Canter v. Alkermes Blue Care Elect Preferred Provider Plan

District Court, S.D. Ohio·Decided December 15, 2022·No. 1:17-cv-00399·Unknown

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO WESTERN DIVISION

KEITH W. CANTER, Case No. 1:17-cv-399 Plaintiff, Cole, J. Litkovitz, M.J. v.

BLUE CROSS BLUE SHIELD OF REPORT AND MASSACHUSETTS, INC., RECOMMENDATION Defendant.

This matter is before the Court on plaintiff’s motion for attorney fees for remand (Docs. 101, 103),1 plaintiff’s amended motion to reopen and return case to the active docket (Doc. 111), and plaintiff’s amended second motion for judgment on the record after remand (Doc. 112). Appropriate response and reply memoranda have been filed (Docs. 106, 107, 118, 119, 120, 121). I. Background The Court previously provided a more complete factual history. (Doc. 100). However, at this procedural juncture, the facts can be briefly summarized as follows. Plaintiff Keith Canter, a full-time employee at Alkermes, Inc., participated in the Alkermes Blue Care Elect Preferred Provider Plan (the Plan) underwritten and insured by defendant Blue Cross Blue Shield of Massachusetts, Inc. (BCBSMA). In 2015, Canter received treatment at the Laser Spine Institute followed by a seven-year battle concerning BCBSMA’s coverage of his medical treatment claims. Following additional evidence on remand from this Court, BCBSMA changed its decision and paid Canter’s claim in the amount of $85,022.

1 Plaintiff refiled the motion for attorney fees (Doc. 101) in the format required to comply with Local Rule 5.1 (Doc. 103). As docket number 103 is identical to docket number 101 except for formatting, the Court will analyze docket number 103 and recommend that docket number 101 be denied as moot. Canter now moves for: (1) payment of his attorney fees and costs; (2) to reopen the case; and (3) for interest on the $85,022 payment. BCBSMA opposes Canter’s motions. The Court will address each motion individually. II. Legal Standard

Pursuant to Subchapter I, Part 4 of the Employee Retirement Income Security Act (ERISA), “a fiduciary shall discharge his duties with respect to a plan solely in the interest of the participants and beneficiaries and . . . in accordance with the documents and instruments governing the plan insofar as such documents and instruments are consistent with the provisions of this subchapter and subchapter III.” 29 U.S.C. § 1104(a)(1)(D). A plan participant may bring a civil 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.” 29 U.S.C. § 1132(a)(1)(B). In an ERISA action brought by a plan participant, “the court in its discretion may allow a reasonable attorney’s fee and costs of action to either party.” 29 U.S.C § 1132(g)(1).

III. Canter’s Amended Motion to Reopen and Return Case to Active Docket (Doc. 111) Should be Denied

Canter moves to reopen this case to consider whether he is entitled to additional benefits pursuant to 29 U.S.C. § 1104(a)(1)(D) and 29 U.S.C. § 1132(a)(1)(B). (Doc. 111). BCBSMA summarily responded that Canter has received all benefits due under the Plan so his motion to reopen is moot. (Doc. 118). As will be explained below, Canter has received the benefits due under the Plan. The Court need not reopen a case to award attorney fees. Thus, Canter’s motion to reopen the case should be denied. IV. Canter’s Amended Second Motion for Judgment on the Record After Remand (Doc. 112) Should be Denied

Canter alleges, pursuant to 29 U.S.C. §§ 1104(a)(1)(D) and 1132(a)(1)(B), that the Plan language requires that interest be paid beginning 45 days after BCBSMA received his claim. (Doc. 112 at PAGEID 2799-2801). Alternatively, Canter contends that BCBSMA must pay prejudgment interest on the claim amount to prevent BCBSMA’s unjust enrichment. (Id. at PAGEID 2802-2803). BCBSMA asserts that the Plan’s interest provision does not apply because: (1) the provider (rather than Canter) filed the underlying claim; (2) the interest provision is permissive rather than mandatory; and (3) Canter waived the interest argument by not raising it in any dispositive motions during the five years the parties litigated this matter. (Doc. 119 at PAGEID 2823-2827). BCBSMA further contends that Canter’s alternative request for prejudgment interest fails because there is no money judgment on which interest could accrue. (Id. at PAGEID 2829-2830). A. Waiver of Entitlement under the Plan’s Interest Provision An argument can be deemed waived if it is raised for the first time in a reply brief, Kroger v. Mohr, 964 F.3d 532, 540 n.2 (6th Cir. 2020) (citing Hunt v. Big Lots Stores, Inc., 244 F.R.D. 394, 397 (N.D. Ohio 2007)), or in a motion for reconsideration, Dayton Veterans Residences Ltd. P’ship v. Dayton Metro. Hous. Auth., No. 3:16-cv-466, 2019 WL 5956543, at

*1-2 (S.D. Ohio Nov. 13, 2019) (“DMHA’s belated argument that the Court committed ‘clear error’ is severely undermined by the fact that it, without any explanation, waited five months to move for reconsideration.”). Similarly, an affirmative defense may be waived if the asserting party fails to plead it in the first responsive pleading or a timely dispositive motion. Abernathy v. Corinthian Colls., Inc., No. 2:10-cv-131, 2013 WL 12099308, at *3 (S.D. Ohio Feb. 7, 2013) (affirmative defense waived when not raised until 48 hours before scheduled trial). However, it is far less clear that an employee waives a claim for prejudgment interest under an ERISA plan by failing to fully develop the argument until the underlying claim is paid.

The Court located no authority for that conclusion, and neither party cited such a case. In addition, Canter requested prejudgment interest in his complaint. (Doc. 1 at PAGEID 14) (asking “[t]hat the Court order the Defendants to pay Plaintiff’s pre-judgment interest on all claim amounts that have accrued prior to the date of judgment”). Canter reiterated his request for prejudgment interest in his motion for judgment on the record. (Doc. 69 at PAGEID 1340). Accordingly, he has not waived his request for prejudgment interest. See Gemini Ins. Co. v. Potts, No. 2:16-cv-612, 2020 WL 4000977, at *3 n.1 (S.D. Ohio July 15, 2020) (ERISA exclusion argument absent from motion for judgment on the pleadings not waived when pled in complaint). B. The Plan’s Interest Provision Does Not Apply

BCBSMA does not contest Canter’s claim that the Court should review the Plan language de novo. (Doc. 112 at PAGEID 2810, Doc. 100 at PAGEID 2571).2 In interpreting an ERISA plan, courts must “begin with the policy’s text.” Fulkerson v. Unum Life Ins. Co. of America, 36 F.4th 678, 681 (6th Cir. 2022). “Unless that text is ambiguous, we presume the policy means what it says and therefore give effect to its ‘plain meaning in an ordinary and popular sense.” Id. (quoting Farhner v. United Transp. Union Discipline Income Prot. Program, 645 F.3d 338, 343 (6th Cir. 2011)).

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