Select Specialty Hospital - Quad Cities, Inc. v. WH Administrators, Inc.

CourtDistrict Court, D. Maryland
DecidedAugust 7, 2020
Docket8:18-cv-03586
StatusUnknown

This text of Select Specialty Hospital - Quad Cities, Inc. v. WH Administrators, Inc. (Select Specialty Hospital - Quad Cities, Inc. v. WH Administrators, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Select Specialty Hospital - Quad Cities, Inc. v. WH Administrators, Inc., (D. Md. 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND

SELECT SPECIALTY HOSPITAL – * QUAD CITIES, INC. * Plaintiffs, *

v. * Civil Action No. PX-18-03586

WH ADMINISTRATORS, INC. *

Defendant. * *****

MEMORANDUM OPINION Pending before the Court is Plaintiff Select Specialty Hospital – Quad Cities, Inc.’s (“SSH”) motion for default judgment. ECF No. 10. Defendant WH Administrator’s Inc. (“WH”) has not responded, and the time for doing so has passed. See Loc. R. 105.2. Pursuant to Local Rule 105.6, a hearing is not necessary. For the following reasons, request for this Court to enter default judgment in the amount of $200,214.98 in damages; $5,610.78 in prejudgment interest; $8,502.50 in costs and reasonable attorney’s fees is GRANTED. I. Background Plaintiff SSH is incorporated in Delaware with its principal place of business in Iowa. ECF No. 1 ¶ 1. Defendant WH is incorporated in Texas with its principal place of business in Maryland. Id. ¶ 2. On October 19, 2016 J.K. (“the Patient”) was admitted to SSH, a long-term acute care hospital specializing in critical care recovery. Id. ¶¶ 6–7. The Patient was covered under an employer-sponsored preferred provider organization health care plan. Id. ¶ 8. On the day of her admission, the Patient assigned her rights to benefits under the plan to SSH and authorized SSH to file claims necessary for the collection of those benefits. Id. ¶ 10. Before providing treatment, SSH contacted the plan administrator, Benefit Administrative Systems (“BAS”). BAS confirmed the Patient’s coverage and authorized admission at SSH. Id. ¶¶ 9, 25–26. BAS issued an extended certification for the Patient’s ongoing care on October 28, 2016. ECF No. 14 ¶ 10. The Patient remained under SSH’s care until her death on November 16, 2016, during

which time SSH provided services valued at $200,214.98. ECF No. 1 ¶¶ 11–12. SSH submitted a claim to BAS for $200,214.98 on November 28, 2016. Id. ¶ 13. On January 3, 2017, BAS informed SSH that the plan had been transferred to Defendant WH. Id. ¶ 14. SSH resubmitted its claim to WH that same day. Id. ¶ 16. WH has refused to pay for the claims despite SSH’s ongoing efforts to obtain payment. Id. ¶ 17. Arising from WH’s nonpayment, SSH filed suit in this Court on November 21, 2018, for breach of contract (Count 1), promissory estoppel (Count 2), and bad faith denial of an insurance claim (Count 3). Id. ¶¶ 18–34. WH was served the Complaint and summons by certified mail on January 22, 2019 in accordance with Federal Rule of Civil Procedure 4(h) and 4(e)(1). ECF No.

9. WH failed to enter an appearance or otherwise respond, and SSH moved for default judgment on January 7, 2020. ECF No. 10. A Clerk’s Order of Default was entered on March 27, 2020. ECF No. 11. On June 5, 2020 this Court ordered SSH to supplement its motion for default judgment with a copy of the coverage plan and evidence supporting the claimed damages. ECF No. 13. While SSH submitted invoices supporting the claimed damages, it did not have in its possession the precise coverage plan governing WH’s payment for services rendered to the Patient.1 ECF

