Renaissance Ranch Outpatient Treatment v. Golden Rule Insurance Company et al

Filing 23

MEMORANDUM DECISION AND ORDER granting in part and denying in part 11 Motion to Dismiss for Failure to State a Claim. Plaintiff to file an amended complaint consistent with this Memorandum Decision and Order within 14 days of entry of this order. Parties are to file an attorneys planning meeting report and proposed scheduling order on or before 7/14/17. Signed by Judge David Nuffer on 6/20/17 (alt)

IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF UTAH, CENTRAL DIVISION
RENAISSANCE RANCH OUTPATIENT
TREATMENT, INC.,
Plaintiff,

MEMORANDUM DECISION AND
ORDER GRANTING IN PART AND
DENYING IN PART DEFENDANTS’
MOTION TO DISMISS

v.
GOLDEN RULE INSURANCE COMPANY,
UNITED HEALTHCARE SERVICES, INC.,
UNITEDHEALTHCARE OF UTAH, INC.,
and UNITED HEALTHCARE LIFE
INSURANCE COMPANY,

Case No. 2:16-cv-00872-DN
District Judge David Nuffer

Defendants.

Plaintiff Renaissance Ranch Outpatient Treatment, Inc. (“Renaissance”), as an assignee
of many of its patients who were treated for drug and alcohol addictions, sues various insurers
for failure to pay claims for treatment. 1 The insurers moved to dismiss many claims as to many
patients. 2 This order grants the Motion to Dismiss in large part.

1
2

Complaint, docket no. 2, filed Aug. 11, 2016.

Defendants’ Motion to Dismiss; Supporting Memorandum (“Motion to Dismiss”), docket no. 11, filed Oct. 13,
2016.

Contents
BACKGROUND ............................................................................................................................ 2
Overview of Complaint....................................................................................................... 2
Motion to Dismiss ............................................................................................................... 3
Overview of Disposition ..................................................................................................... 4
Factual Background ............................................................................................................ 4
DISCUSSION ................................................................................................................................. 5
Renaissance’s state-law causes of action, Claims 1-7, for patients having plans that are
governed by ERISA, are preempted by ERISA ............................................................ 7
This court has no jurisdiction of state-law causes of action, Claims 1-7, for patients
having plans not governed by ERISA ........................................................................... 8
Claims 8-9 fail to state a claim for Renaissance’s patients having plans not subject to
ERISA ......................................................................................................................... 10
Claim 8, alleging breach of fiduciary duty under ERISA fails as a matter of law ........... 11
Renaissance sufficiently alleges its standing to sue under ERISA, Claim 9, for its patients
having plans governed by ERISA and who it provided a written AOB ..................... 13
CONCLUSION ............................................................................................................................. 14
ORDER ......................................................................................................................................... 16

BACKGROUND
Overview of Complaint
Renaissance’s Complaint alleges nine causes of action.
Claims for Relief
1 - Breach of Contract
2 - Breach of Implied Covenant of Good Faith
3 - Unjust Enrichment, Quasi Contract, Quantum Meruit
4 - Fraud
5 - Negligent Misrepresentation
6 - Negligent Misrepresentation
7 - Declaratory Judgment
8 - ERISA Breach of Fiduciary Duties
9 - ERISA Benefits
Claims 1-7 allege state-law causes of action, 3 while Claims 8-9 are pleaded under the
Employment Retirement Income Security Act of 1974 (“ERISA”). 4 The Complaint seeks

3

Complaint ¶¶ 49-100.

4

Id. ¶¶ 101-114.

2

recovery of the denied benefits claims for 28 of its patients, 5 but in subsequent briefing,
Renaissance increased the number of its patients to 36. 6 Patients 1-23 have plans that are
governed by ERISA; patients 24-36 have plans that are not governed by ERISA. 7
Motion to Dismiss
Defendants Golden Rule Insurance Company (“Golden Rule”), United Healthcare
Services, Inc. (“UHS”), United Healthcare of Utah, Inc. (“UHU”), and United Healthcare Life
Insurance Company (“UHLIC”), are referred to collectively “United.” United’s Motion to
Dismiss argues that Renaissance’s state-law causes of action are preempted by ERISA; that these
pendent state-law causes of action should be dismissed for lack of subject-matter jurisdiction;
that Renaissance lacks standing to sue under the ERISA; and that Renaissance has failed to state
a claim under ERISA for breach of fiduciary duty. 8
Renaissance responded that its state-law causes of action are not preempted by ERISA
because these state-law causes of action apply only to its patients’ plans that are not governed by
ERISA; that subject-matter jurisdiction over its state-law causes of action exists because these
causes of action form part of the same case or controversy as its ERISA causes of action; that it
has standing to sue under ERISA as an assignee of its patients; and that it has sufficiently
pleaded a cause of action under ERISA for breach of fiduciary duty. 9

5

Id. ¶¶ 35, 42.

