Patterson v. UnitedHealthcare Insurance Company

CourtDistrict Court, N.D. Ohio
DecidedJanuary 31, 2022
Docket1:21-cv-00470
StatusUnknown

This text of Patterson v. UnitedHealthcare Insurance Company (Patterson v. UnitedHealthcare Insurance Company) is published on Counsel Stack Legal Research, covering District Court, N.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Patterson v. UnitedHealthcare Insurance Company, (N.D. Ohio 2022).

Opinion

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF OHIO EASTERN DIVISION

ERIC L. PATTERSON, ) Case No. 1:21-cv-470 ) Plaintiff, ) Judge J. Philip Calabrese ) v. ) Magistrate Judge ) Thomas M. Parker UNITEDHEALTHCARE ) INSURANCE COMPANY et al., ) ) Defendants. ) )

OPINION AND ORDER This civil action stems from years of State-court litigation between Plaintiff Eric Patterson and several defendants related to an ERISA-covered healthcare plan that Defendant Swagelok Company sponsors. In this lawsuit, Plaintiff sues Swagelok, UnitedHealthcare Insurance Company, UnitedHealth Group, Inc., and United Healthcare Services, Inc. (collectively, “UnitedHealthcare”), Optum Group, LLC and Optum Inc. (collectively, “Optum”), and two attorneys, Shaun Byroads and Daran Kiefer, and their firm, Kreiner & Peters Co., LPA (collectively, “Kreiner & Peters”). Plaintiff asserts nine claims for violations of the Employment Retirement Income Security Act, the Racketeer Influenced and Corrupt Organizations Act, and fraud, conversion, civil conspiracy, and unjust enrichment under State law. (ECF No. 1.) Defendants jointly move to dismiss the complaint under Rules 12(b)(1) and 12(b)(6) (ECF No. 11), which Plaintiff opposes (ECF No. 16). Plaintiff also seeks leave to amend (ECF No. 36), which Defendants oppose (ECF No. 38). For the reasons that follow, the Court DISMISSES Plaintiff’s claims and DENIES leave to amend. FACTUAL AND PROCEDURAL BACKGROUND

On Defendants’ motion to dismiss, the Court takes the facts alleged in the complaint as true and takes judicial notice of State-court opinions and proceedings mentioned in the complaint, without converting this motion into one for summary judgment. See Wyser-Pratte Mgmt. Co. v. Telxon Corp., 413 F.3d 553, 560 (6th Cir. 2005); see also McLaughlin v. CNX Gas Co., 639 F. App’x 296, 298 (6th Cir. 2016). A. Plaintiff’s Case Against Swagelok in State Court At all relevant times, Mr. Patterson was covered under the Swagelok Company

Welfare Benefits Plan-Medical Benefits Program (the “Swagelok Plan”), which is subject to ERISA’s regulations. (ECF No. 1, ¶ 11, PageID #9.) In November 2014, Mr. Patterson was injured in a motor vehicle accident with a semi tractor-trailer. (Id., ¶ 30, PageID #16.) UnitedHealthcare, through the Swagelok Plan, paid for Mr. Patterson’s medical treatment. (Id., ¶ 31, PageID #16.) Mr. Patterson also submitted a claim for compensation to the truck’s insurer. (ECF

No. 1, ¶ 30, PageID #16.) Optum, a subsidiary of UnitedHealthcare, subsequently contacted Mr. Patterson and notified him that if he settled with the insurer for the driver of the truck, UnitedHealthcare, as administrator of the Swagelok Plan, intended to invoke the Swagelok Plan’s subrogation and reimbursement provisions to collect approximately $35,500.00 in medical benefits paid to Mr. Patterson. (Id., ¶¶ 31, 34, PageID #16–17.) On November 18, 2016, Mr. Patterson sued the truck’s insurer for compensatory damages and the Swagelok Plan for declaratory relief in the Summit County Court of Common Pleas. (Id., ¶¶ 30–32.) Mr. Patterson sought a declaration

that he had no obligation to reimburse the Swagelok Plan with the proceeds that he might recover from the truck driver’s insurer. (Id., ¶ 32.) Optum, through Kreiner & Peters, represented the Swagelok Plan in that case. (Id., ¶ 33.) Mr. Patterson maintains that throughout the State proceedings, the Swagelok Plan and UnitedHealthcare represented that no “Plan Document” existed, as Mr. Patterson defined it in his discovery requests, and that the only “document” that did exist was

