Humana, Inc. v. Perez

47 Fla. Supp. 2d 145
CourtCircuit Court for the Judicial Circuits of Florida
DecidedMarch 30, 1991
DocketCase No. 88-19546 (01)
StatusPublished

This text of 47 Fla. Supp. 2d 145 (Humana, Inc. v. Perez) is published on Counsel Stack Legal Research, covering Circuit Court for the Judicial Circuits of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Humana, Inc. v. Perez, 47 Fla. Supp. 2d 145 (Fla. Super. Ct. 1991).

Opinion

OPINION OF THE COURT

JACK MUSSELMAN, Circuit Judge.

ORDER GRANTING THIRD-PARTY DEFENDANT’S HUMANA CARE PLUS, MOTION TO DISMISS THIRD-PARTY PLAINTIFF’S SECOND AMENDED THIRD-PARTY COMPLAINT

THIS CAUSE having come to be heard on Defendant’s, Humana [146]*146Care Plus, Motion to Dismiss Third-party Plaintiffs second amended third-party complaint for failure to state a claim upon which relief can be granted with prejudice, and for appropriate sanctions and attorneys fees, and the Court having heard argument of counsel, and being otherwise advised in the premises, it is hereby

ORDERED and ADJUDGED that,

1. In the case presently before the Court, the Third-party Plaintiffs initial complaint alleged state law claims for fraud and negligent misrepresentation, in connection with Humana Care Plus’s failure to provide benefits under a group health insurance policy. Following an evidentiary hearing, the complaint was dismissed for failure to state a cause of action as the dispute squarely fell within the provisions of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq., which provides an exclusive remedy for the type of claim asserted herein. 29 U.S.C. § 1132

2. Thereafter, Third-party Plaintiff filed an amended complaint stating that the action was being brought under the auspices of ERISA. The amended complaint also contained counts for fraudulent and negligent misrepresentation. The amended complaint was subsequently dismissed by agreed order.

3. Third-party Plaintiff has now filed a second amended complaint alleging four counts: Count I — an ERISA claim under 29 U.S.C. § 1132(a)(1)(B); Count II — a breach of contract action; Count III — a wrongful termination and interference with rights to health benefits action; and Count IV — a breach of fiduciary duty action.

4. Rule 1.140(b), Fla.R.Civ.P., provides that a pleading is subject to attack for failure to state a cause of action. A motion made pursuant to this rule tests the legal sufficiency of the pleading. In reviewing the adequacy of the pleadings, the court must construe the pleadings against the pleader in determining if the necessary allegations have been made. Trawick, Florida Practice and Procedure § 10-4 (1990).

5. In Third-party Plaintiffs complaint, the only reference to ERISA is made in the jurisdictional pleadings. Section 1132(a)(1)(B) of Title 29 of the United States Codes provides that

A civil action may be brought by a participant or beneficiary 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.

6. In Kreml v Diamond Shamrock Corp., 701 F.Supp. 1400, 1404 (N.D. Ill. 1988), the court dismissed the plaintiffs complaint with [147]*147prejudice, ruling that plaintiff could not merely invoke ERISA’s jurisdictional provisions and then allege common law causes of action.

7. “In order to maintain an action under this sub-section, a plaintiff must be seeking to assert rights ‘under the terms of his plan.’ ” Ogden v Michigan Bell Telephone Co., 595 F. Supp. 961, 966 (E.D. Mich. 1984). Herein, the body of Count I is devoid of any specific allegations constituting an ERISA claim other than the titling of the Count. Rather, the third-party plaintiff’s pleading seeks relief based on the misrepresentation of the Third-party Defendant.

8. As recognized by the Ogden court, section 1132(a)(1)(B) is not open ended and the employee benefit plan itself must be the basis of such an action. Id. Accordingly, plaintiff’s complaint, which contained sub-counts A-F averring common law causes of action such as equitable estoppel, innocent misrepresentation and negligence, was dismissed. The court noted the long standing principle that while state courts may have concurrent jurisdiction, they are bound to apply federal law. Id. at 967. Furthermore, when the federal program or legislative scheme requires uniform standards, the application of local principles of law is wholly inappropriate. Id. at 968. In conclusion, the court wrote that plaintiff’s subcounts, asserting contract and tort claims, are independent of the plan. Id. at 970.

For example, sub-count F claims that defendants breached their “duty” to properly advise plaintiffs regarding the availability of the MIPP [the plan]. This claim is not one to “recover benefits due to [them] under the terms of the plan” as required under § 1132(a)(1) (B). Id.

9. In the case sub judice, Third-party Plaintiff has failed to properly plead his cause as an ERISA action. Rather than seeking to assert his rights under the terms of his benefit plan, he is merely invoking ERISA’s jurisdictional provisions and then alleging common law causes of action, i.e. misrepresentation. Accordingly, COUNT I is DISMISSED.

10. Over and above, the Third-party Defendant seeks to have this cause dismissed with prejudice. In their motion, they recognize that courts are ordinarily generous in allowing plaintiffs leave to amend; however, there comes a time when plaintiffs must accept defeat. As stated in Trawick, Florida Practice and Procedure § 14-2 (1990), “[generally three ineffective attempts to state the same cause of action or defense are enough.” See Alvarez v DeAquirre, 395 So.2d 213, 217 (Fla. 3d DCA 1981); Price v Morgan, 436 So.2d 116 (Fla. 5th DCA 1983). Herein, the Third-party Plaintiff has had three opportunities to [148]*148state their cause of action and in spite of the Court’s finding that this matter is exclusively governed by ERISA, Third-party Plaintiff has repeatedly plead state law claims. Accordingly, COUNT I stands DISMISSED WITH PREJUDICE.

11. Before analyzing Counts II-IV, it must be recognized that Congress intended ERISA’s preemptive powers to be broad. See, e.g., Alessi v Raybestos-Manhattan, Inc., 451 U.S. 504, 101 S. Ct. 1895, 68 L.Ed2d 402 (1981). In fact, the Act specifically provides:

... the provisions of this subchapter . . . shall supersede any and all state laws insofar as they may now or hereafter relate to any employee benefit plan ... 29 U.S.C. § 1144(a).

12. In Pilot Life Ins. Co v Dedeaux, 481 U.S. 41, 107 S. Ct. 1549, 95 L.Ed.2d 39 (1987), the Court held that state law relates to a benefit plan if it has a connection with or reference to such a plan. At issue therein, the plaintiff claimed improper termination of benefits, tortious breach of contract, breach of fiduciary duty and fraud. The Supreme Court held that these causes of action related to the employee benefit plan and, therefore, were preempted by ERISA.

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Bluebook (online)
47 Fla. Supp. 2d 145, Counsel Stack Legal Research, https://law.counselstack.com/opinion/humana-inc-v-perez-flacirct-1991.