Ford v. Premera Blue Cross

Filing 20

ORDER granting Defendant's 7 Motion to Dismiss and for Summary Judgment. Plaintiff's lawsuit is DISMISSED with prejudice. Signed by Judge Marsha J. Pechman. (PM)

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17-1738UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF WASHINGTON
AT SEATTLE

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TRISTAN FORD,
Plaintiff,

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v.

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CASE NO. C17-1738 MJP
ORDER ON MOTION TO DISMISS
AND FOR SUMMARY
JUDGMENT

PREMERA BLUE CROSS,
Defendant.

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The Court has received and reviewed:

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1.

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2. Plaintiff’s Opposition to Motion to Dismiss (Dkt. No. 12),

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3. Premera’s Reply in Further Support of Its Motion to Dismiss and for Summary

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Defendant’s Motion to Dismiss and for Summary Judgment (Dkt. No. 7),

Judgment (Dkt. No. 15),
all attached declarations and exhibits, and relevant portions of the record, and rules as follows:
IT IS ORDERED that the motion for summary judgment is GRANTED and this matter is
DISMISSED with prejudice.

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ORDER ON MOTION TO DISMISS AND FOR SUMMARY JUDGMENT - 1

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Background
Defendant Premera Blue Cross (“Premera”) administers an “employee welfare benefit

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plan” (“the Plan”) under ERISA, 29 U.S.C. § 1001, et seq. Among its provisions, the Plan

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contains a limitations period of one year from the final determination of an appealed decision to

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commence any legal action. (See Dkt. No. 8-1, Ex. 1 at 84.)

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Plaintiff filed a claim for payment under the Plan which Premera only partially granted.

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Plaintiff appealed the denial; Premera denied the appeal on November 11, 2014. On November

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15, 2017, Plaintiff filed this complaint in King County Superior Court. Defendant timely

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removed the matter to federal court. In the motion at issue here, Defendant moved for dismissal

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of Plaintiff’s Insurance Fair Conduct Act (“IFCA”) claim pursuant to FRCP 12(b)(6), and

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summary judgment dismissal of the entire lawsuit on the grounds that it is time-barred.

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Finding grounds for granting the summary judgment dismissal, the Court will not address
the “lesser included” 12(b)(6) motion addressing a single claim.

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Discussion

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Motion for summary judgment
The Plan contains a provision which sets the statute of limitations for bringing a lawsuit

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based on denial of a claim at one year from the final adjudication of the denial (which, in this

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case, was November 11, 2014). ERISA itself does not specify a limitation period for plan

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participants to bring suit following an adverse benefits determination, and the Supreme Court has

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upheld the right of ERISA benefit plan providers to prescribe a statute of limitations which is

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shorter than comparable state statutes of limitations. Heimeshoff v. Hartford Life & Accident

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Ins. Co., 134 S.Ct. 604, 610 (2013).

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ORDER ON MOTION TO DISMISS AND FOR SUMMARY JUDGMENT - 2

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Plaintiff first argues that the Washington statutory breach of contract limitations period
(six years; RCW 4.16.040) should apply. But the Supreme Court has clearly stated that
in the absence of a controlling statute to the contrary, a provision in a contract may
validly limit, between the parties, the time for bringing an action on such contract to a
period less than that prescribed in the general statute of limitations, provided that the
shorter period itself shall be a reasonable period.

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Order of United Commercial Travelers of America v. Wolfe, 331 U.S. 586, 608 (1947)(cited

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with approval in Heimeshoff, 134 S.Ct. at 611).

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Plaintiff interposes several ineffectual arguments against adopting Defendant’s position.
One is that neither Plaintiff nor the Court received copies of the actual insurance contract. But

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both Plaintiff and the Court received copies of the Plan summary (Dkt. No. 8-1) containing a

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section entitled “Limits on your right to judicial review” which unequivocally states that “[a]ny

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legal action initiated under the plan must be brought no later than one year following the adverse

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determination on the appeal.” (Id. at 84.) Defendant also submitted into evidence a letter which

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it sent to Plaintiff following denial of appeal which likewise advised him of his right to file a

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lawsuit and the timeframe in which to do so. (Dkt. No. 8-7.)