6

Joint Submission in Response to the Court’s March 6, 2017 Order [Docket #15] (“Joint Brief”) at 1, docket no. 21,
filed Apr. 14, 2017.
7

Id. at 2-3.

8

See also Defendants’ Reply Memorandum in Support of Motion to Dismiss (“Reply”), docket no. 13, filed Nov.
28, 2016.
9

Memorandum in Opposition to Motion to Dismiss (“Opposition”), docket no. 12, filed Nov. 10, 2016.

3

Overview of Disposition
United’s Motion to Dismiss is GRANTED in part because:
•

Renaissance’s state-law causes of action, Claims 1 7, are preempted by ERISA for
Renaissance’s patients having plans that are governed by ERISA;

•

subject-matter jurisdiction over Renaissance’s state-law causes of action,
Claims 1-7, is lacking;

•

Renaissance’s ERISA causes of action, Claims 8-9, fail to state a claim for
Renaissance’s patients having plans not subject to ERISA;

•

Renaissance failed to establish its standing to sue under ERISA for some patients
by failing to show a written assignment of benefits (“AOB”), as would be
required to state ERISA claims; and

•

Renaissance’s cause of action for breach of fiduciary duty under ERISA, Claim 8,
fails as a matter of law.

However, because Renaissance sufficiently pleaded its standing to sue under ERISA for
its patients having plans governed by ERISA and who it provided an AOB, the Motion to
Dismiss is DENIED in part.
Factual Background
Parties’ Roles: Renaissance is a Utah corporation that provides services as an outpatient
substance abuse treatment facility that specializes in treating patients with drug and alcohol
addictions. 10 Golden Rule is an Indiana corporation that provides health and welfare benefit
plans to individuals, including Utah residents, under the UnitedHealth Group global brand. 11
UHS is a Minnesota corporation, UHLIC is a Wisconsin corporation, and UHU is a Utah
corporation, all of which are subsidiaries of the UnitedHealth Group and administer employee

10

Complaint ¶ 14.

11

Id. ¶ 16.

4

health and welfare benefit plans to Utah residents. 12 Renaissance is an out-of-network provider
for United. 13
Assignments of Benefits: Renaissance has a practice of receiving an AOB from each
patient it treats. 14 The AOBs gives Renaissance the right to all benefits under its patients’
plans. 15 Prior to treating its patients Renaissance verifies, through a third-party medical billing
company, whether the patients’ plans will cover Renaissance’s services. 16
Dispute Arises: Beginning in the spring of 2015, United began denying all new claims
for benefits submitted by Renaissance for the treatment of its patients. 17 In subsequent months,
Renaissance attempted to work with United to determine the cause of the denials, but was
unsuccessful. 18 Renaissance alleges that, to date, United owes $1,952,244.50 in wrongfully
denied claims for benefits. 19
DISCUSSION
Dismissal is appropriate under Rule 12(b)(6) of the Federal Rules of Civil Procedure
when the complaint, standing alone, is legally insufficient to state a claim on which relief may be
granted. 20 When considering a motion to dismiss for failure to state a claim, the thrust of all

12

Id. ¶ 15.

13

Id. ¶ 18.

14

Id. ¶ 19.

15

See e.g. Exhibit C to Complaint, docket no. 2-5, filed Aug. 11, 2016.

16

Complaint ¶ 20.

17

Id. ¶¶ 24-25; see also Exhibit E to Complaint, docket no. 2-7, filed Aug. 11, 2016.

18

Complaint ¶¶ 24-47.

19

Id. ¶¶ 41, 48.

20

Sutton v. Utah State Sch. For the Deaf & Blind, 173 F.3d 1226, 1236 (10th Cir. 1999).

