Hill v. Blue Cross and Blue Shield of Michigan

299 F. Supp. 2d 742, 2003 U.S. Dist. LEXIS 23986, 2003 WL 23175560
CourtDistrict Court, E.D. Michigan
DecidedNovember 21, 2003
DocketCIV.03-40025
StatusPublished
Cited by3 cases

This text of 299 F. Supp. 2d 742 (Hill v. Blue Cross and Blue Shield of Michigan) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hill v. Blue Cross and Blue Shield of Michigan, 299 F. Supp. 2d 742, 2003 U.S. Dist. LEXIS 23986, 2003 WL 23175560 (E.D. Mich. 2003).

Opinion

OPINION AND ORDER OF DISMISSAL

GADOLA, District Judge.

This civil action is being prosecuted under the Employee Retirement Income Security Act (“ERISA”). Before the Court is Defendant’s motion to dismiss pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure: dismissal for failure to state a claim upon which relief can be granted. The Court held a hearing on this matter on November 5, 2003. For the reasons set forth below, the Court will grant the motion and dismiss this civil action without prejudice.

I. BACKGROUND

On September 28, 1999, the General Motors Corporation (“GM”) and the International Union, United Automobile, Aerospace and Agricultural Implement Workers of America (“UAW”) entered into a collective bargaining agreement (“CBA”). As a result of this CBA, GM sponsors a health care program (“program”), and this program is an ERISA-protected employee benefit plan. GM has selected Defendant to administer health care coverage under the program.

Plaintiff Hill, Plaintiff Francine Barnes and Plaintiff Celestine are participants in the program. Similarly, Plaintiff Franchot Barnes and Plaintiff Francesca Barnes (the adult son and daughter of Plaintiff Francine Barnes, respectively) were covered by the program at times relevant to their claims via the mother’s participation in the program.

Turning first to Plaintiff Hill, on or about December 11, 2000, Plaintiff Hill went to an emergency room seeking treatment for an infected growth on his back. *746 Under the program, Defendant paid the facility portion of Plaintiff Hill’s claim for this emergency room visit, but Defendant rejected the $108.00 physician portion of the claim. According to Defendant’s corresponding explanation of benefits (“EOB”) form to Plaintiff Hill, Defendant rejected the physician portion of the claim because Plaintiff Hill’s condition was not an emergency. Plaintiff Hill then contacted his union representative, and the representative informed Plaintiff Hill that he had to pay the claim personally, which he did on July 19, 2002.

The four additional Plaintiffs present similar circumstances. As with Plaintiff Hill, Defendant denied payment for at least a portion of emergency rooms visits by these Plaintiffs. Unlike Plaintiff Hill, however, there is no indication that the claims of these four Plaintiffs were ever brought to the attention of a union representative.

Furthermore, Plaintiffs’ amended complaint asserts individual claims as well as the claims of a purported class: Plaintiffs allege that Defendant systematically violated ERISA in its administration of emergency health care benefit claims under the GM-UAW health care program as well as all other employer-sponsored employee benefit plans administered by Defendant. 1 Plaintiffs allege that they and the purported class members are entitled to relief for these alleged violations of ERISA.

Specifically, the amended complaint contains four counts. Count I alleges breach of fiduciary duty by Defendant under 29 U.S.C. § 1104(a)(1). 2 Count II alleges that Defendant is liable for the breaches of co-fiduciaries under 29 U.S.C. § 1105(a). 3 Counts I and II seek equitable relief pursuant to 29 U.S.C. § 1132(a)(3). 4 Further, *747 pursuant to 29 U.S.C. § 1132(a)(1)(B), Count III seeks to recover benefits denied as a result of the same breaches alleged in Counts I and II. 5 Finally, under 29 U.S.C. § 1109, Count IV seeks restitution and recovery of any losses sustained by the pertinent employee benefit plans as a result of the same breaches alleged in Counts I and II. 6 In response to these claims, Defendant has moved to dismiss this action pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure: dismissal for failure to state a claim upon which relief can be granted.

II. LEGAL STANDARD

Rule 12(b)(6) authorizes the district courts to dismiss any complaint that fails “to state a claim upon which relief can be granted.” Fed.R.Civ.P. 12(b)(6). Rule 12(b)(6) affords a defendant an opportunity to test whether, as a matter of law, the plaintiff is entitled to legal relief even if everything alleged in the complaint is true. See QQC, Inc. v. Hewlett-Packard Co., 258 F.Supp.2d 718, 721 (E.D.Mich.2003) (Gadola, J.). In applying Rule 12(b)(6), the Court must presume all well-pleaded factual allegations in the complaint to be true and draw all reasonable inferences from those allegations in favor of the non-moving party. See Mayer v. Mylod, 988 F.2d 635, 638 (6th Cir.1993).

The Court will not, however, accord the presumption of truthfulness to any legal conclusion, opinion, or deduction, even if it is couched as a factual allegation. See Morgan v. Church’s Fried Chicken, 829 F.2d 10, 12 (6th Cir.1987). The Court will not dismiss a cause of action under the Rule 12(b)(6) standard “unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.” Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957). Although the pleading standard is liberal, bald assertions and conclusions of law will not enable a complaint to survive a motion pursuant to Rule 12(b)(6). See QQC, 258 F.Supp.2d at 721; see also Leeds v. Mettz, 85 F.3d 51, 53 (2d Cir.1996).

III. CONSIDERATION OF PROGRAM DOCUMENTS

To adjudicate a Rule 12(b)(6) motion, the Court must not consider matters outside the pleadings. See Fed.R.Civ.P. 12(b). Nevertheless, Rule 10(c) of the Federal Rules of Civil Procedure provides that “[a] copy of any written instrument which is an exhibit to a pleading is a part thereof for all purposes.” Fed.R.Civ.P.

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Related

Hill v. Blue Cross & Blue Shield
237 F.R.D. 613 (E.D. Michigan, 2006)
Mueller v. Gallina
311 F. Supp. 2d 606 (E.D. Michigan, 2004)

Cite This Page — Counsel Stack

Bluebook (online)
299 F. Supp. 2d 742, 2003 U.S. Dist. LEXIS 23986, 2003 WL 23175560, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hill-v-blue-cross-and-blue-shield-of-michigan-mied-2003.