Lake v. Aetna Life Insurance Company

District Court, M.D. Florida·Decided June 28, 2021·No. 8:20-cv-03010·Unknown

Opinion

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION

SCOTT LAKE, on behalf of himself and all other similarly situated,

Plaintiff, v. Case No. 8:20-cv-3010-VMC-TGW

AETNA LIFE INSURANCE COMPANY, and PINELLAS COUNTY SCHOOL BOARD,

Defendants. /

ORDER This matter comes before the Court upon consideration of Defendant Pinellas County School Board’s Motion to Dismiss Amended Complaint (Doc. # 58), filed on May 5, 2021, and Defendant Aetna Life Insurance Company’s Motion to Dismiss Amended Complaint and to Strike (Doc. # 61), filed on May 19, 2021. Plaintiff Scott Lake responded to each Motion on May 25, 2021, and June 9, 2021, respectively. (Doc. ## 62; 63). For the reasons below, the School Board’s Motion is denied, and Aetna’s Motion is granted in part and denied in part. I. Background Both the Court and the parties are familiar with the facts of this putative class action. Thus, the Court need not reiterate them in detail here. This case arose out of a denial of insurance coverage for Lake’s prostate cancer treatment. (Doc. # 53 at ¶ 58). Specifically, Aetna denied Lake’s request to pre-authorize proton beam radiation therapy because his plan “does not cover experimental or investigational services except under certain circumstances.” (Id.). Lake appealed this denial a number of times – both to Aetna and to the School Board, the plan sponsor with whom Lake contracted – but none of those appeals succeeded. (Id. at ¶¶ 4, 48, 60- 68). Despite these denials, Lake still underwent proton beam

radiation therapy. (Id. at ¶ 72). On October 30, 2020, Lake initiated this putative class action in state court. (Doc. # 1). On December 17, 2020, the case was removed to this Court on the basis of Class Action Fairness Act diversity jurisdiction. (Id.). Both Defendants then moved to dismiss. (Doc. ## 9; 12). On March 26, 2021, the Court granted the School Board’s motion, dismissing Lake’s claim for breach of the implied covenant of good faith and fair dealing, and granting leave to amend. (Doc. # 50). On April 21, 2021, Lake filed an amended complaint. (Doc. # 53). In the amended complaint, Lake seeks to represent a nationwide class of other similarly situated individuals who

were denied coverage by Aetna for proton beam radiation therapy. (Id. at ¶ 74). Lake also proposes a subclass for Florida plan participants. (Id. at ¶ 75). The amended complaint includes the following claims: tortious interference with a contractual relationship against Aetna (Count I), breach of contract against the School Board (Count II), and declaratory and injunctive relief against Aetna (Count III). (Doc. # 53). The amended complaint includes class allegations against Aetna only. (Id. at ¶¶ 93-123). Now, both the School Board and Aetna move to dismiss the amended complaint. (Doc. ## 58; 61). Aetna also requests that

the Court strike the class allegations. (Doc. # 61 at 1). Lake has responded to each Motion (Doc. ## 62; 63), and they are now ripe for review. II. Legal Standard On a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6), the Court accepts as true the allegations in the complaint and construes them in the light most favorable to the plaintiff. Jackson v. Bellsouth Telecomms., 372 F.3d 1250, 1262 (11th Cir. 2004). Further, the Court favors the plaintiff with all reasonable inferences from the allegations in the complaint. Stephens v. Dep’t of Health & Human Servs., 901 F.2d 1571, 1573 (11th Cir. 1990). But,

[w]hile a complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual allegations, a plaintiff’s obligation to provide the grounds of his entitlement to relief requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do. Factual allegations must be enough to raise a right to relief above the speculative level.

Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007) (quotations and citations omitted). Courts are not “bound to accept as true a legal conclusion couched as a factual allegation.” Papasan v. Allain, 478 U.S. 265, 286 (1986). The Court must limit its consideration to “well-pleaded factual allegations, documents central to or referenced in the complaint, and matters judicially noticed.” La Grasta v. First Union Sec., Inc., 358 F.3d 840, 845 (11th Cir. 2004). Under Federal Rule of Civil Procedure 12(f), a court “may strike from a pleading an insufficient defense or any redundant, immaterial, impertinent, or scandalous matter.” Fed. R. Civ. P. 12(f). However, motions to strike are considered drastic remedies, and are thus disfavored by courts. See Thompson v. Kindred Nursing Ctrs. E., LLC, 211 F. Supp. 2d 1345, 1348 (M.D. Fla. 2002). Indeed, they are generally denied “unless the allegations have no possible relation to the controversy and may cause prejudice to one of the parties.” Agan v. Katzman & Korr, P.A., 328 F. Supp. 2d 1363, 1367 (S.D. Fla. 2004) (citations omitted). III. Analysis Both the School Board and Aetna move to dismiss the claims against them. (Doc. ## 58; 61). Additionally, Aetna requests that the Court strike Lake’s class allegations. (Doc. # 61 at 1). The Court will address each Motion in turn. A. The School Board’s Motion to Dismiss The School Board moves to dismiss Count II – Lake’s claim for breach of contract – arguing that it fails because “[t]he allegations in the amended complaint are expressly

contradicted by [the School Board’s] denial letter.” (Doc. # 58 at 9). Lake responds that (1) “[t]he Court cannot accept the contents of the denial letter as true at the dismissal stage,” and (2) “[e]ven assuming the contents of that letter were entirely truthful and accurate[,] . . . it raises factual issues that cannot be resolved by the Court at this stage.” (Doc. # 62 at 7, 10). To state a cause of action for breach of contract under Florida law, the plaintiff must allege: “(1) the existence of a contract, (2) a breach of the contract, and (3) damages resulting from the breach.” Textron Fin. Corp. v. Lentine Marine Inc., 630 F. Supp. 2d 1352, 1356 (S.D. Fla. 2009)

(citation omitted). Here, Lake alleges that the School Board “breached its contract for insurance coverage with [Lake] by arbitrarily and wrongfully denying coverage for [proton beam radiation therapy].” (Doc. # 53 at ¶¶ 71, 109). Specifically, the School Board breached “the terms of his insurance plan . . . by relying upon an outdated and arbitrary ‘Policy Bulletin’ without ever reviewing the medical evidence submitted by [Lake] and his providers” and “failing to provide the full extent of insurance benefits owed to him, as [proton beam radiation therapy] was medically necessary.” (Id. at ¶¶ 109, 111). Lake was allegedly harmed by this breach because

he had “a right to receive [the] benefits.” (Id. at ¶ 113).

Free access — add to your briefcase to read the full text and ask questions with AI

Lake v. Aetna Life Insurance Company, (M.D. Fla. 2021).

Lake v. Aetna Life Insurance Company (Lake v. Aetna Life Insurance Company) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Malowney v. Federal Collection Deposit Group
193 F.3d 1342 (Eleventh Circuit, 1999)
Neal Horsley v. Gloria Feldt
304 F.3d 1125 (Eleventh Circuit, 2002)
Sandra Jackson v. BellSouth Telecommunications
372 F.3d 1250 (Eleventh Circuit, 2004)
Papasan v. Allain
478 U.S. 265 (Supreme Court, 1986)
Lujan v. Defenders of Wildlife
504 U.S. 555 (Supreme Court, 1992)
Bell Atlantic Corp. v. Twombly
550 U.S. 544 (Supreme Court, 2007)
Jean Resnick v. AvMed, Inc.
693 F.3d 1317 (Eleventh Circuit, 2012)
McCurdy v. Collis
508 So. 2d 380 (District Court of Appeal of Florida, 1987)
Morsani v. Major League Baseball
663 So. 2d 653 (District Court of Appeal of Florida, 1995)
OE Smith's Sons, Inc. v. George
545 So. 2d 298 (District Court of Appeal of Florida, 1989)
Salit v. Ruden, McClosky, Smith, Schuster
742 So. 2d 381 (District Court of Appeal of Florida, 1999)
SEC. TITLE GUAR. CORP. v. McDill Columbus Corp.
543 So. 2d 852 (District Court of Appeal of Florida, 1989)
Morgan v. Ocwen Loan Servicing, LLC
795 F. Supp. 2d 1370 (N.D. Georgia, 2011)
GLOBAL TEL LINK CORP. v. Scott
652 F. Supp. 2d 1240 (M.D. Florida, 2009)
Textron Financial Corp. v. Lentine Marine Inc.
630 F. Supp. 2d 1352 (S.D. Florida, 2009)
Agan v. Katzman & Korr, P.A.
328 F. Supp. 2d 1363 (S.D. Florida, 2004)
Thompson v. Kindred Nursing Centers East, LLC
211 F. Supp. 2d 1345 (M.D. Florida, 2002)