5

well-pleaded facts is presumed, but conclusory allegations need not be considered. 21 And the
complaint’s legal conclusions and opinions are not accepted, even if they are couched as facts. 22
Where United’s Motion to Dismiss challenges federal subject-matter jurisdiction over
causes of action, Renaissance has the burden of establishing jurisdiction. 23 Subject-matter
jurisdiction can be established through diversity jurisdiction, 24 federal question jurisdiction, 25
and supplemental jurisdiction. 26 Renaissance must also establish its standing to sue. 27 To aid in
the determination of these issues, supplemental briefing was requested from the parties. 28 The
supplemental briefing included identification of the patients from which Renaissance received a
written AOB, and identification of patients’ plans governed by ERISA. 29
The review and consideration of these supplemental materials to determine subject-matter
jurisdiction and standing does not convert United’s Motion to Dismiss into one for summary
judgment. 30 “A court has wide discretion to allow affidavits, other documents, and a limited
evidentiary hearing to resolve disputed jurisdictional facts under Rule 12(b)(1)” to resolve a
factual attack on subject-matter jurisdiction. 31 When ruling on a motion to dismiss an ERISA
claim under Rule 12(b)(6), benefits plans and other documents, if they are “referred to in the

21

Cory v. Allstate Ins., 583 F.3d 1240, 1244 (10th Cir. 2009).

22

Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007); see also Brown v. Zavaras, 63 F.3d 967, 972 (10th Cir.
1995).

23

Montoya v. Chao, 296 F.3d 952, 955 (10th Cir. 2002).

24

28 U.S.C. § 1332.

25

Id. § 1331.

26

Id. § 1367; see also McDonald v. Nationwide Title Clearing, Inc., 661 Fed. App’x 518, 520-21 (10th Cir. 2016).

27

Yarbary v. Martin, 643 Fed. App’x 813, 816 (10th Cir. 2016).

28

Order for Supplemental Briefing, docket no. 15, filed Mar. 6, 2017.

29

Joint Brief at 1-3.

30

Holt v. United States, 46 F.3d 1000, 1003 (10th Cir. 1995).

31

Id.

6

complaint” and are “central to the plaintiff’s claim” may be considered without converting the
motion into one for summary judgment. 32
Renaissance’s state-law causes of action, Claims 1-7, for patients having plans that are
governed by ERISA, are preempted by ERISA
United argues that Claims 1-7 are preempted by ERISA. 33 The Supreme Court has held
that Congress intended to make ERISA “exclusively a federal concern.” 34
When a federal statute wholly displaces the state-law cause of action through
complete pre-emption, the state claim can be removed. This is so because when
the federal statute completely pre-empts the state-law cause of action, a claim
which comes within the scope of that cause of action, even if pleaded in terms of
state-law, is in reality based on federal law. ERISA is one of these statutes …
Therefore, any state-law cause of action that duplicates, supplements, or supplants
the ERISA civil enforcement remedy … is therefore pre-empted. 35
Therefore, to the extent that as Renaissance’s state-law causes of action,
Claims 1-7, seek to recover unpaid benefits under plans that are governed by ERISA,
they are preempted by ERISA. The parties’ supplemental briefing identified patients 1-23
as having plans governed by ERISA. 36 Therefore, United’s Motion to Dismiss is
GRANTED as to Claims 1-7 for patients 1-23.
However, to the extent that Claims 1-7 relate to patients 24-36 whose plans are
not governed by ERISA, those claims are not preempted. Nevertheless, this does not
mean that Claims 1-7 for patients 24-36 survive dismissal.

32

GFF Corp. v. Associated Wholesale Grocers, Inc., 130 F.3d 1381, 1384 (10th Cir. 1997).

33

Motion to Dismiss at 1-4; Reply at 3.

34

Aetna Health Inc. v. Davila, 542 U.S. 200, 208 (2004) (internal quotations omitted).

35

Id. at 207-08 (internal citations and quotations omitted).

36

Joint Brief at 2-3.

