Jackson v. The Aliera Companies Inc

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

Opinion

6 UNITED STATES DISTRICT COURT 7 WESTERN DISTRICT OF WASHINGTON AT SEATTLE 8 JACKSON, et al. Case No.: 19-cv-01281-BJR 9 Plaintiffs, ORDER STRIKING AS MOOT 10 v. MOTION TO STAY PROCEEDINGS PENDING APPEAL, VACATING JULY 11 THE ALIERA COMPANIES, INC., et al. 20, 2020 ORDER DENYING MOTION TO COMPEL ARBITRATION, AND 12 Defendants. GRANTING MOTION TO COMPEL ARBITRATION AND STAY 13 PROCEEDINGS

14 I. INTRODUCTION 15 Plaintiffs bring this putative class action suit against Defendants Aliera Companies, Inc., 16 its now-defunct subsidiary Aliera Healthcare, Inc. (collectively “Aliera”), and Trinity 17 HealthShare, Inc. (“Trinity”). Plaintiffs allege that Defendants sold unauthorized health 18 insurance plans in violation of Washington law and engaged in unfair and deceptive practices in 19 violation of the Washington Consumer Protection Act, RCW 19.86.010 et seq. Currently before 20 the Court are Aliera’s and Trinity’s motions to stay proceedings pending appeal of this Court’s 21 order denying Defendants’ motion to compel arbitration. Dkt. Nos. 101 and 103. Plaintiffs 22 oppose the motion. Dkt. No. 116. 23 1 II. BACKGROUND 2 A. Factual Background 3 Defendant Trinity offers a healthcare cost sharing plan known as “AlieraCare” and 4 Defendant Aliera markets, sells, and administers AlieraCare in Washington State on behalf of

5 Trinity. See Dkt. 57, Second Amend. Comp. (“SAC”). According to Plaintiffs, Trinity is a health 6 insurance company and AlieraCare is a health insurance plan, and therefore subject to federal 7 and state laws governing health insurance. See id. Defendants counter that Trinity is not an 8 insurance company and does not provide health insurance. See Dkt. Nos. 62, 63, Defs.’ Answers 9 to Pls.’ SAC. Instead, Defendants assert that Trinity qualifies as a healthcare sharing ministry 10 (“HCSM”) under the Affordable Care Act (“ACA”) that facilitates the sharing of healthcare 11 expenses among its members. Regardless, the parties agree that AlieraCare provides members 12 with benefits for medical coverage in exchange for their monthly premiums. 13 Plaintiffs enrolled in AlieraCare in 2018 and 2019. Dkt. No. 57 Plaintiffs, all of whom

14 paid their monthly premiums and met their standard deductibles, expected that Trinity would pay 15 their medical claims as detailed by the AlieraCare benefits booklet (“Member Guide”), which the 16 parties agree is a binding contract. See Member Guide, Dkt. No. 57, Ex. B. However, each 17 Plaintiff was denied healthcare coverage after submitting their claims to Trinity. Dkt. No. 57 18 B. Procedural History 19 Plaintiffs Gerald Jackson, Roslyn Jackson, and Dean Mellom (“the Original Plaintiffs”) 20 initiated this lawsuit in August 2019. Dkt. No. 1. The complaint, later amended in October 2019 21 (“the First Amended Complaint”), has two counts: Count I “Illegal Contract” and Count II 22 violation of the Washington Consumer Protection Act. Id. at 12-13. The First Amended 23 1 Complaint was amended in June 2020. Dkt. Nos. 57, 67. It asserts the same two counts but adds 2 Plaintiffs Jon and Julie Perrin (“the Perrins”) as named plaintiffs to the lawsuit. Dkt. No. 57. 3 1. Defendants’ Motions to Dismiss the First Amended Complaint 4 In November 2019 and before the Perrins were added to the lawsuit, Defendants moved

5 to dismiss the First Amended Complaint. Dkt. Nos. 21, 23. Both Defendants argued that the 6 claims raised in the First Amended Complaint were premature and not yet subject to review by a 7 tribunal because the Original Plaintiffs had not exhausted the dispute resolution procedures 8 outlined in the Member Guide. Dkt. Nos. 21, 23. Defendants urged this Court to dismiss the First 9 Amended Complaint in its entirety; they did not, however, seek dismissal with prejudice on this 10 basis. 11 Aliera also moved to dismiss Count I of the First Amendment Complaint pursuant to 12 Federal Rule 12(b)(6) for failure to state a claim on which relief can be granted. Dkt. No. 23 at 2. 13 It is important to note that Aliera did not seek to dismiss Count I with prejudice. Trinity moved

14 to dismiss both Counts I & II—with prejudice—as preempted by federal agency action. Dkt. No. 15 21 at 2. Specifically, Trinity argued that the claims in the First Amended Complaint depended on 16 a finding that Trinity is not a HCSM under the ACA. According to Trinity, the Internal Revenue 17 Service (“IRS”) has already determined that Trinity is an HCSM and, as such, the claims were 18 preempted by the IRS’s conclusion. Dkt. No. 21 at 2. 19 2. Order Denying the Motions to Dismiss 20 The Court denied Defendants’ motions to dismiss on May 26, 2020. Dkt. No. 47. In 21 doing so, the Court reached the following conclusions. With respect to Defendants’ argument 22 that Counts I & II should be dismissed as premature because the Original Plaintiffs had not 23 exhausted the dispute resolution procedures outlined in the Member Guide, this Court 1 determined that the First Amended Complaint contained sufficient factual matter, accepted as 2 true, to plausibly allege that AlieraCare is a health insurance policy governed by Washington 3 State law. Dkt. No. 47 at 8. This Court further determined that the First Amended Complaint also 4 plausibly alleged that the dispute resolution procedures outlined in the Member Guide are void

5 under Washington insurance law and, if such allegations were proven true, the Original Plaintiffs 6 did not have to exhaust the procedures before filing their lawsuit. Id. at 12. Thus, the Court 7 denied Defendants’ motions to dismiss the First Amended Complaint on the basis that Counts I 8 & II were prematurely filed. 9 Next, with respect to Trinity’s contention that Counts I & II were preempted by federal 10 agency action because the IRS has allegedly determined that Trinity is a HCSM, the Court once 11 again concluded that the First Amended Complaint contained sufficient factual matter that 12 accepted as true, plausibly alleged that Trinity does not qualify as a HCSM. Id. at 8. Thus, 13 Counts I & II survived Trinity’s motion to dismiss based on federal preemption.1

14 3. Defendants’ motions to compel arbitration

15 Less than two weeks after this Court issued the order denying Defendants’ motions to 16 dismiss, Trinity and Aliera jointly moved to compel arbitration and stay proceedings pending 17 completion of arbitration. Dkt. No. 52. Defendants argued that they had not moved to compel the 18 matter to arbitration earlier because the Original Plaintiffs had not yet completed all stages of the 19 dispute resolution procedures. Dkt. No. 52 at 2. According to Defendants, those procedures 20 required the parties to complete several steps before the matter could be referred to binding 21 arbitration. Id. However, Defendants argued, because the Court determined that the complaint 22 sufficiently alleged allegations, that if proven true, would mean the dispute resolution procedures 23 1 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 2 those procedures before filing the lawsuit, the issue of arbitration was now ripe. Id. at 3. 3 After the motion was fully briefed, but before the Court decided the issue, the Original 4 Plaintiffs filed the Second Amended Complaint in which they added the Perrins as named

5 plaintiffs. Dkt. No. 57. In response, Defendants filed a motion to compel the Perrins to arbitrate 6 their claims as well. Dkt. No. 61.

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