N. v. Gillette Childrens Specialty Healthcare Medical Benefit Plan

CourtDistrict Court, D. Minnesota
DecidedAugust 8, 2023
Docket0:23-cv-02450
StatusUnknown

This text of N. v. Gillette Childrens Specialty Healthcare Medical Benefit Plan (N. v. Gillette Childrens Specialty Healthcare Medical Benefit Plan) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
N. v. Gillette Childrens Specialty Healthcare Medical Benefit Plan, (mnd 2023).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UTAH

SHANI N., AND J.G., ORDER GRANTING IN PART AND DENYING IN PART MOTION TO Plaintiffs, DISMISS OR, IN THE ALTERNATIVE, TO TRANSFER VENUE v. Case No. 4:22-cv-00070-RJS-PK GILLETTE CHILDREN’S SPECIALTY HEALTHCARE MEDICAL BENEFIT Chief District Judge Robert J. Shelby PLAN, Magistrate Judge Paul K. Kohler Defendant.

This case arises under the Employee Retirement Income Security Act of 1974 (ERISA). Plaintiffs Shani N. and J.G. allege Defendant Gillette Children’s Specialty Healthcare Medical Benefit Plan (the Plan) violated ERISA in denying payment for treatment J.G. received at residential facilities in Utah and Arizona. Though all parties reside in Minnesota, Plaintiffs filed suit in this district against the Plan, asserting a lone claim for denial of Plan benefits pursuant to 29 U.S.C. § 1132(a)(1)(B).1 Now before the court is the Plan’s Motion to Dismiss or, in the Alternative, to Transfer Venue (Motion).2 In it, the Plan first argues it is not subject to personal jurisdiction in Utah, and for the same reasons, venue is improper. Second, it argues to the extent Plaintiffs intended to allege in their lone claim a breach of fiduciary duty, that claim is inadequately pled. Finally, the Plan argues in the alternative under 28 U.S.C. § 1404(a) that if dismissal is not warranted, the court should transfer venue to Minnesota “for the convenience of parties and witnesses, [and] in

1 Dkt. 2, Complaint, at 8-9 (using court’ ECF pagination). 29 U.S.C. § 1132(a)(1)(B) states an ERISA plan participant or beneficiary may file a civil action “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 . . . .” 2 Dkt. 12. the interest of justice. . . .” For the reasons explained below, the court DENIES the Motion to Dismiss, but GRANTS Defendant’s Alternative Motion to Transfer Venue under § 1404(a). BACKGROUND The Plan moves to dismiss pursuant to Federal Rules of Civil Procedure 12(b)(2) for lack of personal jurisdiction, 12(b)(3) for improper venue, and 12(b)(6) for failure to state a claim—in

addition to moving alternatively for transfer of venue under § 1404(a). In evaluating these grounds for dismissal, the court may consider facts and evidence outside the Complaint but must accept all uncontroverted well-pled allegations in the Complaint and resolve factual ambiguities in Plaintiffs’ favor.3 The following facts are drawn from Plaintiffs’ Complaint4 and two declarations from Karen Brady, Vice President of People Strategy at Gillette Children’s Specialty Healthcare (Gillette), the Plan Sponsor.5 Plaintiff Shani N. is Plaintiff J.G.’s mother.6 Both reside in St. Paul, Minnesota.7 Shani N. works for Gillette,8 a non-profit corporation registered and domesticated in St. Paul.9 Gillette has no offices, locations, or employees in Utah.10

