ELIZABETH ERNY FOOTE, District Judge.
Before the Court are three motions to dismiss, filed by Lincoln National Life Insurance Company ("Lincoln National") [Record Document 37], United of Omaha Life Insurance Company ("United of Omaha") [Record Document 45], and Eldorado Casino Shreveport Joint Venture ("Eldorado") [Record Document 51]. This is the second round of motions to dismiss by these defendants. Plaintiff's original complaint alleged only state law causes of action, Record Document 1, and the Court found that those state law claims against defendant Lincoln National were completely preempted by ERISA. Record Document 35. Plaintiff was granted leave to amend her complaint to expressly include a claim for benefits under ERISA.
For the reasons that follow, Lincoln National's Motion To Dismiss [Record Document 37] is
United of Omaha's Motion To Dismiss [Record Document 45] is
The facts of this case were set out in detail in the Court's first memorandum order on the motions to dismiss. Record Document 35. Only a brief restatement is necessary here. Katheryn Swenson, the Plaintiff, is the widow of Donald Swenson, who was employed by Eldorado Casino. Record Document 36, p.2. Plaintiff states that Mr. Swenson took a leave of absence from his employment at Eldorado, for, it appears, just over a year, from January 1, 2013, to January 27, 2014, for medical treatment. Record Document 36, pp. 2-3. According to Plaintiff, Mr. Swenson remained on the Eldorado payroll during this time, but Eldorado never scheduled him to return to work after he returned from leave.
Eldorado purchased group life insurance policies through two companies, Lincoln National, the insurer through the end of 2013, and United of Omaha, the insurer beginning in 2014.
Plaintiff's amended complaint alleges seven state law claims against all three defendants: negligence, equitable estoppel, detrimental reliance, "negligence in law/negligence per se," bad faith, "waiver by Lincoln National," and breach of contract. Record Document 36, p. 10-17. Plaintiff further alleges fourteen "federal causes of action," entitled: breach of fiduciary duty under ERISA, Conversion/Portability/Continuation/Eligibility Waiting Period rights, detrimental reliance, promissory estoppel or equitable estoppel, futility of administrative appeals, violations of COBRA, reformation, breach of fiduciary duty by misrepresentation of plan terms, injunctive relief, declaratory judgment relief, attorney fees, unjust enrichment, discovery sought for complete administrative record, and an uninsured status claim against Eldorado.
Defendants move to dismiss Plaintiff's claims under Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim upon which relief may be granted. Record Documents 37, 45 and 51.
At the outset, the Court notes that some of Plaintiff's alleged "federal causes of action" are not, in fact, causes of action. A cause of action is the legal theory on which basis the Plaintiff asserts she is entitled to relief. Plaintiff's tenth
Plaintiff's twelfth cause of action is "attorney fees." Record Document 36, p. 40. ERISA allows courts to award attorneys' fees to either party. 29 U.S.C. § 1132(g)(1). As with injunctive relief, attorneys' fees are another form of relief a court may award. Once again, the Court will consider this claim to be a part of Plaintiff's prayer for relief rather than its own cause of action.
Finally, Plaintiff's fourteenth federal cause of action is styled "discovery sought for complete administrative record." Record Document 36, p. 41. Seeking discovery is not a cause of action, but rather a mechanism for obtaining facts to prove a cause of action. The Court will consider discovery requests at the appropriate time.
A plaintiff's complaint must "state a claim to relief that is plausible on its face."
The Court previously held that Plaintiff's state law claims against Lincoln National were preempted by ERISA and dismissed those claims with prejudice. Record Document 35, p.9. Plaintiff cannot re-assert them.
One of Plaintiff's purported "federal causes of action" is also, in reality, a repetition of her state law claims. In her eleventh federal cause of action, "declaratory judgment relief," Plaintiff seeks a declaratory judgment that "the Louisiana life insurance claims are not preempted by ERISA." Record Document 36, p. 40. Plaintiff essentially asks the Court to reconsider its previous finding. The Court declines to do so. Plaintiff's claim for declaratory judgment must be dismissed with prejudice.
