Putney v. Medical Mutual

111 F. App'x 803
CourtCourt of Appeals for the Sixth Circuit
DecidedSeptember 10, 2004
DocketNo. 02-3901
StatusPublished
Cited by26 cases

This text of 111 F. App'x 803 (Putney v. Medical Mutual) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Putney v. Medical Mutual, 111 F. App'x 803 (6th Cir. 2004).

Opinion

BATCHELDER, Circuit Judge.

Robert Putney (“Putney”) appeals the district court’s order dismissing under Federal Rule of Civil Procedure 12(b)(6) Counts Two through Seven of Putney’s Second Amended Complaint in this action brought pursuant to the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., and Ohio law. Those counts allege conflict of interest and self-dealing in violation of 29 U.S.C. § 1106(a) (Count Two); failure to comply with ERISA procedural requirements (Count Three); promissory estoppel based on preauthorization (Count Four); waiver and estoppel based on history of accepted late payments (Count Five); violation of ORC § 3999.32(E) (Count Six); and violation of ORC § 1751.13(1)(2)(b) (Count Seven). Putney appeals as well the [805]*805district court’s order granting judgment on the administrative record and dismissing Count One of the Second Amended Complaint, which raises a claim for benefits under ERISA, 29 U.S.C. § 1132(a)(1)(B). Finding no reversible error, we affirm the judgments of the district court.

I.

In 1998 Putney was an employee of Gary and Randy Wilburn, who were doing business as First Choice Rental (“First Choice”). First Choice had entered into a group contract with Medical Mutual under which Medical Mutual agreed to act as an insurer for First Choice’s health benefits plan (“the Plan”) and pay claims due under the Plan. The contract between First Choice and Medical Mutual consisted of the Group Contract, Schedules of Benefits, Riders, and Endorsements. Putney was covered under the Plan as an incident of his employment.

First Choice’s premium payment under the Plan was due the first of each month. Benefits under the Group Contract were expressly conditioned on First Choice’s timely payment of premiums. The terms of the Group Contract specifically provided that if First Choice failed to pay any required premium the Contract would “automatically” terminate “without notice” “at the end of the last period for which payment was made.” First Choice paid in November 1998 the premium for coverage for the period November 1, 1998, through December 1, 1998, but failed to pay the premium due on December 1,1998, for the period December 1, 1998, through January 1, 1999. When First Choice still had not paid this premium by December 22, 1998, Medical Mutual sent First Choice a Delinquent Notification stating that it had ten days to send the payment or Medical Mutual would terminate the contract.

On December 30, 1998, Putney underwent triple bypass surgery at Bethesda Hospital. Putney asserts in his affidavit that he obtained pre-admission authorization from Medical Mutual. Putney asserts in his brief that Medical Mutual paid Bethesda Hospital $21,980.18 on January 9,1999.

First Choice never responded to Medical Mutual’s Delinquent Notification and never paid the premium. Medical Mutual consequently notified First Choice on January 11,1999, that the Group Contract was terminated as of December 1, 1998, the last day of the period for which First Choice had paid premiums. Under the contract, “termination” meant that the Plan did not cover any medical claims of Plan participants — meaning First Choice employees — incurred after December 1, 1998.

At some point after January 11, 1999, Putney made an application for benefits to pay for his December 30, 1998, surgery and treatment associated with that surgery. Medical Mutual denied Putney’s claim. Putney states in his brief that on February 22, 1999, Medical Mutual reclaimed the $21,980.18 it had previously paid Bethesda Hospital.

II.

The district court dismissed Counts Two through Seven pursuant to Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim upon which relief may be granted. To the extent Putney appeals the dismissal of those claims, this Court’s review is de novo. Lewis v. ACB Bus. Servs., Inc., 135 F.3d 389, 405 (6th Cir.1998).

A.

Putney argues before this Court that Medical Mutual committed a per se violation of ERISA under 29 U.S.C. § 1106(b) [806]*806when it charged back or “confiscated” the money it had paid to Bethesda Hospital on Putney’s account, even though Medical Mutual’s contract with the hospital permitted the charge back. § 1106(b) states in pertinent part that:

A fiduciary with respect to a plan shall not-(l) deal with the assets of the plan in his own interest or for his own account, (2) in his individual or in any other capacity act in any transaction involving the plan on behalf of a party (or represent a party) whose interests are adverse to the interests of the plan or the interests of its participants or beneficiaries, or (3) receive any consideration for his own personal account from any party dealing with such plan in connection with a transaction involving the assets of the plan.

29 U.S.C. § 1106(b). Putney argues that once Medical Mutual segregated the funds and paid them as a benefit, the funds were no longer part of the common pool, but became “plan assets.” According to Putney, therefore, when Medical Mutual confiscated the funds and returned them to the common pool, “co-mingling” the “plan assets” with its own funds, Medical Mutual was dealing on its own account in violation of § 1106(b)(1) and (3).

Putney did not allege in his Second Amended Complaint that Medical Mutual had violated § 1106(b), nor did he raise before the district court the argument that Medical Mutual “confiscated benefits” paid. Rather, before the district court, Putney complained that Medical Mutual, acting as a nonfiduciary, had engaged in self-dealing and other actions prohibited under § 1106(a).' The district court dismissed this claim under Federal Rule of Civil Procedure 12(b)(6) because the complaint contained no facts even suggesting that Medical Mutual had engaged in any of the transactions prohibited by § 1106(a). In this appeal, Putney makes no mention of § 1106(a) or the district court’s disposition of this claim. Putney’s attempt to now raise a claim under § 1106(b) is therefore not properly before this court.

But even if Putney’s self-dealing claim were properly before us, we would find it meritless. Despite Putney’s express denial in Count Two of the Second Amended Complaint that Medical Mutual was a fiduciary (“The Defendant Medical Mutual ... is not a fiduciary but instead is an ‘interested party’ under ERISA”), this claim is in substance a claim for breach of fiduciary duty.

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Bluebook (online)
111 F. App'x 803, Counsel Stack Legal Research, https://law.counselstack.com/opinion/putney-v-medical-mutual-ca6-2004.