7

This court has no jurisdiction of state-law causes of action, Claims 1-7,
for patients having plans not governed by ERISA
United argues that diversity jurisdiction is lacking and any pendent state-law causes of
action of Renaissance, which at this point relate only to patients having plans not covered by
ERISA, should be dismissed for lack of subject-matter jurisdiction. 37 Renaissance’s Claims 1-7
are state-law causes of action 38 that are not governed by a federal question. Therefore, if
diversity jurisdiction or supplemental jurisdiction are absent, the court has no jurisdiction over
these claims. 39
Diversity jurisdiction exists when the parties of a civil action are “citizens of different
States.” 40 The Supreme Court has interpreted this to require “complete diversity between all
plaintiffs and defendants.” 41 Further, corporations “shall be deemed to be a citizen of any State
by which it has been incorporated and of the State where it has its principal place of business.” 42
Complete diversity is lacking on Claims 1-7 for patients having plans not governed by
ERISA. Renaissance alleges that UHU “is a Utah corporation that maintains its principal place of
business in Salt Lake County, Utah.” 43 Renaissance also alleges that it is “a Utah corporation
that maintains its principal place of business in Salt Lake County, Utah.” 44 Therefore, because
Renaissance and UHU are both citizens of Utah, diversity jurisdiction cannot be used to establish
subject-matter jurisdiction over Claims 1-7 for Renaissance’s patients having plans not governed

37

Motion to Dismiss at 9-11; Reply at 3.

38

Complaint ¶¶ 49-100.

39

28 U.S.C. §§ 1331, 1332, 1367; see also McDonald, 661 Fed. App’x at 520-21.

40

28 U.S.C. § 1332(a)(1).

41

Lincoln Property Co. v. Roche, 546 U.S. 81, 89 (2005).

42

28 U.S.C. § 1332(c)(1).

43

Complaint ¶ 6.

44

Id. ¶ 1.

8

by ERISA. Accordingly, if Claims 1-7 (now for patients whose plans are not governed by
ERISA) are to remain federal court it could only be through supplemental jurisdiction. 45
District courts may exercise supplemental jurisdiction over pendent causes of action
lacking diversity or federal question jurisdiction when the causes of action “are so related to
claims in the action within such original jurisdiction that they form part of the same case or
controversy under Article III of the United States Constitution.”46 “A claim is part of the same
case or controversy if it ‘derives from a common nucleus of operative fact.’” 47 Moreover, “the
Supreme Court repeatedly has determined that supplemental jurisdiction is not a matter of the
litigants’ right, but of judicial discretion.” 48
Patients 24-36 have plans not governed by ERISA. 49 These patients presumably had
differing diagnoses and treatments at Renaissance. They also have plans containing differing
terms and provisions under which benefits are authorized, and benefits claims are made,
reviewed, and approved or denied. 50 Additionally, Renaissance’s communication and interaction
with Golden Rule was separate from its attempts to work with UHS, UHU, and UHLIC
regarding the denials of benefits claims. 51 And each of patients 24-36’s benefits claims will have
a distinct procedural history and administrative record that must be reviewed to determine the
propriety of United’s denials of each patient’s benefits claim. Likewise, the benefits claims of

45

28 U.S.C. §§ 1331, 1332, 1367; see also McDonald, 661 Fed. App’x at 520-21.

46

28 U.S.C. § 1367(a).

47

Price v. Wolford, 608 F.3d 698, 702-03 (10th Cir. 2010) (quoting City of Chicago v. Int’l Coll. of Surgeons, 552
U.S. 156, 165 (1997)).
48
Estate of Harshman v. Jackson Hole Mountain Resort Corp., 379 F.3d 1161, 1165 (10th Cir. 2004) (citing City of
Chicago, 522 U.S. at 173).
49

Joint Brief at 2-3.

50

Exhibit A to Joint Brief, docket no. 21-1, filed Apr. 14, 2017.

51

Complaint at 10.

