Jackson v. The Aliera Companies Inc

District Court, W.D. Washington·Decided October 6, 2020·No. 2:19-cv-01281·Unknown

Opinion

UNITED STATES DISTRICT COURT AT SEATTLE JACKSON, et al. Case No.: 19-cv-01281-BJR Plaintiffs, ORDER STRIKING AS MOOT v. MOTION TO STAY PROCEEDINGS PENDING APPEAL, VACATING JULY THE ALIERA COMPANIES, INC., et al. 20, 2020 ORDER DENYING MOTION TO COMPEL ARBITRATION, AND Defendants. GRANTING MOTION TO COMPEL ARBITRATION AND STAY

I. INTRODUCTION Plaintiffs bring this putative class action suit against Defendants Aliera Companies, Inc., its now-defunct subsidiary Aliera Healthcare, Inc. (collectively “Aliera”), and Trinity HealthShare, Inc. (“Trinity”). Plaintiffs allege that Defendants sold unauthorized health insurance plans in violation of Washington law and engaged in unfair and deceptive practices in violation of the Washington Consumer Protection Act, RCW 19.86.010 et seq. Currently before the Court are Aliera’s and Trinity’s motions to stay proceedings pending appeal of this Court’s order denying Defendants’ motion to compel arbitration. Dkt. Nos. 101 and 103. Plaintiffs oppose the motion. Dkt. No. 116. A. Factual Background Defendant Trinity offers a healthcare cost sharing plan known as “AlieraCare” and Defendant Aliera markets, sells, and administers AlieraCare in Washington State on behalf of

Trinity. See Dkt. 57, Second Amend. Comp. (“SAC”). According to Plaintiffs, Trinity is a health insurance company and AlieraCare is a health insurance plan, and therefore subject to federal and state laws governing health insurance. See id. Defendants counter that Trinity is not an insurance company and does not provide health insurance. See Dkt. Nos. 62, 63, Defs.’ Answers to Pls.’ SAC. Instead, Defendants assert that Trinity qualifies as a healthcare sharing ministry (“HCSM”) under the Affordable Care Act (“ACA”) that facilitates the sharing of healthcare expenses among its members. Regardless, the parties agree that AlieraCare provides members with benefits for medical coverage in exchange for their monthly premiums. Plaintiffs enrolled in AlieraCare in 2018 and 2019. Dkt. No. 57 Plaintiffs, all of whom

paid their monthly premiums and met their standard deductibles, expected that Trinity would pay their medical claims as detailed by the AlieraCare benefits booklet (“Member Guide”), which the parties agree is a binding contract. See Member Guide, Dkt. No. 57, Ex. B. However, each Plaintiff was denied healthcare coverage after submitting their claims to Trinity. Dkt. No. 57 B. Procedural History Plaintiffs Gerald Jackson, Roslyn Jackson, and Dean Mellom (“the Original Plaintiffs”) initiated this lawsuit in August 2019. Dkt. No. 1. The complaint, later amended in October 2019 (“the First Amended Complaint”), has two counts: Count I “Illegal Contract” and Count II violation of the Washington Consumer Protection Act. Id. at 12-13. The First Amended Complaint was amended in June 2020. Dkt. Nos. 57, 67. It asserts the same two counts but adds Plaintiffs Jon and Julie Perrin (“the Perrins”) as named plaintiffs to the lawsuit. Dkt. No. 57. 1. Defendants’ Motions to Dismiss the First Amended Complaint In November 2019 and before the Perrins were added to the lawsuit, Defendants moved

to dismiss the First Amended Complaint. Dkt. Nos. 21, 23. Both Defendants argued that the claims raised in the First Amended Complaint were premature and not yet subject to review by a tribunal because the Original Plaintiffs had not exhausted the dispute resolution procedures outlined in the Member Guide. Dkt. Nos. 21, 23. Defendants urged this Court to dismiss the First Amended Complaint in its entirety; they did not, however, seek dismissal with prejudice on this basis. Aliera also moved to dismiss Count I of the First Amendment Complaint pursuant to Federal Rule 12(b)(6) for failure to state a claim on which relief can be granted. Dkt. No. 23 at 2. It is important to note that Aliera did not seek to dismiss Count I with prejudice. Trinity moved

to dismiss both Counts I & II—with prejudice—as preempted by federal agency action. Dkt. No. 21 at 2. Specifically, Trinity argued that the claims in the First Amended Complaint depended on a finding that Trinity is not a HCSM under the ACA. According to Trinity, the Internal Revenue Service (“IRS”) has already determined that Trinity is an HCSM and, as such, the claims were preempted by the IRS’s conclusion. Dkt. No. 21 at 2. 2. Order Denying the Motions to Dismiss The Court denied Defendants’ motions to dismiss on May 26, 2020. Dkt. No. 47. In doing so, the Court reached the following conclusions. With respect to Defendants’ argument that Counts I & II should be dismissed as premature because the Original Plaintiffs had not exhausted the dispute resolution procedures outlined in the Member Guide, this Court determined that the First Amended Complaint contained sufficient factual matter, accepted as true, to plausibly allege that AlieraCare is a health insurance policy governed by Washington State law. Dkt. No. 47 at 8. This Court further determined that the First Amended Complaint also plausibly alleged that the dispute resolution procedures outlined in the Member Guide are void

under Washington insurance law and, if such allegations were proven true, the Original Plaintiffs did not have to exhaust the procedures before filing their lawsuit. Id. at 12. Thus, the Court denied Defendants’ motions to dismiss the First Amended Complaint on the basis that Counts I & II were prematurely filed. Next, with respect to Trinity’s contention that Counts I & II were preempted by federal agency action because the IRS has allegedly determined that Trinity is a HCSM, the Court once again concluded that the First Amended Complaint contained sufficient factual matter that accepted as true, plausibly alleged that Trinity does not qualify as a HCSM. Id. at 8. Thus, Counts I & II survived Trinity’s motion to dismiss based on federal preemption.1

3. Defendants’ motions to compel arbitration

Less than two weeks after this Court issued the order denying Defendants’ motions to dismiss, Trinity and Aliera jointly moved to compel arbitration and stay proceedings pending completion of arbitration. Dkt. No. 52. Defendants argued that they had not moved to compel the matter to arbitration earlier because the Original Plaintiffs had not yet completed all stages of the dispute resolution procedures. Dkt. No. 52 at 2. According to Defendants, those procedures required the parties to complete several steps before the matter could be referred to binding arbitration. Id. However, Defendants argued, because the Court determined that the complaint sufficiently alleged allegations, that if proven true, would mean the dispute resolution procedures The Court did not directly address Aliera’s argument that Count I was not sufficiently pled to raise the right to relief on this claim above the speculative level, but implicitly denied Aliera’s motion as to this issue. 1 are invalid under Washington law and therefore the Original Plaintiffs did not have to exhaust those procedures before filing the lawsuit, the issue of arbitration was now ripe. Id. at 3. After the motion was fully briefed, but before the Court decided the issue, the Original Plaintiffs filed the Second Amended Complaint in which they added the Perrins as named

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