AK v. Behavioral Health Sys., Inc.

382 F. Supp. 3d 772
CourtDistrict Court, M.D. Tennessee
DecidedMay 28, 2019
DocketCase No. 3:18-cv-01238
StatusPublished
Cited by18 cases

This text of 382 F. Supp. 3d 772 (AK v. Behavioral Health Sys., Inc.) is published on Counsel Stack Legal Research, covering District Court, M.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
AK v. Behavioral Health Sys., Inc., 382 F. Supp. 3d 772 (M.D. Tenn. 2019).

Opinion

WAVERLY D. CRENSHAW, JR., CHIEF UNITED STATES DISTRICT JUDGE

In this case, C.K., an employee of American Family Care, Inc. and a participant in its Group Healthcare Plan ("the Plan"), seeks to have Defendants pay for residential treatment for her daughter A.K.'s eating disorder. Claims are brought under both the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1132 et seq. , and the Mental Health Parity and Addiction Equity Act ("MHPAEA"), 29 U.S.C. § 1185, which amends ERISA and is "designed to end discrimination in the provision of coverage for mental health and substance use disorders as compared to medical and surgical conditions in employer-sponsored group health plans[.]" Coal. for Parity, Inc. v. Sebelius, 709 F.Supp.2d 10, 13 (D.D.C. 2010) ; see also, Wilson v. Anthem Health Plans of Kentucky, Inc., No. 3:14-CV-743-TBR, 2017 WL 56064, at *2 (W.D. Ky. Jan. 4, 2017) (noting that "Congress enacted [MHPAEA] as an amendment to ERISA, making it enforceable through a cause of action under 29 U.S.C. § 1132(a)(3)").

The Plan has filed a Motion to Dismiss (Doc. No. 27), as has Behavioral Health Systems, Inc. ("BHS") (Doc. No. 25), which is alleged to have provided claims administration and review services as a subcontractor for Blue Cross Blue Shield of Alabama. Those Motions have been fully briefed by the parties (Doc. Nos. 26, 28, 31, 33, 34, & 37), including a sur-reply filed by Plaintiffs. In that sur-reply, Plaintiffs argue that "BHS is being very clever in regard to its Motion to Dismiss" because "[i]t is making arguments appropriate for consideration in the course of adjudicating a Motion for Judgment on the Administrative Record, packaging its arguments under Rule 12(b)(6), and hoping that no one *774will notice the difference." (Doc. No. 37 at 1). That is, while "BHS is free to make all the arguments it wants to make - eventually," id., a Rule 12(b)(6) motion is not the proper vehicle to resolve this dispute.

The Court will not go so far as to say that BHS is being clever, but, to an extent, Plaintiffs have a point. "[J]udgment on the administrative record ... ordinarily is the appropriate means of resolving a claim for wrongful denial of benefits under ERISA." Sullivan v. Cap Gemini Ernst & Young, 573 F.Supp.2d 1009, 1012 (N.D. Ohio 2008). Indeed, the Sixth Circuit "has instructed district courts to follow a two-step process in adjudicating an ERISA benefit action:

'1. As to the merits of the action, the district court should conduct a de novo review based solely upon the administrative record, and render findings of fact and conclusions of law accordingly. The district court may consider the parties' arguments concerning the proper analysis of the evidentiary materials contained in the administrative record, but may not admit or consider any evidence not presented to the administrator.
2. The district court may consider evidence outside of the administrative record only if that evidence is offered in support of a procedural challenge to the administrator's decision, such as an alleged lack of due process afforded by the administrator or alleged bias on its part. This also means that any prehearing discovery at the district court level should be limited to such procedural challenges.' "

Moore v. Lafayette Life Ins. Co., 458 F.3d 416, 430 (6th Cir. 2006) (quoting Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 618-19 (6th Cir.1998) ). This is not to say that dismissal is never appropriate in an action for benefits under ERISA or, by extension, the MHPAEA. See Jones v. Allen, No. 2:11-CV-380, 2012 WL 2918442, at *1 (S.D. Ohio July 17, 2012) (observing that "the 2 Court of Appeals has not exempted ERISA pleadings from Rule 12(b)(6) scrutiny as a general matter, so there is nothing inherently wrong with Defendants having filed that motion here."). It is to say, however, that dismissal for failure to state a claim under Rule 12(b)(6) is inappropriate where the parties do not even agree on what constitutes the plan documents. No doubt, "identifying 'the plan' is not always a clear-cut task," Administrative Committee of Wal-Mart Stores, Inc. Associate's Health & Welfare Plan v. Gamboa, 479 F.3d 538, 542 (8th Cir. 2007), and "there are often multiple documents that together represent the whole of the plan," Moore v. Life Insurance Company of North America, 6:17-CV-00030, 2018 WL 1461502, at *2 (W.D. Va. Mar. 23, 2018). But determining what constitutes the relevant plan documents and whether the decision was proper under those documents is an even less clear-cut task when the Court is relying simply on counsels' say-so, rather than what the administrator used to make his or her determination.

Apart from the ERISA and MHPAEA claims, BHS in its reply brief notes that "Plaintiff failed to respond to several arguments," including "(1) that class-wide relief is unavailable as the Complaint is currently pled; ... (2) that the Court should reject Plaintiffs' request to 'conduct discovery'; ... and (3) that the Court should reject Plaintiffs' request for penalties under 29 U.S.C. § 1132(c)(1)." (Doc. No. 33 at 5, n. 7).

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Bluebook (online)
382 F. Supp. 3d 772, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ak-v-behavioral-health-sys-inc-tnmd-2019.