9

patients 1-23 having ERISA-governed plans 52 (under other causes of action) will have a distinct
procedural history and administrative record that must be reviewed to determine the propriety of
United’s denials of each patient’s benefits claim.
Under these circumstances, each patients 24-36’s benefits claims has its own “nucleus of
operative fact” 53 that is unique to the specific treatment of the patient, the particular benefits
allowed by the patient’s plan, and the plan’s procedures for making benefits claims and internal
appeals of adverse benefits determinations. Because of the singular nature of each patient’s
benefits claim, Renaissance’s Claims 1-7 are not part of the same case or controversy as its
causes of action under ERISA. Therefore, supplemental jurisdiction will not be exercised over
Claims 1-7 for Renaissance’s patients having plans not governed by ERISA. United’s Motion to
Dismiss is GRANTED as to Claims 1-7 for patients 24-36. However, this dismissal is without
prejudice to refiling in an appropriate forum.
Claims 8-9 fail to state a claim for Renaissance’s patients
having plans not subject to ERISA
“The district courts shall have original jurisdiction of all civil actions arising under the
Constitution, laws, or treaties of the United States.” 54 A cause of action arises under federal law
if the complaint “establishes either that federal law creates the cause of action or that the
plaintiff’s right to relief necessarily depends on resolution of a substantial question of federal
law.” 55
Claims 8-9 purport to be claims under Sections 502(a)(1)(B) and 502(a)(3)(B) of ERISA.
Those sections do create private causes of action and establish federal question jurisdiction for
52

Joint Brief at 2-3.

53

Price, 608 F.3d at 703 (quoting City of Chicago, 552 U.S. at 165).

54

28 U.S.C. § 1331.

55

Franchise Tax Board v. Constr. Laborers Vacation Trust, 462 U.S. 1, 27-28 (1983).

10

Renaissance’s Claims 8-9. 56 However, these private causes of action apply only to plans that are
governed by ERISA. 57 The parties’ supplemental briefing establishes that patients 1-23 have
plans governed by ERISA, 58 and patients 24-36 do not. 59
The portions of Claims 8-9 which relate to patients 24-36 whose plans are not governed
by ERISA fail to state a claim on which relief may be granted. Therefore, United’s Motion to
Dismiss is GRANTED as to Claims 8-9 for patients 24-36. This dismissal is with prejudice.
Claim 8, alleging breach of fiduciary duty
under ERISA fails as a matter of law
United argues that Claim 8, Renaissance’s cause of action for breach of fiduciary duty
under ERISA § 502(a)(3), fails as a matter of law because it is duplicative of Claim 9 for benefits
under ERISA § 502(a)(1)(B), and because individual relief is not available for a breach of
fiduciary duty under ERISA § 502(a)(3). 60
The Supreme Court has recognized that “[t]he words of [ERISA § 502(a)](3) —
‘appropriate equitable relief’ to ‘redress’ any ‘act or practice which violates any provision of this
title’ — are broad enough to cover individual relief for breach of a fiduciary obligation.” 61
However, the Supreme Court also recognized that “in fashioning ‘appropriate’ equitable relief,
[courts must] keep in mind the special nature and purpose of employee benefit plans, and [give]
respect to the policy choices reflected in the inclusion of certain remedies and the exclusion of
others.” 62 Therefore, “where Congress elsewhere provided adequate relief for a beneficiary’s

56

29 U.S.C. §§ 1132(a)(1)(B), (3)(B).

57

Id. § 1003.

58

Joint Brief at 2-3.

59

Id.

60

Motion to Dismiss at 7-9; Reply at 9-10.

61

Varity Corp. v. Howe, 516 U.S. 489, 510 (1996).

62

Id. at 515 (internal quotations omitted).

11

injury, there will likely be no need for further equitable relief, in which case such relief normally
would not be ‘appropriate.’” 63
The Tenth Circuit Court of Appeals applied this guidance in a case where “improperly
denying, de facto, benefits under [a] plan[,]” was the alleged injury caused by an ERISA breach
of fiduciary duty. 64 The court held that “consideration of a claim under [ERISA § 502](a)(3) is
improper when [the plaintiff] states a cognizable claim under [ERISA § 502](a)(1)(B)[.]” 65 This
is because ERISA § 502(a)(1)(B) already “provides adequate relief for [the] alleged … injury.” 66
Therefore, “[d]ismissal of the [ERISA § 502](a)(3) claim was proper as a matter of law.” 67
Renaissance argues that it asserted a cause of action for breach of fiduciary duty under
ERISA § 502(a)(3) “solely to ensure appropriate equitable relief for injuries caused by violations
that ERISA does not elsewhere adequately remedy.” 68 Claim 8 requests relief in the form of “an
accounting and other equitable relief available to redress [United]’s violations of their
obligations under [United]’s Plans and ERISA.” 69 However, the only injury alleged in Claim 8 is
the improper denial and delay of payments on the patients’ benefits claims. 70 Because Claim 9,
as to patients with ERISA-governed plans, asserts a cognizable cause of action for the denial of
benefits under ERISA § 502(a)(1)(B), 71 adequate relief is available for Renaissance’s alleged
injury and the claims of patients having plans governed by ERISA do not need further equitable

63

Id.

