Cole v. Central States, Southeast & Southwest Areas Health & Welfare Fund

227 F. Supp. 2d 190, 2001 U.S. Dist. LEXIS 24962, 2001 WL 34035319
CourtDistrict Court, D. Massachusetts
DecidedSeptember 21, 2001
Docket00-11573-MLW
StatusPublished
Cited by4 cases

This text of 227 F. Supp. 2d 190 (Cole v. Central States, Southeast & Southwest Areas Health & Welfare Fund) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cole v. Central States, Southeast & Southwest Areas Health & Welfare Fund, 227 F. Supp. 2d 190, 2001 U.S. Dist. LEXIS 24962, 2001 WL 34035319 (D. Mass. 2001).

Opinion

ORDER

WOLF, District Judge.

The court has considered the June 28, 2001 Report and Recommendation of the Magistrate Judge and the defendant’s objections to it. The issue of whether venue in Massachusetts is proper pursuant to 29 U.S.C. § 1132(e)(2) because the breach took place in Massachusetts is challenging. However, this question would be moot if Massachusetts is a jurisdiction “where [the] defendant ... may be found.” See 29 U.S.C. § 1132(e)(2). As the Magistrate Judge wrote, discovery is required to develop the information necessary to decide if the defendant is “found” in Massachusetts for the purposes of this case.

Accordingly, for the reasons described in the Report and Recommendation (Docket No. 19), Defendant’s Motion to Dismiss or, Alternatively, to Transfer Venue (Docket No. 4) is hereby DENIED without prejudice.

REPORT AND RECOMMENDATION ON DEFENDANT’S MOTION TO DISMISS, OR, ALTERNATIVELY, TO TRANSFER VENUE (¶4)

COLLINGS, Chief United States Magistrate Judge.

I. Introduction

On August 4, 2000, plaintiff Richard A. Cole, M.D. (“Cole”), instituted the instant *191 action against Central States Southeast and Southwest Areas Health and Welfare Fund (“Central States” or “the Plan”). The defendant not only answered the four count complaint, but on October 20, 2000, also filed a motion to dismiss or, alternatively, to transfer venue, together with a memorandum and affidavit in support. Cole duly submitted an opposition to the motion and, with leave of the District Judge to whom this case is assigned, Central States filed a reply. At this juncture, the dispositive motion is in a posture for resolution. 1

II. The Facts

The place to begin is with a review of the allegations of the complaint, starting with an introduction of the players. At all pertinent times, Cole was a medical doctor authorized to engage in the practice of medicine in the Commonwealths of Pennsylvania and Massachusetts. (Complaint ¶ 1 § 1) In Pennsylvania where he practiced medicine as a professional corporation, Richard A. Cole, M.D., Inc., the plaintiff maintained his principal place of business in Erie. (¶ 1 § 1) At present Cole is a resident of Newburyport, Massachusetts. (¶ 1 § 1)

Regulated under the Employee Retirement Income Security Act (“ERISA”), Central States is an employee welfare benefit plan which provides benefits to its participants. (¶ 1 § 2) The administrator of the Plan is located in Rosemont, Illinois. (¶ 1 § 2) 2 According to the plaintiff, one of his patients, Barbara McClellan (“McClellan”), 3 had contracted with Central States to provide her with health care benefits and the “Plan had promised to pay all her doctor bills.” (¶ 1 § 2) Any and all claims of McClellan against Central States have been assigned to Richard A. Cole, M.D., Inc., which in turn assigned them to the plaintiff as remuneration for his services to the corporation. (¶ 1 §§ 1, 3)

The underlying events as related in the complaint are as follows. On her initial visit to Cole on February 20,1991, McClellan was treated “for a complex medical problem with the diagnosis: endocrinopa-thy, autonomic neuropathy, and postmenopausal osteoporosis.” (¶ 1 § 4) The charge for that date in the amount of $1,603.00 was submitted to the defendant for payment. (¶ 1 § 4) So as to expedite the processing of the claim, upon request Cole contends that he forwarded further information to Central States under cover of a letter dated May 15, 1991. (¶ 1 § 4, Exh. 2, 3 4 ) The February 20, 1991 claim was neither paid nor denied at that time. 5 (¶ 1 § 4)

*192 The plaintiff treated McClellan again on February 23, 1991, on this occasion for allergies to drugs and endocrinopathy. (¶ 1 § 4) After a claim was submitted, on April 11, 1991 Central States paid Cole $425.80 of the $432.00 charged. (¶ 1 § 4, Exh. 1)

A third medical visit was made four days later on February 27, 1991, when McClellan was once more treated by Cole “for a complex medical problem with diagnoses: allergies to drugs, endocrinopathy and postmenopausal osteoporosis.” (¶ 1 § 5) The charge this time was $703.00. (¶ 1 § 5) The Plan again requested further information. (¶ 1 § 5, Exh. 4) Cole alleges that he sent additional information to Central States, but that his claim was never processed. (¶ 1 § 5, Exh. 5)

Some years later in 1998, Cole avers that he wrote to the Plan regarding the two unpaid claims, but to no avail. (¶ 1 § 6)' He then undertook a formal appeal the' result of which is reflected in a March 25,1999 letter from Central States to Cole:

The Health and Welfare Board of Trustees met on March 17, 1999 and reviewed your appeal for payment of charges for services you rendered on February 20, 1991, February 23, 1991 and February 27,1991.
The Fund’s Medical Consultants reviewed the information we received regarding the charges incurred on the dates mentioned above. However, they could not identify the medical necessity for those services. In addition, our records indicate that we did not receive your charges of February 23, 1991 until February, 1998. Since that is well over the 1 year filing limitation, benefits would not allowed (sic) for those charges even if our Medical Consultant could identify their medical necessity.
The Plan states in Article XI, Section 11.13:
Right to Review All-Claims
The Fund reserves the right to question any charge or procedure and to have the same professionally reviewed to determine if it is covered under the Plan.
The Plan states in Article XI, Section 11.03:
Time Within Which Certain Claims Are To Be Filed
A Claim for any loss (excluding Prescription Benefits, Total and Permanent Disability or Waiver of Premium) must be filed within one (1) year after the date of such loss. A claim for Prescription Benefits must be filed within two (2) years after the date such prescription drugs were dispensed. A claim for Total and Permanent Disability or Waiver of Premium must be filed within three years (3) after termination of Coverage.
We regret to inform you that for this reason, the Trustees voted to deny your claim. You have now exhausted all administrative appeal avenues. I regret that I could not be of more assistance to you.
Sincerely,
On Behalf of the Health and Welfare Board of Trustees /s/
William J.

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Bluebook (online)
227 F. Supp. 2d 190, 2001 U.S. Dist. LEXIS 24962, 2001 WL 34035319, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cole-v-central-states-southeast-southwest-areas-health-welfare-fund-mad-2001.