1 SSH moves to seal exhibits “E”, “F”, and “I” from ECF No. 14 because the exhibits include personal and health information. ECF No. 16. As a general matter, “[s]ensitive medical or personal identification information may be sealed,” so long as the request is not overbroad. Rock v. McHugh, 819 F. Supp. 2d 456, 475 (D. Md. 2011) No. 15 at 12; ECF No. 14 ¶ 5. SSH averred that because the coverage plan was stored exclusively on WH’s website, and the website is no longer functional, SSH cannot access the coverage plan. Id. Instead, SSH submits a coverage plan that SSH represents is the same in all material respects. ECF No. 14-2. The submitted coverage plan was also part of the record evidence in a

similar action before the Honorable Richard D. Bennett in this court. Acosta v. WH Administrators, Inc., No. RDB-18-1290, 2020 WL 1479580 (D. Md. Mar. 26, 2020).2 In Acosta, WH, as the party defendant, had represented that the coverage plan is “substantially similar to the contents of all other compliance service agreements that WH Administrators entered into with its other employer clients.” Acosta, No. RDB-18-1290, Sec. of Labor’s Memo. In Support of His Motion for Summary Judgment at 16, n. 9 (ECF. No. 38-1). Accordingly, SSH correctly urges the Court to construe the rights and obligations as laid out in the Acosta coverage plan as the same governing this matter. The Court will do so for purposes of resolving this motion. Pertinent here, the coverage plan clearly states that participants enjoy protection of the

Employee Retirement Income Security Act of 1974 (ERISA). ECF No. 14-2 at 113. Participants are owed the right to request and receive copies of plan documents, the right to file suit in state or federal court for enforcement of claims for benefits, and the right to seek redress in the event that the plan fiduciaries misuse the plan’s funds. Id.

(citing Pittston Co. v. United States, 368 F.3d 385, 406 (4th Cir. 2004) and Briggs v. Marriott Int’l, Inc., 368 F. Supp. 2d 461, 463 n. 1 (D. Md. 2005), aff’d, 205 Fed. Appx. 183 (2006)). Plaintiff’s motion to seal is therefore granted.

2 WH’s behavior in the present case fits the pattern of systemic misconduct, and lack of responsiveness, demonstrated in Acosta. Acosta v. WH Administrators, Inc., 2020 WL 1479580, at *9 (D. Md. Mar. 26, 2020). There, Judge Bennett found that WH violated a wide range of fiduciary obligations under ERISA and permanently enjoined WH from acting as a fiduciary or service provider for any ERISA-covered employee benefit plan. Id. at *10. As for the terms governing WH’s obligations to reimburse for services, the coverage plan requires that WH issue a decision on post-service claims for payment “not later than 30 days after receipt of the claim[.]” Id. at 56. If payment is not received, a claimant such as SSH may take legal action 90 days after a claim has been properly submitted. Id. at 65. Where the Patient- participant assigned her right to benefits to SSH as the provider, the plan authorizes a provider

like SSH to submit claims and receive payment of benefits as the participant’s assignee. Id. at 64. Under the coverage plan, the court retains discretion to award the provider’s costs and legal fees. Id. at 113. II. Standard of Review Pursuant to Federal Rule of Civil Procedure 55(a), “[w]hen a party against whom a judgment for affirmative relief is sought has failed to plead or otherwise defend, and that failure is shown by affidavit or otherwise, the clerk must enter the party’s default.” The Court may conduct hearings or make referrals when necessary to determine the damages, establish the truth of any allegation by evidence, or investigate any other matter. Fed. R. Civ. P. 55(b)(2).

Thereafter, the court may enter default judgment at the plaintiff’s request and with notice to the defaulting party. Id. Plaintiff, however, is not automatically entitled to default judgment simply because the defendant has not responded. Rather, entry of default judgment is left to the sound discretion of the court. See, e.g., Choice Hotels International, Inc. v. Jai Shree Navdurga, LLC, DKC 11- 2893, 2012 WL 5995248, at *1 (D. Md. Nov. 29, 2012); see also Choice Hotels International, Inc. v. Austin Area Hospitality, Inc., TDC 15-0516, 2015 WL 6123523, at *1 (D. Md. Oct. 14, 2015). Although the United States Court of Appeals for the Fourth Circuit has announced a “strong policy” in favor of deciding cases on their merits, United States v.

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