64

Lefler v. United Healthcare of Utah, Inc., 72 Fed. App’x 818, 826 (10th Cir. 2003).

65

Id.

66

Id.

67

Id.

68

Opposition at 16.

69

Complaint ¶ 102.

70

Id. ¶¶ 105, 107.

71

Id. ¶¶ 108-114.

12

relief under Claim 8. 72 Therefore, dismissal with prejudice of Renaissance’s cause of action for
breach of fiduciary duty under ERISA is proper. 73 United’s Motion to Dismiss is GRANTED as
to Claim 8.
Renaissance sufficiently alleges its standing to sue under ERISA, Claim 9,
for its patients having plans governed by ERISA and who it provided a written AOB
United challenges Renaissance’s standing to sue under ERISA. 74 “In the ERISA context,
civil suits may only be filed ‘by a participant or beneficiary’ of an ERISA plan ‘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.’” 75 This means that
healthcare providers, such as Renaissance, “generally are not considered beneficiaries or
participants under ERISA and thus lack standing to sue unless they have a written assignment of
claims from a patient with standing to sue under ERISA.” 76
In the parties’ supplemental briefing, Renaissance identified and provided written AOBs
for 20 of its patients having plans governed by ERISA—patients 1-2, 4-13, 15-17, and 19-23. 77
The allegations within Renaissance’s Complaint 78 and the submission of these AOBs are
sufficient to defeat United’s challenge to Renaissance’s standing under the standard of review for

72

Lefler, 72 Fed. App’x at 826.

73

Id.

74

Motion to Dismiss at 4-6; Reply at 4-8.

75

Yarbary, 643 Fed. App’x at 816 (quoting 29 U.S.C. § 1132(a)(1)).

76

Denver Health and Hosp. Auth. v. Beverage Distrib. Co., LLC, 546 Fed. App’x 742, 745 (10th Cir. 2013) (internal
citation omitted).
77

Joint Brief at 2-3.

78

Complaint ¶¶ 18-23, 35, 42; Joint Brief at 2-3; Exhibit A to Joint Brief.

13

a motion to dismiss.79 Therefore, as to Renaissance’s standing to assert Claim 9 for patients 1-2,
4-13, 15-17, and 19-23, United’s Motion to Dismiss is DENIED. 80
However, no written AOBs were identified or provided for three of Renaissance’s
patients having plans governed by ERISA—patients 3, 14, and 18. 81 Therefore, Renaissance has
failed to allege sufficient facts or present evidence demonstrating its standing to sue under
ERISA for these patients. United’s Motion to Dismiss is GRANTED as to Claim 9 for patients 3,
14, and 18. This dismissal is without prejudice.
CONCLUSION
Because Renaissance’s state-law causes of action, Claims 1-7, are preempted by ERISA
for Renaissance’s patients having plans that are governed by ERISA, 82 United’s Motion to
Dismiss is GRANTED as to Claims 1-7 for patients 1-23. Claims 1-7 for patients 1-23 are
DISMISSED with prejudice.
Because Renaissance’s state-law causes of action, Claims 1-7, for its patients having
plans not governed by ERISA have no federal question, lack complete diversity, and
supplemental jurisdiction will not be exercised, 83 United’s Motion to Dismiss is GRANTED as
to Claims 1-7 for patients 24-36. Renaissance’s Claims 1-7 for patients 24-36 are DISMISSED
without prejudice to their refiling in an appropriate forum.

79

Cory v. Allstate Ins., 583 F.3d 1240, 1244 (10th Cir. 2009).

80

United challenged the validity of Renaissance’s AOBs, citing to anti-assignment provisions in the patients’ plans.
Motion to Dismiss at 5, docket no. 11, filed Oct. 13, 2016; Reply at 4-8, docket no. 13, filed Nov. 28, 2016.
However, Renaissance countered by arguing that the anti-assignment provisions are not enforceable because United
waived them and is estopped from relying on them through making partial payments to Renaissance. Opposition at
13-14. Because determining these issues will involve fact-intensive inquiries into each plan and each AOB, and the
parties’ conduct, these issues are more appropriately resolved on summary judgment or at trial and will not be
addressed in this Memorandum Decision and Order.
81

Joint Brief at 2-3.