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Plaintiff asserts that there are no Washington cases upholding the shorter limitations

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period, but that is a curious defense in the face of a Supreme Court case indicating that the

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practice is permissible. Additionally, there is Ninth Circuit authority which accepted a plaintiff’s

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concession that a one-year limitation period under analogous circumstances was reasonable.

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Scharff v. Raytheon Co. Short Term Disability Plan, 581 F.3d 899 (9th Cir. 2009).

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Plaintiff maintains that the issue of whether reducing a six-year limitations period on

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contract actions to one year is “reasonable” is a “question of material fact.” (Dkt. No. 12,

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Response at 7.) Plaintiff does not elaborate, and the Court fails to see how this presents a factual

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issue. While the Plan’s limitation period is unquestionably shorter, the Court is presented with a

ORDER ON MOTION TO DISMISS AND FOR SUMMARY JUDGMENT - 3

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Supreme Court ruling that “[Plaintiff] does not dispute that a hypothetical 1-year limitations

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period commencing at the conclusion of internal review would be reasonable… We cannot fault

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a limitations provision that would leave the same amount of time…” Heimeshoff, supra at 612.

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It is controlling precedent in this matter.

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Plaintiff makes two other last-ditch attempts to salvage his case. The first is an argument

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that his bad faith claim sounds in tort and was filed within the three-year limitations period for

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tort actions in Washington. RCW 4.16.080(2). As the argument on adopting Washington’s six-

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year contract limitation period fails, this must fail as well. Additionally, Defendant establishes

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conclusively that Plaintiff’s lawsuit was filed more than three years after the final denial of

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Plaintiff’s internal appeal.

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Finally, Plaintiff interposes a cursory FRCP 56(d) argument, but it is stated in a summary

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and conclusory fashion that is not in keeping with either the letter or spirit of the procedural rule.

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Plaintiff makes no showing of what evidence he thinks additional discovery would produce, nor

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how that evidence would alter the outcome of the Court’s ruling. On that basis, his 56(d) request

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is deficient and will be denied.

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The Court finds that, in the face of the Supreme Court Heimeshoff ruling, these parties

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had a right to contract for a one-year limitation period, and that such a period is reasonable.

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Plaintiff did not timely file his lawsuit and Defendant is entitled to the summary judgment it

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seeks.

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Motion to dismiss

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Defendant moves, pursuant to FRCP 12(b)(6), to dismiss Plaintiff’s IFCA claim on the

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grounds that IFCA (RCW 48.30 et seq.) specifically excludes “health plan[s] carried by a health

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carrier.” RCW 48.30.015(7). While the Court believes the argument is meritorious, this portion

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ORDER ON MOTION TO DISMISS AND FOR SUMMARY JUDGMENT - 4

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of Defendant’s motion is superfluous in the face of the complete summary judgment dismissal

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already obtained.

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Conclusion
Defendant has successfully established that there are no genuinely disputed issues of

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material fact and that it is entitled to summary judgment as a matter of law. Plaintiff has failed to

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meet his burden on summary judgment and failed to establish his right to a continuance of this

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motion under FRCP 56(d). The Court finds that the Plan’s one-year limitation period is

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reasonable and enforceable, and that Defendant is entitled to a ruling that this lawsuit was not

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timely filed thereunder.

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Accordingly, Plaintiff’s lawsuit is DISMISSED with prejudice.

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The clerk is ordered to provide copies of this order to all counsel.

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Dated: April 4, 2018.

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A
The Honorable Marsha J. Pechman
United States Senior District Court Judge

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ORDER ON MOTION TO DISMISS AND FOR SUMMARY JUDGMENT - 5