Denver Health & Hospital Authority v. Beverage Distributors Co.

843 F. Supp. 2d 1171, 2012 WL 400320, 2012 U.S. Dist. LEXIS 15901
CourtDistrict Court, D. Colorado
DecidedFebruary 8, 2012
DocketCivil Case No. 11-cv-01407-LTB-KLM
StatusPublished
Cited by7 cases

This text of 843 F. Supp. 2d 1171 (Denver Health & Hospital Authority v. Beverage Distributors Co.) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Denver Health & Hospital Authority v. Beverage Distributors Co., 843 F. Supp. 2d 1171, 2012 WL 400320, 2012 U.S. Dist. LEXIS 15901 (D. Colo. 2012).

Opinion

MEMORANDUM OPINION AND ORDER

BABCOCK, District Judge.

This matter is before me on three motions. The first is Defendant Principal Life Insurance Company’s (“Principal”), Motion to Dismiss Plaintiffs complaint pursuant to Fed.R.Civ.P. 12(b)(6) [Docs # 5 and 6]. The second is Plaintiff Denver Health and Hospital Authority’s (“DHHA”), Motion for Leave to Amend Complaint pursuant to Fed.R.Civ.P. 15(a)(2) [Doc # 31]. The third is the Motion for Judgement on the Pleadings [Doc # 34], filed jointly by Beverage Distributors Company, LLC (“Beverage”), and A Plan Designed to Provide Security for Employees of Beverage Distributors Company, LLC (the “Plan”) (jointly, “Beverage Distributors”). After consideration of the parties’ arguments, and for the reasons stated herein, I DENY Principal’s motion in accordance with the instructions below; I GRANT DHHA’s motion and accept its second amended complaint tendered therewith; and I GRANT Beverage Distributors’ motion. These orders leave the case to proceed with two claims and two defendants: (1) the negligent misrepresentation claim against Beverage, and (2) the promissory estoppel claim against Principal.

I. Background

DHHA alleges the following in its first amended complaint. DHHA is a political subdivision of the State of Colorado. It operates the City and County of Denver’s health system, including Denver Health Medical Center (“Denver Health”).

Beverage is a Colorado limited liability company. Beverage provides medical and other benefits to its full time, active duty employees and their dependents through the Plan.

The Plan is an employee welfare benefit plan pursuant to, and for the purposes of, the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”). Beverage is the Plan’s Administrator. The Plan does not identify who or what is the claims administrator, but it defines the term as “an entity authorized by the Plan Administrator to process claims for benefits under this plan.”

Principal is a company authorized to conduct business in Colorado and was so conducting at all times pertinent to this lawsuit. One of its functions is to process claims under the Plan according to the Plan’s provisions.

Junnapa Intarakamhang was a full time, active duty Beverage employee. As such, she was a member under the Plan. She had established a domestic partnership with Terrence Hood in 2006. Together, they submitted an application for domestic partner coverage for Hood under the Plan on June 25, 2008.

On March 21, 2009, while Intarakamhang was a Plan member, Hood sustained severe and traumatic injuries in a motorcycle crash. Paramedics rushed Hood to Denver Health where he would receive lifesaving medical care and treatment for months. On March 24, 2009, Denver Health solicited and received hospital preadmission authorization from Principal for [1175]*1175Hood’s hospital stay. Over the next several weeks, Principal repeatedly preauthorized additional days for Hood’s stay. These authorizations led Denver Health to continue caring for Hood and to decline seeking a different third party payor. Hood was discharged on June 10, 2009.

By letter dated May 14, 2009, Beverage advised Intarakamhang that coverage for Hood under the Plan had been rescinded because Hood “did not qualify for benefits ... due to his marital status currently and at the time he certified the declaration of domestic partnership form[.]” The information in Beverage’s files did not support rescission. Beverage never provided notice to Hood himself that it had rescinded his coverage under the Plan. Nor did it return any premiums Hood paid for coverage. The Plan does not provide for rescission of a member or covered dependent’s coverage in the event of a misstatement in an application or under any other circumstances.

Principal later advised Denver Health by letter that benefits were not payable for Hood’s care because he was not a covered dependent under the Plan and that there was a “plan termination date of 06/20/2008.” Principal did not notify Hood directly of its determination that benefits were not payable for the charges incurred at Denver Health.

Hood incurred approximately $750,000 in medical bills for his treatment at Denver Health. He assigned his right to recover benefits under the Plan to Denver Health and thereby assigned them to DHHA. DHHA alleges that the attempted rescission and refusal to pay covered benefits under the Plan were not substantially justified, were arbitrary and capricious, were unsupported by substantial evidence, constituted abuse of any allowed discretion, and were wrongful.

DHHA filed suit in state court on April 4, 2011. On April 21, 2011, it filed its first amended complaint. The first amended complaint asserted three causes of action. First was a claim for benefits due and equitable relief under § 502(a)(1) of ERISA, 29 U.S.C. § 1132(a)(1)(B) (the “§ 1132(a)(1)(B) claim”). Second was that Principal unreasonably delayed and denied payment of Hood’s claim in violation of Colo.Rev.Stat. §§ 10-3-1115 and 10-3-1116(a). Third was promissory estoppel against Principal. Defendants removed the case to this Court on ERISA and federal question grounds pursuant to § 502(e) of ERISA, 29 U.S.C. § 1132(e), and 28 U.S.C. § 1331, respectively.

After removal, Principal filed its motion to dismiss. DHHA then filed its motion for leave to amend its first amended complaint. Next came Beverage Distributors’ motion for judgment on the pleadings. In the interest of clarity, brevity, deciding only those issues that I must, and for the reasons explained below, I address the motions out of the order in which they were filed. I begin with DHHA’s motion, then turn to Principal’s, and end with Beverage Distributors’. As will be elucidated, this order of operations obviates much of Principal’s motion but does not prejudice it.

II. DHHA’s Motion

DHHA’s motion seeks leave to file a second amended complaint pursuant to Rule 15(a)(2). DHHA tendered that second .amended complaint with its motion. Its second amended complaint asserts a negligent misrepresentation claim against Beverage and clarifies that the § 1132(a)(1)(B) claim is asserted against only the Plan and not Principal. I note that the second amended complaint also excludes the Colo.Rev.Stat. §§ 10-3-1115 and 10-3-1116(a) claim. I infer from that material change that DHHA is withdrawing that claim. To be clear, then, the second amended complaint asserts three [1176]*1176claims: first, a § 1132(a)(1)(B) claim against the Plan; second, a negligent misrepresentation claim against Beverage; and third, a promissory estoppel claim against Principal. For the reasons herein, I grant DHHA’s motion and accept its second amended complaint.

A. Rule 15(a)(2)

Rule 15 governs amendments to pleadings generally. See Fed.R.Civ.P.

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843 F. Supp. 2d 1171, 2012 WL 400320, 2012 U.S. Dist. LEXIS 15901, Counsel Stack Legal Research, https://law.counselstack.com/opinion/denver-health-hospital-authority-v-beverage-distributors-co-cod-2012.