Sentara Virginia Beach General Hospital v. LeBeau

182 F. Supp. 2d 518, 2002 U.S. Dist. LEXIS 1905, 2002 WL 130919
CourtDistrict Court, E.D. Virginia
DecidedJanuary 30, 2002
Docket2:01CV242
StatusPublished
Cited by10 cases

This text of 182 F. Supp. 2d 518 (Sentara Virginia Beach General Hospital v. LeBeau) is published on Counsel Stack Legal Research, covering District Court, E.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sentara Virginia Beach General Hospital v. LeBeau, 182 F. Supp. 2d 518, 2002 U.S. Dist. LEXIS 1905, 2002 WL 130919 (E.D. Va. 2002).

Opinion

OPINION

REBECCA BEACH SMITH, District Judge.

This matter is before the court on Motions to Dismiss, pursuant to Federal Rule of Civil Procedure 12(b)(6), brought by third-party defendants A.S.G., Inc. and Trigon Insurance Company. For the reasons set forth below, the motion of A.S.G., Inc. is DENIED, and the motion of Trigon Insurance Company is GRANTED in part, and DENIED in part.

I. Factual and Procedural History

On January 8, 2001, Sentara Virginia Beach General Hospital filed a complaint in the Circuit Court for the City of Virginia Beach, Virginia, against June C. Le-Beau, Executor of the estate of Ernest R. LeBeau, and June C. LeBeau, Individually, (collectively, “LeBeau”), seeking payment of hospital bills arising from her late husband’s hospitalization. LeBeau filed a Third-Party Motion for Judgment against A.S.G., Inc., d/b/a Angelos Restaurant (“A.S.G.”), and Trigon Insurance Company (“Trigon”). Trigon removed the case to federal court on April 5, 2001. By leave of the court, LeBeau filed an amended third- *520 party complaint. A.S.G. moved to dismiss Count I of the amended third-party complaint, pursuant to Federal Rule of Civil Procedure 12(b)(6). LeBeau filed a response in opposition to A.S.G.’s motion to dismiss Count I, to which A.S.G. replied. Trigon moved to dismiss Counts III, IV, and V of the amended third-party complaint, pursuant to Federal Rule of Civil Procedure 12(b)(6). LeBeau filed a response in opposition to Trigon’s motion to dismiss Counts III, IV, and V. The matter is ripe for review.

II. Analysis

A complaint should not be dismissed for failure to state a claim pursuant to Rule 12(b)(6), unless it appears to a certainty that the nonmoving party cannot prove any set of facts in support of its claim that would entitle it to relief. Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957); Labram v. Havel, 43 F.3d 918, 920 (4th Cir.1995). The standard governing Rule 12(b)(6) dismissal motions requires that a court reviewing such a motion accept the complaint’s factual allegations as true and view the allegations in a light most favorable to the nonmoving party. Jenkins v. McKeithen, 395 U.S. 411, 421-22, 89 S.Ct. 1843, 23 L.Ed.2d 404 (1969); Mylan Labs., Inc. v. Matkari, 7 F.3d 1130, 1134 (4th Cir.1993).

A.S.G. seeks to dismiss Count I of the amended complaint on the grounds that the only stated cause of action is preempted by ERISA or states a claim not available under ERISA. Likewise, Trigon seeks to dismiss Counts III, IV, and V of the amended complaint on the grounds that these causes of action are preempted by ERISA or seek remedies not available under ERISA. Trigon claims LeBeau’s remedy is limited to an enforcement action under ERISA § 502(a), 29 U.S.C. § 1132(a), a remedy LeBeau alleges in Count II of the amended complaint.

Count I: Equitable Estoppel

Count I alleges that A.S.G., Le-Beau’s employer, intentionally and knowingly failed to inform LeBeau that Le-Beau’s health plan would be cancelled, and after it was cancelled, failed to inform LeBeau that it had been cancelled. It further alleges that A.S.G. made false representations of material facts with the intent to mislead LeBeau, that A.S.G. knew or should have known LeBeau would reasonably and detrimentally rely upon these misrepresentations, and that LeBeau did in fact rely upon them and suffer damages as a direct and proximate result of such reliance.

The parties agree the health plan at issue is an ERISA-regulated plan. When Congress enacted ERISA, it created a federal statutory scheme to govern employee benefit plans. Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 44, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987). However, Congress intended courts to fill in the statute’s gaps by developing a federal common law of rights and obligations under ERISA-regu-lated plans. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 110, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989). The Supreme Court and the Fourth Circuit have authorized federal courts to develop this federal common law when ERISA fails to address an issue and the state law governing that issue has been preempted. Phoenix Mut. Life Ins. Co. v. Adams, 30 F.3d 554, 560 (4th Cir.1994). Although ERISA broadly preempts state laws, courts may look to state common law in fashioning federal common law for ERISA claims. Singer v. Black & Decker Corp., 964 F.2d 1449, 1452 (4th Cir.1992). “Courts must be conscientious to fashion federal common law only when it is ‘necessary to effectuate the purposes of ERISA.’ ” Id. (quoting Provident Life & Accident Ins. Co. v. Waller, 906 F.2d 985, 992 (4th Cir.1990)). One of the purposes of ERISA is “to promote the *521 interests of employees and their beneficiaries in employee benefit plans.” Shaw v. Delta Air Lines, 463 U.S. 85, 90, 103 S.Ct. 2890, 77 L.Ed.2d 490 (1983).

Although A.S.G. concedes that federal common law may be applied in certain circumstances when considering ERISA claims, A.S.G. asserts that “the subject of equitable estoppel is not one of those circumstances.” Reply to June C. LeBeau’s Resp. to Mot. of A.S.G., Inc. to Dismiss Am. Compl., at 1-2. A.S.G. is incorrect in its categorical assertion. Multiple federal courts of appeals have determined that, in some circumstances, equitable estoppel principles are applicable in fashioning federal common law for ERISA claims. See e.g., Greany v. Western Farm Bureau Life Ins. Co., 973 F.2d 812, 821 (9th Cir.1992) (recognizing that federal equitable estop-pel principles can, in certain circumstances, apply to claims arising under ERISA); Armistead v. Vernitron Corp., 944 F.2d 1287, 1298 (6th Cir.1991) (same); Kane v. Aetna Life Ins., 893 F.2d 1283, 1285-86 (11th Cir.), cert. denied, 498 U.S. 890, 111 S.Ct. 232, 112 L.Ed.2d 192 (1990) (same).

The Fourth Circuit has held that estop-pel principles cannot be invoked in fashioning federal common law governing ERISA claims, when to do so would modify or alter a term of a written employee benefit plan. Coleman v. Nationwide Life Ins. Co.,

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182 F. Supp. 2d 518, 2002 U.S. Dist. LEXIS 1905, 2002 WL 130919, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sentara-virginia-beach-general-hospital-v-lebeau-vaed-2002.