Trigon Insurance v. Columbia Naples Capital, LLC

235 F. Supp. 2d 495, 2002 U.S. Dist. LEXIS 25869, 2002 WL 31863722
CourtDistrict Court, E.D. Virginia
DecidedDecember 17, 2002
DocketCIV.A. 3:02CV582
StatusPublished
Cited by6 cases

This text of 235 F. Supp. 2d 495 (Trigon Insurance v. Columbia Naples Capital, LLC) 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
Trigon Insurance v. Columbia Naples Capital, LLC, 235 F. Supp. 2d 495, 2002 U.S. Dist. LEXIS 25869, 2002 WL 31863722 (E.D. Va. 2002).

Opinion

MEMORANDUM OPINION

HUDSON, District Judge.

This matter is before the Court on the Defendants-* Motion to Dismiss all counts of the Complaint pursuant to Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim upon which relief can be *498 granted and Plaintiffs Motion for Partial Summary Judgment as to Counts 1, II, III, and V under Federal Rule of Civil Procedure 56. The Plaintiff, Trigon Insurance Company (“Trigon”), was a third-party “Claims Administrator” for an employee benefit plan (the “Plan”) that was terminated on December 31, 2001. Trigon provided these services pursuant to an Administrative Services Agreement (“ASA”). Defendants are Columbia Naples Capital, LLC (“CNC”), Columbia Naples Capital, LLC Welfare Benefit Plan Trust (the “Trust”), Columbia Naples Capital, LLC Welfare Benefit Plan (the “Plan”), and Robert R. Kaplan (“Kaplan”), a former managing director of CNC and a former trustee of the Trust.

Trigon is suing the Defendants to recover benefits costs and administrative service charges and/or other monetary relief in connection with services allegedly rendered and benefits allegedly paid by Trigon to beneficiaries of the Plan following its termination. Trigon is pursuing this relief under the Employee Retirement Income Security Act of 1974 (“ERISA”) and federal common law (Counts I, II, III, and IV), as well as under Virginia state law (Counts V and VI). Although Trigon asks the Court to order CNC and the Trust to “fund” and “make good to the Plan” amounts sufficient to cover these costs and charges, Trigon concedes that these funds would be used by Trigon to pay and reimburse itself, and that the source of its authority to “reimburse” itself is the ASA. Thus, the issue before the Court is not whether beneficiaries may have had a cause of action for benefits under the Plan after its termination, but whether, in connection with services provided, Trigon has a cause of action (either under federal or state law) against any of the Defendants to recover money allegedly past due under the ASA.

For the reasons set forth herein, the Court finds that Trigon does not have a cause of action to recover such costs from any of the Defendants under ERISA or federal common law, and accordingly has failed to state a claim upon which relief can be granted with respect to Counts I, II, III, and IV. The Court will therefore grant the Defendants’ Motion to Dismiss these counts with prejudice. With respect to the remaining two state-law counts, Count V for breach of contract (under the ASA and a Letter Agreement) and Count VI for fraud and misrepresentation (in connection with execution of the ASA), both under Virginia law, the Court will decline to exercise supplemental jurisdiction over such claims and will dismiss these two counts without prejudice to refile in state couib. The Court, therefore, need not reach a decision with respect to the remainder of the Defendants’ Motion to Dismiss and the Plaintiff’s Motion for Partial Summary Judgment.

I. BACKGROUND

On December 29, 2000, CNC, as “Employer,” and trustees Kaplan and Larry L. Chamberlin created a Trust by agreement (“Trust Agreement”). Compl. ¶ 9; Ex. C. 1 The purpose of the Trust was “to fund the welfare benefit plans (collectively, The Plans’) established for the benefit of employees of the Employer and members of its ‘controlled group of corporations’ or ‘trades or businesses under common control.’ ” Id. The Trust Agreement provided that CNC would be the “named fiduciary of the Plans.” Id. In this action, Trigon *499 has named and defined the “Plan” to include all of these plans. Id. ¶ 10.

On January 3, 2001, Kaplan, as Trustee for the Plan Administrator (defined in the agreement as CNC) and Trigon executed a Letter of Agreement for Payment Terms (“Letter Agreement”). Id. Ex. E. On May 17, 2001, Trigon and Kaplan, again as Trustee for the Plan Administrator, executed the ASA; in this agreement, however, according to Trigon, Kaplan “in handwriting unilaterally added ‘Welfare Benefit Plan Trust’ after the pre-printed ‘Columbian Naples Capital, LLC’ on the signature page.” Id. ¶ 26; Ex. D at 13. Although Trigon asserts that CNC executed the ASA id. ¶ 15, Trigon provided documentation supporting Defendants’ claim that “CNC is not a party to the Agreement,” that Kaplan “acted only on behalf of the Trust, not CNC,” and that Trigon even agreed “during the course of the negotiations that only the Trust, and not any of the participating companies, would be a party to the Agreement.” Id. ¶ 26; Ex. B. 2

“Starting on January 1, 2001 (the retroactive date of the ASA) and until the present, Trigon has provided administrative services to CNC, including processing claims and paying benefits as necessary, consistent with the ASA and the benefits brochure.” Id. ¶ 21. The ASA provided that the Plan Administrator would have “ultimate responsibility” for interpretation of Plan provisions, claim determinations, and all Plan expenses, while Trigon would be responsible for “standard claim administration services.” Id. Ex. D at 1, 2, 4. The Plan was “self-funded” up to and except for certain stop-loss limits, to which an excess risk policy issued by Trigon would apply. Id. ¶¶ 14, 19; Ex. F.

On behalf of the Plan, Trigon issued to beneficiaries a brochure summary describing Plan benefits. Id. ¶ 20. In a section entitled “Cancellation or termination,” it stated that “[y]our employer may cancel this health plan on the last day of any month by giving, us a[sic] least 30 days written notice,” and that “termination of the health plan automatically ends your coverage.” Id. Ex. G at 50-51. In another section entitled “Timely Filing of Claims,” it required that written notice of a claim be made within twenty days after the occurrence or loss, and written proof of loss be furnished within ninety days after the date of service. Id. Ex. G at 38. Failure to give this notice would not “invalidate or reduce any claim” as long as notice was “given as soon as reasonably possible,” but in no event would the claim be paid if the proof of loss was received more than fifteen months after the date of service. Id. Ex. G. at 38.

To cover the cost of benefits and its administrative service fees, Trigon was to receive a monthly “pre-payment” in the amount of $77,500, beginning on March 19, 2001, along with additional month- and year-end settlement payments, if required, based on incurred costs. Id. ¶ 18; Ex. D at 16; Ex. E at 1-2. The monthly prepayments were to continue for two months after contract termination, and the month-end settlement payments were to continue for the twenty-four month “run-out” period after contract termination. Id. Ex. E at 2. 3

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Coresource Inc v. Metaldyne LLC
Michigan Court of Appeals, 2018
Self Insured Servs. Co. v. Panel Sys., Inc.
352 F. Supp. 3d 540 (E.D. Virginia, 2018)
Sherman v. Litton Loan Servicing, L.P.
796 F. Supp. 2d 753 (E.D. Virginia, 2011)
Masco Contractor Services East, Inc. v. Beals
279 F. Supp. 2d 699 (E.D. Virginia, 2003)

Cite This Page — Counsel Stack

Bluebook (online)
235 F. Supp. 2d 495, 2002 U.S. Dist. LEXIS 25869, 2002 WL 31863722, Counsel Stack Legal Research, https://law.counselstack.com/opinion/trigon-insurance-v-columbia-naples-capital-llc-vaed-2002.