over administration of the plan, not just the plan itself or the
plan administrator. See Daniel v. Eaton Corp., 839 F.2d 263, 266 (6th Cir. 1988); see also Moore
v. LaFayette Life Ins. Co., 458 F.3d 416, 438 (6th Cir. 2006) (dismissing plan administrator as
proper party defendant because plan administrator did not exercise discretionary control over
claim for benefits.)
a party who “exercises discretionary authority or discretionary control” respecting the
management of the plan or disposition of its assets or “has any discretionary authority
or discretionary responsibility in the administration” of the plan is a fiduciary. 29
U.S.C. § 1002(21)(A). This definition is broad and “does not turn upon formal
designations.” Smith v. Provident Bank, 170 F.3d 609, 613 (6th Cir. 1999). Thus, a
party who exercises discretionary control or authority over the plan is a fiduciary
irrespective of any formal designation as such. Mich. Affiliated Healthcare Sys., Inc.
v. CC Sys. Corp. of Mich., 139 F.3d 546, 549 (6th Cir. 1998). A plaintiff must “set
forth particularized allegations” in its complaint to support the conclusion that a party
is a fiduciary for ERISA purposes. Riverview Health Inst. LLC v. Med. Mut. of Ohio,
601 F.3d 505, 522-23 (6th Cir. 2010), cert. denied, 131 S. Ct. 220 (2010) (citing
D’Amato v. Corporate Consulting, Inc., No. 94-3218, 1995 WL 510041, at *2 (6th Cir.
Aug. 28, 1995)).
Plaintiffs’ Complaint concedes that MCA is not the plan administrator. As
such, for MCA to be a proper party defendant to the instant action, MCA must have
fiduciary status under ERISA. Nowhere in the Complaint do plaintiffs allege that
MCA has fiduciary status nor do plaintiffs allege that MCA had discretionary
authority or control over administration of the plan requisite to confer fiduciary status
upon MCA.2 Plaintiffs’ allegations as to MCA consist of statements contained within
two paragraphs of the Complaint which provide that MCA served as Wellmont’s
Third -Party Claims Administrator and that MCA was substantially involved in the
denial of benefits claims under the plan.3 These statements are merely conclusory
allegations devoid of any particularized factual allegations necessary to support the
conclusion that MCA is a fiduciary under ERISA. Because the plaintiff has failed to
plead factual content sufficient to draw a reasonable inference that MCA was a
fiduciary under ERISA, MCA is not a proper party defendant to the instant action.
V. Conclusion
For the reasons set forth herein, the motion to dismiss filed by the defendant,
MCA, pursuant to Rule 12(b) of the Federal Rules of Civil Procedure, [Doc. 14], is
GRANTED. As such, the plaintiffs’ claims against MCA are hereby DISMISSED.
SO ORDERED.
ENTER:
s/J. RONNIE GREER
UNITED STATES DISTRICT JUDGE
2
Plaintiff specifically alleges in paragraph 12 of the complaint [Doc. 1] that defendant,
Wellmont, is “plan administrator and plan supervisor and, as such, is a fiduciary under ERISA.”
3
Plaintiff attached the Plan Information and a letter denying benefits as exhibits to the
Complaint, [Doc. 1, Atts. 8 and 7], both of which reference MCA. Those documents indicate
MCA’s role as Third-Party Administrator.
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