Harrison v. TEAMCARE-A Central States Health Plan

187 F. Supp. 3d 812, 2016 WL 2858520
CourtDistrict Court, E.D. Kentucky
DecidedMay 13, 2016
DocketCIVIL ACTION NO. 15-60-DLB-CJS
StatusPublished
Cited by2 cases

This text of 187 F. Supp. 3d 812 (Harrison v. TEAMCARE-A Central States Health Plan) is published on Counsel Stack Legal Research, covering District Court, E.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Harrison v. TEAMCARE-A Central States Health Plan, 187 F. Supp. 3d 812, 2016 WL 2858520 (E.D. Ky. 2016).

Opinion

MEMORANDUM OPINION AND ORDER

David L. Bunning, United States District Judge

I. Introduction

Defendant Central States Southeast and Southwest Areas Health and Welfare Fund (“Central States”) moves to dismiss Count I of Plaintiff Rodney Harrison’s Amended Complaint for failure to state a claim upon which relief may be granted. Central States argues that Harrison cannot seek equitable relief under ERISA pursuant to § 502(a)(3) because he is able to proceed under § 502(a)(1)(B), another of ERISA’s civil enforcement mechanisms. Central States further insists that a claim under § 502(a)(1)(B) is premature because Harrison has not exhausted his administrative remedies or demonstrated that exhaustion would be futile. Defendant Health Care Service Corporation (“HCSC”), doing business as Blue Cross and Blue Shield of Illinois, moves to dismiss Counts II through VI of Harrison’s Amended Complaint, arguing that- these state law claims are subject to conflict preemption. The Court has jurisdiction over this matter pursuant to 28 U.S.C. §§ 1331 and 1367.

II. Factual and Procedural Background

Harrison participated in Central States’ Southeast and Southwest Areas Health and Welfare Fund, a nationally administered'employee benefit plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”). (Id. at p. 3, ¶ 2, 7). HCSC, the third party administrator for the plan, was responsible for “renderfing] advice with respect to Claim Payments and makfing] Claim Payments on behalf of the plan administrator of the Fund’s ERISA benefit plan.” (Doc. # 36 at 10). HCSC was “not the plan administrator of the Fund’s separate ERISA welfare benefit plan,” nor was it “a named fiduciary with respect to the Fund’s separate ERISA welfare benefit plan.” (M). ■

In March of 2012, Harrison was injured in a car accident. (Doc. # 1-1, p. 3, ¶ 7). Central States paid some of the medical expenses he incurred as a result of that accident. {Id.). Harrison sued the other party to the accident, and two years later, they reached a settlement. {Id. at p. 3, ¶ 8). Under the terms of the plan, a subrogation lien in Central States’ favor attached to the settlement funds. (Id.). Harrison and Central States then settled this subrogation lien. (Id. at p. 4, ¶ 9), Harrison agreed to pay Central States $57,628.45, and in exchange, Central States agreed to pay any outstanding medical claims. (Id. at p. 4, ¶ 10). Central States also agreed to pay future claims pursuant to the terms of Harrison’s major medical extension. (Id.).

On September 23, 2014, Central States received a check from Harrison for the agreed-upon sum and confirmed that his medical claims would be processed and [815]*815paid. (Id.). Central States failed to pay the outstanding medical expenses the following month, which adversely affected Harrison’s credit profile. (Id. at p. 4, ¶ 12, 13, 15). He notified Central States of this problem in late October, and again in late November. (Id. at p. 4, ¶ 12, 14). In early December, Central States assured Harrison that his claims had been processed and checks submitted to the proper payees. (Id. at p. 4, ¶ 16). However, as of January 14, 2015, only minimal payments had been made on the outstanding account balance, (Id. at p. 5, ¶ 17). Central States promised Harrison that checks.would be sent to the proper payees on January 21, 2015, claiming that the delay was caused by communication issues with HCSC, the plan’s third party administrator. (Id.). However, Harrison still had a $12,000 balance with Commonwealth Orthopaedic Centers as of March 16, 2015. (Id. at p, 5, ¶ 18-20).

That same day, Harrison filed suit against Central States and HCSC, asserting claims for breach of contract, breach of the implied covenant of, good faith and fair dealing, violations of the Kentucky Unfair Claims Settlement Practices Act, common law bad faith, and violations of the Kentucky Consumer Protection Act. (Doc. # 1-1). On April 4, 2015, Harrison’s outstanding bills from Commonwealth Orthopaedic Centers were paid in full.1 (Doc. # 47 at 2, n. 2). Shortly thereafter, HCSC removed this case to federal court on the basis of federal question jurisdiction, asserting that “the crux of the lawsuit at issue is a claim for benefits under an ERISA-based insurance policy.” (Doc., # 1). Central States consented to the removal. (Doc. # 6).

Although HCSC removed the case to this Court on the basis of federal question jurisdiction, the Court immediately noticed that Harrison’s complaint asserted only state law claims. To ensure that removal was proper, the Court ordered the parties to submit memoranda discussing the existence of federal question jurisdiction. (Doc. # 7). After reviewing the memoranda, the Court sustained the removal, finding that Harrison’s state law claims against Central States and HCSC were completed preempted by ERISA. (Doc. #26). The Court further ordered Harrison to file an .amended complaint re-characterizing his claims under ERISA. (Id.).

; Approximately two weeks later, Harrison filed a Motion to Alter, Amend and/or Vacate the Court’s Order. (Doc, #28). Harrison admitted that his claims against Central States should be re-cast in terms of ERISA, but insisted that his state law claims against HCSC should remain undisturbed. The Court ultimately agreed with Harrison, reasoning that he could not have brought his claims against HCSC under one of ERISA’s civil enforcement mechanisms ..because HCSC is neither the plan nor the plan .administrator. Accordingly, the Court concluded that Harrison’s claims against HCSC were- not completely preempted, and thus, did not require re-characterization under ERISA. However, the Court retained supplemental jurisdiction over these state law claims because they arose out of the same facts as the ERISA-based claim against Central States.

Consistent with the Court’s Orders, Harrison filed- his Amended Complaint on October 27, 2015. (Doc. # 38). He asserted one ERISA-based claim for breach of fiduciary duty against Central States. (Id.). He also brought state law claims for breach of contract, violation of the implied covenant of good faith and fair dealing, violation of the Kentucky Unfair Claims Settlement [816]*816Practices Act, common law bad faith and violation of the Kentucky Consumer Protection Act against HCSC. (Id.). In response, Central States and HCSC filed the instant Motions to Dismiss,2 which are fully briefed and ripe for review. (Docs. # 40, 41, 44, 45,46 and 47).

III. Analysis

A. Standard of Review

A complaint must include a “short and plain statement of the claim showing that the pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2). It must also contain “sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’ ” Ashcroft v. Iqbal, 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009)(quoting Twombly v. Bell Atl. Corp.,

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Bluebook (online)
187 F. Supp. 3d 812, 2016 WL 2858520, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harrison-v-teamcare-a-central-states-health-plan-kyed-2016.