82

Supra at 7.

83

Supra at 8-10.

14

Because Renaissance’s ERISA causes of action, Claims 8-9, fail to state a claim on which
relief may be granted for Renaissance’s patients having plans not governed by ERISA, 84
United’s Motion to Dismiss is GRANTED as to Claims 8-9 for patients 24-36. Claims 8-9 for
patients 24-36 are DISMISSED with prejudice.
Because Renaissance’s cause of action for breach of fiduciary duty under ERISA,
Claim 8, fails as a matter of law, 85 United’s Motion to Dismiss is GRANTED as to Claim 8.
Claim 8 is DISMISSED with prejudice.
Because Renaissance sufficiently alleges its standing to sue under ERISA, Claim 9, for
its patients having plans governed by ERISA and who provided it a written AOB, 86 United’s
Motion to Dismiss is DENIED as to Renaissance’s standing to assert Claim 9 for patients 1-2,
4-13, 15-17, and 19-23.
Because Renaissance failed to establish its standing to sue under ERISA, Claim 9, for its
patients having plans governed by ERISA that did not provide it a written AOB, 87 United’s
Motion to Dismiss is GRANTED as to Claims 8-9 for patients 3, 14, and 18. Claims 8-9 for
patients 3, 14, and 18 are DISMISSED without prejudice.
Therefore, the only remaining claims in this case are those stated in Renaissance’s
Claim 9 for patients 1-2, 4-13, 15-17, and 19-23. For sake of clarity moving forward,
Renaissance is directed to file an amended complaint within 14 days that is consistent with this
Memorandum Decision and Order, and which adequately identifies each patient, each patient’s

84

Supra at 10-11.

85

Supra at 11-13.

86

Supra at 13-14.

87

Id.

15

plan, the AOB provided by each patient, and the amount of each patient’s alleged improperly
denied benefits claims.
Additionally, because of the singular nature of the treatment each patient received from
Renaissance, the benefits allowed by each patient’s plan, each plan’s procedures for making
benefits claims and internal appeals of adverse benefits determinations, and each patient’s
administrative record, 88 the parties must meet and confer to develop a case schedule, including
appropriate treatment for the highly individualized remaining claims and whether mediation will
be beneficial. On or before July 14, 2017, the parties shall file an attorneys’ planning meeting
report and submit a proposed scheduling order as outlined at
http://www.utd.uscourts.gov/attorney-planning-meeting-and-report.
ORDER
IT IS HEREBY ORDERED that United’s Motion to Dismiss 89 is GRANTED in part and
DENIED in part as follows:
(1)

GRANTED as to Claims 1-7 for patients 1-23. Claims 1-7 for patients 1-23 are

DISMISSED with prejudice.
(2)

GRANTED as to Claims 1-7 for patients 24-36. Claims 1-7 for patients 24-36 are

DISMISSED without prejudice to their refiling in an appropriate forum.
(3)

GRANTED as to Claims 8-9 for patients 24-36. Claims 8-9 for patients 24-36 are

DISMISSED with prejudice.
(4)

GRANTED as to Claim 8. Claim 8 is DISMISSED with prejudice.

88

Supra at 9.

89

Docket no. 11, filed Oct. 13, 2016.

16

(5)

DENIED as to Renaissance’s standing to assert Claim 9 for patients 1-2, 4-13,

15-17, and 19-23.
(6)

GRANTED as to Claim 9 for patients 3, 14, and 18. Claim 9 for patients 3, 14,

and 18 is DISMISSED without prejudice.
IT IS FURTHER HEREBY ORDERED that within 14 days after the entry of this
Memorandum Decision and Order, Renaissance shall file an amended complaint consistent with
this Memorandum Decision and Order.
IT IS FURTHER HEREBY ORDERED that the parties must meet and confer to develop
a case schedule including appropriate treatment for the remaining claims and whether mediation
will be beneficial. On or before July 14, 2017, the parties shall file an attorneys’ planning
meeting report and submit a proposed scheduling order as outlined at
http://www.utd.uscourts.gov/attorney-planning-meeting-and-report.
Signed June 20, 2017.
BY THE COURT

________________________________________
David Nuffer
United States District Judge

17