a Summary Plan Description, or SPD, which provided for subrogation and reimbursement. (Id., ¶ 34, PageID #17–21.) In June 2017, Mr. Patterson and the State defendants settled, and Mr. Patterson agreed to pay Optum $25,000, which would partially reimburse the Swagelok Plan and UnitedHealthcare. (Id., ¶ 35, PageID #21.) B. Mrs. Patterson and the “Smoking Gun” A short time later, Mr. Patterson’s wife—Laura Patterson—was involved in

separate car accident. (Id., ¶ 36, PageID #21–22.) At the time, she was also covered by the Swagelok Plan administered by UnitedHealthcare, and she likewise received Plan benefits for her injuries. (Id.) As with her husband, Optum contacted Mrs. Patterson on behalf of UnitedHealthcare seeking subrogation or reimbursement of payments that it made on her behalf, should she ultimately recover from the other driver or his insurance. (Id., ¶ 37, PageID #22.) Mrs. Patterson sued the negligent driver’s insurer in State court for compensatory damages and sought a declaratory judgment against the Swagelok Plan regarding its subrogation and reimbursement rights. (Id., ¶ 38.) Again, the

Swagelok Plan allegedly denied that a Plan Document existed and referred the court to the SPD containing the pertinent language. (Id., ¶ 39, PageID #22–27.) Mrs. Patterson subsequently settled with the negligent driver and his insurer, but continued to pursue the claim against the Swagelok Plan. (Id., ¶¶ 47–48, PageID #27.) After more discovery, the Swagelok Plan and its attorneys turned over to

Mrs. Patterson the Plan Document “for the first time.” (Id., ¶ 49, PageID #28.) The State court eventually entered summary judgment for Mrs. Patterson, declaring that the Swagelok Plan had no subrogation or reimbursement provisions and that she was not required to reimburse it for benefits paid on her behalf. (Id., ¶ 52, PageID #29.) By the time of this ruling, however, Mr. Patterson had already paid the Plan the $25,000 he agreed to pay under the 2017 settlement agreement in his action in State court. (Id., ¶ 53.)

C. The Original Complaint in This Federal Lawsuit Complaining that he paid “money in response to claims of legal obligations that did not exist,” Mr. Patterson sues UnitedHealthcare, Optum, Swagelok, and Kreiner & Peters. (Id., ¶¶ 1, 11–16, PageID #4, #9–11.) Plaintiff does not sue the Plan. Under ERISA, Plaintiff (1) seeks a declaratory judgment that the subrogation and reimbursement terms of the Swagelok Plan are invalid (Count I); (2) asserts a claim for breach of fiduciary duty (Count II); (3) claims violations of 29 U.S.C. § 1106 (prohibited transactions) (Count III); and (4) alleges violations of 29 U.S.C. §§ 1021, 1082–1085b through Swagelok’s alleged failure properly to notify Swagelok Plan

beneficiaries of its financial status (Count IX). (Id., PageID #27, 28, 35.) For each claim, Plaintiff seeks to (1) enjoin Defendants from further ERISA violations, (2) remove and replace UnitedHealthcare and Optum as the Plan Administrators, and (3) recover $25,000 in monetary relief. (Id., PageID #61, 62, 65.) Plaintiff also alleges that Swagelok, Optum, UnitedHealthcare, and Kreiner & Peters engaged in a civil RICO conspiracy, in violation of 18 U.S.C. § 1962 (Count VI).

(Id. PageID #48.) Specifically, Plaintiff alleges that Defendants were engaged in an enterprise to “share profits derived from the subrogation [or] reimbursement scheme,” which amounts to a “pattern of racketeering activity” based on predicate acts including embezzlement, mail fraud, wire fraud, and unlawful welfare-fund collection. (Id., ¶ 124, PageID #49.) On this count, Plaintiff seeks $25,000 in compensatory damages. (Id., PageID #61.) Finally, Plaintiff brings State-law claims of fraudulent and negligent

misrepresentation (Count IV), conversion (Count V), civil conspiracy (Count VII), and unjust enrichment (Count VIII) against UnitedHealthcare, Optum, and Swagelok. (Id., PageID #45, 48.) On each of these claims, Plaintiff also seeks $25,000 in compensatory damages.

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Patterson v. UnitedHealthcare Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/patterson-v-unitedhealthcare-insurance-company-ohnd-2022.