Klover v. Antero Healthplans

64 F. Supp. 2d 1003, 1999 U.S. Dist. LEXIS 14710, 1999 WL 759726
CourtDistrict Court, D. Colorado
DecidedSeptember 24, 1999
DocketCiv.A. 98-B-920
StatusPublished
Cited by5 cases

This text of 64 F. Supp. 2d 1003 (Klover v. Antero Healthplans) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Klover v. Antero Healthplans, 64 F. Supp. 2d 1003, 1999 U.S. Dist. LEXIS 14710, 1999 WL 759726 (D. Colo. 1999).

Opinion

MEMORANDUM OPINION AND ORDER

BABCOCK, District Judge.

Three of the five Defendants, Antero Healthplans a/k/a Mutual of Omaha of Colorado, Inc. (“Antero”), Mutual of Omaha Health Plans, Inc. (“Health Plans”), and Mutual of Omaha Insurance Company (“Mutual of Omaha”) (collectively “third party administrators” or “Defendants”), move to dismiss the claims against them pursuant to Rule 12(b)(6). Plaintiffs, Kellie Klover, Susan Klover, and Steven Klover (collectively “the Klo-vers” or “Plaintiffs”), oppose this motion. For the reasons set forth below I grant in part and deny in part Defendants’ motion. Jurisdiction is proper in this Court pursuant to the Employer Retirement Insurance Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq., original federal question jurisdiction, 28 U.S.C. §§ 1331 & 1441(a), and supplemental jurisdiction, 28 U.S.C. §§ 1367 & 1441(c).

I. Background

In 1982, Plaintiff. Steven Klover began working for Rockwell International Corporation (“Rockwell”) at the Rocky Flats Environmental Technology Site (“Rocky Flats”) in Golden, Colorado. Rockwell managed the environmental decontamination program at Rocky Flats pursuant to a contract with the United States Depart *1006 ment of Energy (“DOE”), the federal agency responsible for oversight of Rocky Flats. Between 1982 and 1989, Mr. Klover and his family participated in, and received benefits under, Rockwell’s self-funded, health benefits plan known as Plan Number 676 (the “Plan”).

On September 22,1990, Rockwell agreed to transfer its responsibilities under the contract to a new contractor effective January 1,1990. Shortly thereafter, the DOE named EG & G Rocky Flats, Inc. (“EG & G”) as Rockwell’s successor. Pursuant to a three-party transfer agreement between Rockwell, DOE, and EG & G, executed December 29,1989, EG & G assumed all of Rockwell’s assets relating to the company’s Rocky Flats division and all of Rockwell’s liabilities relating to the Rocky Flats’ operation. EG & G, therefore, became a successor sponsor of the Plan. Mr. Klover worked for EG & G from January 1, 1990 through June 30, 1995, during which time he continued to participate in the Plan.

As a result of workforce restructuring and layoffs beginning in 1992, the number of non-DOE employees at Rocky Flats decreased. As part of its workforce restructuring plan, the DOE established a Displaced Workers Program (“DWP”) entitling employees of EG & G to participate in the Plan even after their termination. Management of the environmental decontamination program at Rocky Flats changed hands again on July 1, 1995. Pursuant to a three-party transfer agreement between EG & G, DOE, and Kaiser-Hill, executed June 30, 1995, Kaiser-Hill assumed EG & G’s health benefits obligations and agreed to provide benefits to employees and individuals “otherwise entitled to benefits previously paid by EG & G....” (Transfer Agreement of 6/30/95 at 6-7). Kaiser-Hill, as the Plan Sponsor and Plan Administrator, hired several companies to assist in processing'claims and offering an HMO network under the Plan. These companies included, among others, third-party administrators Antero and Mutual of Omaha. Antero subcontracted some of its administrative service duties to Health Plans. (Rembold Affidavit).

As a part of continuing workforce decreases, Mr. Klover accepted voluntary termination in June 1995 and, therefore, never worked directly for Kaiser-Hill. Mr. Klover was, however, a displaced worker eligible to continue participation in the Plan by virtue of the DWP. Therefore, the Klovers continued to participate after Mr. Klover’s voluntary termination, although they enrolled in a different type of health insurance effective July 1, 1995. The Klover’s allege that representatives of the third party administrators informed them that their new coverage was materially identical to their previous coverage. (Complaint ¶ 15).

Kellie Klover, Steven Klover’s daughter, underwent orthopedic surgery on October 16, 1996. Despite alleged pre-approval of the surgery and post-operative services, Defendants denied the Klovers’ benefits claim on December 13, 1996, stating: “Our records indicate that we did not receive your coupon or premium payment due October 1, 1996. Your coverage has been terminated effective October 1, 1996.” (Complaint ¶ 20). The Klovers deny that they failed to pay their October 1996 premium in a timely manner. They appealed Mutual of Omaha's decision, but Kaiser-Hill denied the appeal on December 23, 1996. (Complaint ¶ 21). The Klovers commenced this action on February 27, 1998 in the District Court of Adams County, Colorado. The Klovers alleged seven claims against the third party administrators and three claims against Kaiser-Hill. All claims were derived from the common law of Colorado. Defendants removed to this Court on April 24, 1998, relying on ERISA as a basis of subject matter jurisdiction.

On December 7, 1998, I issued an order dismissing all of the Klovers’ claims against all Defendants as preempted by ERISA. The Klovers filed a motion for reconsideration, and on January 27,1999,1 partially granted this motion. I held that *1007 only the Klovers’ breach of contract claim, premised on “substantial compliance,” remained viable. I further allowed the Klo-vers to file an amended complaint on or before February 10, 1999. The Klovers filed such an amended complaint, and made the following claims against all five current Defendants including the third party administrators, Kaiser-Hill, and the Plan:

(1) Breach of Contract;
(2) 29 U.S.C. § 1132(a)(1)(B) — claim for ERISA benefits;
(3) 29 U.S.C. § 1132(a)(3) — promissory estoppel; and
(4) 29 U.S.C. § 1132(a)(3) — equitable relief.

The three third party administrators filed a motion to dismiss this amended complaint on March 3,1999.

II.

Under Rule 12(b)(6), a district court may dismiss a complaint for failure to state a claim upon which relief can be granted if it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief. See Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957). If the plaintiff has pled facts that would support a legally cognizable claim for relief, a motion to dismiss should be denied. See id. In evaluating a 12(b)(6) motion to dismiss, “all well-pleaded factual allegations in the amended complaint are accepted as true and viewed in the light most favorable to the nonmoving party.”

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Bluebook (online)
64 F. Supp. 2d 1003, 1999 U.S. Dist. LEXIS 14710, 1999 WL 759726, Counsel Stack Legal Research, https://law.counselstack.com/opinion/klover-v-antero-healthplans-cod-1999.