Beach v. Mutual of Omaha Insurance

229 F. Supp. 2d 1230, 29 Employee Benefits Cas. (BNA) 1744, 2002 U.S. Dist. LEXIS 21455
CourtDistrict Court, D. Kansas
DecidedOctober 28, 2002
Docket02-2124-DJW
StatusPublished
Cited by14 cases

This text of 229 F. Supp. 2d 1230 (Beach v. Mutual of Omaha Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Kansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Beach v. Mutual of Omaha Insurance, 229 F. Supp. 2d 1230, 29 Employee Benefits Cas. (BNA) 1744, 2002 U.S. Dist. LEXIS 21455 (D. Kan. 2002).

Opinion

ORDER

WAXSE, United States Magistrate Judge.

Plaintiff brings this action pursuant to the Employee Retirement Income Security Act of 1974 1 (“ERISA”), and Kansas state law, seeking medical benefits under a group health insurance policy. Plaintiff also seeks an injunction requiring health insurance coverage. Currently pending before the Court is Plaintiffs Motion for Leavé to Amend Complaint (doc. 19), Defendants’ Motion to Dismiss (doc. 2) and Plaintiffs Motion for Oral Argument on both of Defendants’ Motions (doc. 28). For the reasons stated below, Plaintiffs Motion for Leave to Amend Complaint will be granted and Defendants’ Motion to Dismiss will be granted in part and denied in part as specifically set forth herein.

Moreover, the Court determines, after examining the briefs submitted by the parties, that oral argument would not maternally assist in resolving the pending Motions. Thus, Plaintiffs. Motion for Oral Argument will be denied.

I. Facts

Plaintiffs First Amended Complaint alleges the following facts, which the Court accepts as true for purposes of the pending Motion to Dismiss 2 :

Defendant Peter Kiewit Sons’, Inc. (“Kiewit”) is a construction company incorporated in Nebraska. During the relevant time period, Plaintiffs father, Barry Beach, worked for Kiewit. Kiewit’s group health insurance policy (“the Benefit Plan” or “the Plan”) is self-funded. Defendant Mutual of Omaha Insurance Company (“Mutual of Omaha”) is an administrator of the Benefit Plan.

Prior to December 31, 2000, Plaintiff was an eligible beneficiary under the Benefit Plan because he was Barry Beach’s natural-born, unmarried son, under the age of 23 years, who was a full-time student at an accredited college and chiefly dependent on Barry Beach for support. Plaintiffs eligibility for plan benefits lapsed on or about December 31, 2000, however, because Plaintiff chose not to continue full-time enrollment as a college student.

On or about July 13, 2001, Plaintiff was accepted as a student at Iowa Western Community College. At that time, Plaintiff enrolled in classes on a full-time basis with course work to begin on August 20, 2001. Plaintiff paid $1,568.00 in tuition for 18 credit hours, purchased required tools and supplies in an amount exceeding $400.00 and attended a day-long on-campus mandatory orientation session for full-time students.

On or about July 30, 2001, Barry Beach contacted agents of the administrator of the Plan to advise them of his desire to have Plaintiff covered under the Benefit Plan based on Plaintiffs recent college enrollment. On or about July 30, 2001— and on several other occasions prior to August 13, 2001-agents of the administrator of the Plan, including but not limited to Sandy Otto and Kris Athey, orally informed Barry Beach that Plaintiff was covered by the Benefit Plan as of Barry Beach’s July 30, 2001 request for such *1233 coverage. Such agents further communicated to Barry Beach that ah enrollment form would be sent to Barry Beach by the Plan administrator, which he should return when completed.

Between the time period of July 30, 2001 and August 13, 2001, neither Defendant provided the referenced enrollment form to Barry Beach. On August 13, 2001, Plaintiff was seriously injured in an automobile accident, rendering him a paraplegie. Since the accident, Plaintiff has made claims for medical benefits under the Benefit Plan. Plaintiffs claims for benefits have been denied. In support of denial, Defendants assert that, at the time of the accident, Plaintiff had not yet begun attending classes and thus was not eligible to receive benefits under the Benefit Plan.

Plaintiff brings this lawsuit against Defendants seeking benefits under the Benefit Plan, as well as an injunction requiring coverage under the Benefit Plan. In his original Complaint, Plaintiff asserts the following four claims against Defendants: (1) ERISA Civil Enforcement; (2) Promissory Estoppel; (3) Negligent Misrepresentation; and (4) Intentional Misrepresentation.

On April 23, 2002, Defendants moved to dismiss Counts II, II, and IV of the Complaint on grounds that those three claims are preempted by ERISA. After the Motion to Dismiss was fully briefed, Plaintiff moved to amend the original Complaint by modifying the promissory estoppel claim in Count II of the Complaint; More specifically, Plaintiff seeks in his Motion for Leave to Amend to change the Kansas common law promissory estoppel claim to a claim for equitable estoppel under federal ERISA law. In his Motion for Leave to Amend, Plaintiff also seeks to add his father as a party plaintiff.

Based on the relationship between the two pending motions, the Court finds it prudent to resolve Plaintiffs Motion for Leave to Amend the Complaint before turning to the issues presented by Defendants’ Motion to Dismiss.

II. Motion for Leave to Amend Complaint

Rule 15 of the Federal Rules of Civil Procedure allows one amendment of the pleadings, before a responsive pleading is served or within twenty days after service. 3 Subsequent amendments are allowed by leave of court or by written consent of an adverse party and should be “freely given when justice so requires.” 4 “The decision to grant leave to amend a complaint, after the permissive period, is within the trial court’s discretion .:. and will not be disturbed absent an abuse of that discretion.” 5 The district court should deny leave to amend only when it finds “undue delay, undue prejudice to the opposing party, bad faith or dilatory motive, failure to cure deficiencies by amendments previously allowed, or' futility of amendment.” 6

• Amending Count II: Promissory Es-toppel

In support of their Motion to Dismiss Count II of Plaintiffs Complaint, Defendants assert Plaintiffs state law claim of promissory estoppel is preempted by ERISA and thus fails to state a claim for relief on its own. In his Motion for Leave to Amend, Plaintiff seeks to rectify this *1234 preemption issue by changing the state law promissory estoppel claim to an equitable estoppel claim under federal ERISA law. Defendants oppose the motion, arguing “Plaintiffs request to recharacterize his state law promissory estoppel claim as an estoppel claim under ERISA is [merely] an attempt to avoid dismissal.” 7 Defendants further oppose the motion on grounds that “the Tenth Circuit has not adopted an ERISA equitable estoppel claim and Plaintiff has not presented facts that would support such a claim even if it were adopted.” 8

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Bluebook (online)
229 F. Supp. 2d 1230, 29 Employee Benefits Cas. (BNA) 1744, 2002 U.S. Dist. LEXIS 21455, Counsel Stack Legal Research, https://law.counselstack.com/opinion/beach-v-mutual-of-omaha-insurance-ksd-2002.