Soileau & Associates, LLC v. Louisiana Health Service & Indemnity Company

District Court, E.D. Louisiana·Decided April 23, 2020·No. 2:18-cv-00710·Unknown

Opinion

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF LOUISIANA

SOILEAU & ASSOCIATES, LLC, ET AL. CIVIL ACTION

VERSUS NO. 18-710-WBV-JCW c/w 18-7613 LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY SECTION: D (2)

ORDER AND REASONS

Before the Court is Louisiana Health Service & Indemnity Company d/b/a Blue Cross and Blue Shield of Louisiana’s (“Blue Cross”) Motion in Limine to Exclude Plaintiffs’ Proposed Experts.1 The Motion is opposed,2 and movant has filed a Reply.3 After careful consideration of the parties’ memoranda and the applicable law, the Motion is GRANTED. I. FACTUAL AND PROCEDURAL BACKGROUND4 This action involves Plaintiffs’ challenge to benefit determinations made by Louisiana Health Service & Indemnity Company d/b/a Blue Cross and Blue Shield of Louisiana (hereafter, “Blue Cross”), for services received by K.S., a minor child, pursuant to the terms of an employee welfare benefit plan governed by the Employee

1 R. Doc. 127. 2 R. Doc. 137. 3 R. Doc. 146. 4 A detailed summary of the procedural history in this case is set forth in the Court’s September 19, 2019 Order and Reasons granting Blue Cross’s Motion to Dismiss (R. Doc. 103) and, for the sake of brevity, will not be repeated here. Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”).5 Plaintiffs seek benefits under the ERISA Plan pursuant to 29 U.S.C. § 1132(a)(1)(B) (hereafter, “§ 502(a)(1)(B)”). Blue Cross removed the case to this Court on January

23, 2018,6 and the Court denied Plaintiffs’ Motion to Remand on August 15, 2018.7 Before the Court ruled on the Motion to Remand, however, Plaintiffs filed a second state court action against Blue Cross and its alleged agent, New Directions Behavioral Health, LLC (“New Directions”), which Blue Cross also removed to this Court.8 The two cases were consolidated on October 26, 2018. 9 Through a series of amended complaints, Plaintiffs added Health Integrated, Inc., another purported agent of Blue Cross, as a defendant in this case.10 In their

Third Amending & Supplemental Complaint, Plaintiffs asserted the following eight causes of action against all three defendants: (1) a claim for benefits under § 502(a)(1)(B); (2) a claim for equitable relief under 29 U.S.C. § 1132(a)(3) (“§ 502(a)(3)”); (3) a claim for breach of fiduciary duty under 29 U.S.C. § 1132(a)(2) (“§ 502(a)(2)”); (4) a claim for failure to timely provide ERISA plan documents under 29 U.S.C. § 1132(c)(1) (“§ 502(c)(1)”); (5) a claim for equitable estoppel under § 502(a)(3);

(6) a claim based on the alleged failure to provide a full and fair review of their claims under 29 U.S.C. § 1133 (“§ 503”); (7) state law claims for negligence, breach of

5 See R. Doc. 1-2. A detailed summary of the medical treatment at issue in this case is set forth in the Court’s August 15, 2018 Order and Reasons denying Plaintiffs’ Motion to Remand (R. Doc. 22) and, for the sake of brevity, will not be repeated here. 6 R. Doc. 1. 7 R. Doc. 22. 8 See R. Doc. 1-2 in Soileau & Associates, LLC et al. v. Louisiana Health Service & Indemn. Co., Civ. A. No. 18-7613 (E.D. La.). 9 R. Doc. 37. 10 See R. Docs. 33, 71, 95. fiduciary duty, unjust enrichment, bad faith claims handling, civil conspiracy and tortious interference with contract; and (8) a claim that ERISA is unconstitutional as applied because it violates Plaintiffs’ Seventh Amendment right to a jury trial.11

Plaintiffs also asserted a ninth claim against Blue Cross, alleging that its benefit determination violated the Americans with Disabilities Act or, alternatively, violated the Patient Protection and Affordable Care Act.12 Blue Cross, Health Integrated, Inc. and New Directions filed separate motions to dismiss, with Blue Cross seeking dismissal of all but Plaintiffs’ § 502(a)(1)(B) claim,13 and Health Integrated, Inc. and New Directions seeking dismissal of all of Plaintiffs’ claims asserted against them.14 The Court granted all three motions in

September 2019.15 Thus, the only remaining claim in this case is Plaintiffs’ § 502(a)(1)(B) claim against Blue Cross. On July 8, 2019, prior to the Court ruling on the three motions to dismiss, Blue Cross filed the instant Motion in Limine, seeking to prohibit Plaintiffs’ seven proposed experts from providing any opinions and/or reports in this case.16 Blue Cross argues that all of the expert opinions and expert reports should be excluded

because the Fifth Circuit has held that expert testimony in an ERISA benefits case is only admissible to assist the Court in understanding medical terminology or

11 R. Doc. 95. 12 Id. 13 R. Doc. 103. 14 R. Docs. 140 & 150. 15 R. Docs. 168, 169, 172, 173, 174 & 175. 16 R. Doc. 127. practice relating to a claim.17 Blue Cross contends that Plaintiffs’ proposed experts, six of K.S.’s treating physicians and an expert regarding the “insurance industry,” are being offered to testify regarding the merits of Plaintiffs’ claim and Blue Cross’s

underlying benefit determination, and that the opinions were not submitted as part of the administrative processing of the claim for benefits.18 Blue Cross asserts that, because this case involves a § 502(a)(1)(B) claim, the Court’s role is to review the administrative record compiled during the administrative processing of Plaintiffs’ claim to determine whether Blue Cross’s benefit determination was arbitrary and capricious.19 Blue Cross contends that it is well settled that evidence outside of the administrative record should not be considered except in very limited circumstances,

none of which are present in this case.20 Blue Cross points out that Plaintiffs designated five of K.S.’s treating physicians, Dr. Daniel N. Davidow, Dr. David M. Greer, Dr. Manal Durgin, Dr. Milton Anderson and Dr. Ronald Federici as experts relating to “the course of treatment of K.S., diagnosis and medical necessity for treatment of K.S.,” and designated a sixth treating physician, Dr. Betty Bueler, to testify as to K.S.’s “course of treatment.”21

Blue Cross argues that Plaintiffs are attempting to introduce evidence relating to the

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