3 Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (noting that court considering Rule 12(b)(6) motion to dismiss should “assume the veracity of” well-pleaded allegations in the complaint in determining whether a plausible cause of action is stated), Dudnikov v. Chalk & Vermilion Fine Arts, Inc., 514 F.3d 1063, 1070 (10th Cir. 2008) (noting plaintiff bears burden at motion to dismiss stage of making prima facie showing of personal jurisdiction and that when evaluated on the basis of the complaint and affidavits, well-pled allegations are taken as true and any “factual disputes in the parties’ affidavits must be resolved in plaintiff’s favor” (citations omitted)), and Hancock v. Am. Tel. & Tel. Co., 701 F.3d 1248, 1260 (10th Cir. 2012) (noting in face of Rule 12(b)(3) challenge, “a plaintiff may rest on the well-pled facts in the complaint to oppose a motion to dismiss for improper venue, but ‘only to the extent that such facts are uncontroverted by defendant's’ evidence.” (quoting Pierce v. Shorty Small's of Branson Inc., 137 F.3d 1190, 1192 (10th Cir.1998)). 4 Dkt. 2. 5 Dkt. 13, First Declaration of Karen Brady (First Brady Decl.) and Dkt. 22-1, Second Declaration of Karen Brady (Second Brady Decl.). 6 Dkt. 2, Complaint, at ¶¶ 1-2. 7 Id. 8 Id. at ¶ 1. 9 Dkt. 13, First Brady Decl., at ¶ 3. 10 Id. at ¶¶ 4-5. Plaintiffs were covered by Gillette’s Medical Benefit Plan, ‘NationalOne Plan,’ a self- insured employee welfare benefit plan as defined under ERISA.11 Claims made under the Plan are administered by HealthPartners Administrators, Inc., another Minnesota non-profit corporation and managed care organization.12 J.G. has struggled with multiple mental health conditions.13 She received residential

mental health treatment at Wingate Wilderness Therapy (Wingate) in Kanab, Utah, from June 7 through August 20, 2018.14 She also received treatment from August 21, 2018, through an unspecified date at Spring Ridge Academy (Spring Ridge), a residential mental health treatment facility in Arizona.15 Neither facility is in-network under the Plan.16 At some point, the Plan received a request for authorization of J.G.’s treatment at Wingate and related claims for payment.17 The Plan, through HealthPartners, denied payment for J.G.’s treatment at Wingate on the grounds that the facility is a ‘wilderness program’ and wholly excluded from coverage.18 Plaintiffs appealed this decision, but HealthPartners repeatedly upheld the denial.19

11 Id. at ¶ 6. 12 Id. at ¶¶ 7-8. 13 Dkt. 2, Complaint, at ¶ 7. 14 Id. at ¶ 2. 15 Id. 16 Dkt. 13, First Brady Decl., at ¶¶ 13-14. 17 The Plan claims it only received an authorization request on June 26, 2018, a few weeks after J.G. already entered Wingate, and cites for this proposition the documents attached at Exhibit 4 to Brady’s First Declaration (Dkt. 13). Those documents are letters from HealthPartners dated August 21 and July 3, 2018, as well as some claim file notes. None state when an authorization request was received for the Wingate treatment. But Plaintiffs do not directly dispute that they did not seek pre-treatment authorization for care at Wingate in Utah. See Dkt. 20 at 4 (noting the failure to seek authorization may result in a reduction of coverage but not “rescission of coverage.”). The court does not find material whether the Plan did or did not have advance opportunity to authorize coverage in evaluating the Plan’s connections to Utah and due process issue related to any burden in litigating here. The court finds there is personal jurisdiction over Utah whether the Plan did or did not have that opportunity. 18 Dkt. 2, Complaint, at ¶¶ 8-18. 19 Id. HealthPartners approved only partial payments for J.G.’s treatment at Spring Ranch, up to when J.G. turned eighteen years of age.20 At that point, HealthPartners denied further payment on the grounds of her age. HealthPartners again upheld this denial throughout the prelitigation appeals process.21 Following these denials and after exhausting their appeals, Plaintiffs filed this action

against the Plan, asserting a lone cause of action for Plan benefits under 29 U.S.C. § 1132

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N. v. Gillette Childrens Specialty Healthcare Medical Benefit Plan, Counsel Stack Legal Research, https://law.counselstack.com/opinion/n-v-gillette-childrens-specialty-healthcare-medical-benefit-plan-mnd-2023.