S. v. United Healthcare Insurance

CourtDistrict Court, D. Utah
DecidedSeptember 13, 2019
Docket2:18-cv-00803
StatusUnknown

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

Bluebook
S. v. United Healthcare Insurance, (D. Utah 2019).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UTAH

DAVID S., VERONICA S., and S.S., MEMORANDUM DECISION AND Plaintiffs, ORDER

v. Case No. 2:18-cv-803

UNITED HEALTHCARE INSURANCE Chief Judge Robert J. Shelby COMPANY, Magistrate Judge Evelyn J. Furse Defendant.

This case stems from Plaintiff S.S.’s mental health, behavioral, and substance abuse treatment at two facilities located in Utah. S.S. and his parents, co-Plaintiffs David S. and Veronica S., claim Defendant United Healthcare Insurance Company owes them for the costs of S.S.’s treatments. Plaintiffs seek relief under the Employee Retirement Income Security Act and the Mental Health Parity and Addiction Equity Act.1 United moves to dismiss on the grounds that Plaintiffs are members of a class action predating this suit, Plaintiffs fail to state a claim upon which relief can be granted, and Plaintiffs David S. and Veronica S. lack standing.2 For the reasons given, United’s Motion to Dismiss is GRANTED IN PART.

1 Dkt. 2 (Complaint) ¶¶ 59–71. 2 Dkt. 5 at 1–2, 8–23. BACKGROUND Over the course of several months in 2015 and 2016, S.S. attended two treatment facilities in Utah: Open Sky Wilderness Therapy and Catalyst Residential Treatment Center.3 Based on the recommendation of his treating medical professionals, S.S. was first admitted to Open Sky on July 15, 2015, for mental health and substance abuse treatment.4 S.S. received

treatment at Open Sky until his discharge on September 29, 2015.5 In S.S.’s discharge summary, Open Sky recommended that S.S. “attend a residential treatment center to support continued growth and success.”6 On September 30, 2015, one day after his discharge from Open Sky, S.S. was admitted to Catalyst.7 S.S. remained at Catalyst until his discharge on October 31, 2016.8 S.S. relapsed and began a second stay at Catalyst on December 30, 2016, which lasted until his discharge on February 28, 2017.9 David S. is a participant in United’s “fully-insured employee welfare benefits plan under [ERISA].”10 S.S. is a beneficiary of David S.’s insurance plan (the Plan).11 When United denied coverage for S.S’s treatment at Open Sky, David S. and Veronica S. filed a complaint with the

3 Dkt. 2 (Complaint) ¶¶ 4, 15, 32, 46. 4 Id. ¶¶ 15. 5 Id. ¶ 30. 6 Id. 7 Id. ¶ 31. 8 Id. ¶ 45. 9 Id. ¶¶ 46, 48–49. 10 Id. ¶ 3. 11 Id. ¶¶ 1–3. Texas Department of Insurance.12 The Texas Department of Insurance directed Plaintiffs to appeal to United, which they did.13 United did not process the appeal.14 On October 12, 2015, United informed David S. and Veronica S. that it was also denying coverage for a substantial portion of S.S.’s first treatment at Catalyst.15 David S. and Veronica S. appealed, and United upheld its denial of S.S.’s first treatment at Catalyst from October 10, 2015

to October 31, 2016.16 David S. and Veronica S. appealed United’s denial of coverage to an external review agency, which also upheld the denial.17 On April 10, 2017, United also denied coverage for S.S.’s second stay at Catalyst.18 David S. and Veronica S. appealed this denial, which United upheld.19 Plaintiffs initiated this action against United on October 12, 2018, asserting two causes of action: (1) Claim for Recovery of Benefits Under 29 U.S.C. § 1132(a)(1)(B), and (2) Claim for Violation of [the Parity Act] Under 29 U.S.C. § 1132(a)(3).20 In response, United moved to dismiss, asserting three separate grounds for dismissal.21 The court now takes up United’s Motion to Dismiss.

12 Id. ¶¶ 16–20. 13 Id. ¶¶ 19–20. 14 Id. ¶ 27. 15 Id. ¶ 32. 16 Id. ¶¶ 33–36. 17 Id. ¶¶ 37–44. 18 Id. ¶ 47. 19 Id. ¶¶ 48–51. 20 Id. ¶¶ 59–71. 21 Dkt. 5 at 1–3. LEGAL STANDARD Rule 8(a)(2) of the Federal Rules of Civil Procedure requires a complaint to include “a short and plain statement of the claim showing that the pleader is entitled to relief.” Under Rule 12(b)(6), a court must dismiss causes of action that “fail[] to state a claim upon which relief can be granted.”22

To survive a Rule 12(b)(6) motion to dismiss, “a complaint must contain sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face.”23 A claim is plausible on its face “when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.”24 When evaluating a motion to dismiss, the court “accept[s] all well-pleaded facts [in the complaint] as true and view[s] them in the light most favorable to the plaintiff.”25 However, the court will not accept as true “[t]hreadbare recitals of the elements of a cause of action, supported by mere conclusory statements.”26 The reviewing court is required to “draw on its judicial experience and common sense” to evaluate whether the well-pled facts state a plausible claim for relief.27 “Though a

complaint need not provide detailed factual allegations, it must give just enough factual detail to provide [defendants] fair notice of what the . . . claim is and the grounds upon which it rests.”28

22 Fed. R. Civ. P. 12(b)(6). 23 Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quotation and citation omitted). 24 Id. 25 Jordan-Arapahoe, LLP v. Bd. of Cnty. Comm’rs, 633 F.3d 1022, 1025 (10th Cir. 2011) (citation omitted). 26 Iqbal, 556 U.S. at 678. 27 Id. at 679. 28 Warnick v. Cooley, 895 F.3d 746, 751 (10th Cir. 2018) (citing Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555 (2007)) (quotations omitted). ANALYSIS I. United Healthcare’s Motion to Dismiss is GRANTED IN PART. United raises three arguments in support of its Motion to Dismiss.29 First, United urges the court to dismiss on the grounds that Plaintiffs are members of a prior-filed class action with identical claims. Second, United argues Plaintiffs inadequately pled their Parity Act claim.

Third, United contends Plaintiffs David S. and Veronica S. lack statutory and constitutional standing to assert the ERISA and Parity Act claims. The court will address each argument, in turn. a. The First-to-File Rule. United seeks dismissal on the grounds that Plaintiffs “are members of one or more certified plaintiff classes in a pending class action premised on the same grounds as this action.”30 In essence, United seeks dismissal pursuant to the first-to-file rule. Under the first-to- file rule, “the first federal district court which obtains jurisdiction of parties and issues should have priority and the second court should decline consideration of the action until the proceedings before the first court are terminated.”31 Intended to “prevent inconsistent rulings

and to preserve judicial resources,”32 the first-to-file rule applies “when two district courts have jurisdiction over the same controversy.”33 When determining whether the first-to-file rule applies, courts consider three factors: “(1) the chronology of events, (2) the similarity of the

29 Dkt. 5 at 1–3. 30 Id. at 1. 31 O'Hare Int'l Bank v. Lambert, 459 F.2d 328, 331 (10th Cir. 1972) (citation omitted). 32 Aurora Bank, FSB v. Universal Am. Mortg. Co., No.

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