As this Court has previously noted, Plaintiff's suit is fundamentally a claim for benefits, although she does not set this out in a specific cause of action. Record Document 35, p. 1. Throughout her amended complaint, Plaintiff alleges that Lincoln National wrongfully denied a claim for benefits under its life insurance plan. Record Document 36, p. 18 ("[P]laintiff is seeking . . . to redress violations of the policies and denial of benefits owed [and] to enforce any provisions of the terms of the plans."), p. 21 ("defendants unlawfully denied coverage. Plaintiff has been denied ERISA benefits . . ."), p. 29 ("Plaintiff is entitled to benefits under the policies . . ."), p. 38 ("Lincoln National unlawfully denied coverage . . ."), p. 39 ("Plaintiff seeks injunctive relief prohibiting [United of Omaha] and Lincoln National from denying coverage under their policies."). Construing the complaint liberally, the Court reads Plaintiff's complaint to allege, under 29 U.S.C. § 1132(a)(1)(B), that Lincoln National wrongfully denied life insurance plan benefits.
ERISA provides a plan participant or beneficiary with a cause of action to recover benefits allegedly due to her under the terms of the plan, to enforce her rights under the plan, or to clarify her rights to future benefits under the terms of the plan. 29 U.S.C. § 1132(a)(1)(B). However, a plaintiff claiming benefits owed under an ERISA plan "must first exhaust available administrative remedies under the plan before bringing suit to recover benefits."
Plaintiff cites no authority that supports this definition of futility, relying only on a single case in which the exhaustion doctrine was found to be inapplicable because there was no cause of action relating to an ERISA plan.
In a case considering the futility question at length, a plaintiff brought suit against an ERISA plan but failed to first exhaust his administrative remedies.
Plaintiff filed a claim with Lincoln National that was denied. Record Document 36-1, p. 4-6. Lincoln National informed Plaintiff of its appeals process at that time, but Plaintiff has offered no evidence that she pursued the appeal. Instead, Plaintiff concludes that because the original claim was denied, the appeal would certainly have been too. Whatever the probability of this outcome, this argument could be made for any insurance company review process, and therefore cannot be the sort of exceptional circumstances required by the Fifth Circuit to excuse the exhaustion requirement. Plaintiff's denial of benefits claim against Lincoln National must therefore be dismissed without prejudice as premature.
Plaintiff alleges that defendants violated COBRA, although she does not give details about how each defendant allegedly did so. Construing the complaint liberally, Plaintiff appears to assert that defendant Lincoln National violated COBRA's notification requirement. Lincoln National does not specifically address COBRA's application.
COBRA, the Consolidated Omnibus Budget Reconciliation Act, allows beneficiaries of a group health plan to continue paying for insurance after a "qualifying event" occurs that would otherwise terminate the coverage.
Lincoln National provided the required notification when coverage began. In the policy it provided to Eldorado, there is a section titled "Continuation of Coverage" that explains the circumstances under which insurance coverage may be continued, and the requirements for doing so. Record Document 9-2, p. 26. This section goes on to say that coverage cannot be continued "when Policy coverage terminates solely because: (1) an Insured Person's Employer ceases to be a Participating Employer; or (2) this Policy terminates."
To the extent that Plaintiff is alleging that Lincoln National violated a notification requirement because it did not send a "qualifying notice" before the policy's termination on December 31, 2013, or at the time of Mr. Swenson's leave of absence, this is a misunderstanding of the notification requirements. Record Document 36, p. 35. COBRA requires the employer to notify the plan administrator of the occurrence of a qualifying event. 29 U.S.C. § 1166(a)(3). Nowhere does COBRA require an insurer to notify a beneficiary that the plan has been terminated because the employer ended participation in the plan. Nor is the insurer required to notify the employee of a qualifying event; in fact, this notification requirement flows in the opposite direction.
Plaintiff argues a related point in her claim for violation of her conversion and other related rights because Mr. Swenson was not given the opportunity to convert his group policy to an individual policy when the Lincoln National policy ended. Record Document, p. 22-27. This is a claim Plaintiff previously asserted under state law. Record Document 1-1, p. 6. As with Plaintiff's other state law claims, a claim relating to the right to convert from an ERISA plan is preempted by ERISA. The Magistrate Judge's well-reasoned Report and Recommendation analyzed a number of cases considering whether conversion rights are preempted by ERISA. Record Document 30, p. 7-10. After an independent review of those cases, the Court finds that Plaintiff's claim for conversion rights is a claim for rights under an ERISA plan, and is therefore preempted.
Plaintiff points to no provision of federal law in her attempt to restate this claim as a federal claim. However, to the extent that this cause of action is intended to assert a claim under federal law, it is governed by ERISA, and it too must be dismissed for failure to exhaust administrative remedies before bringing this action.
Plaintiff's amended complaint also seeks various forms of equitable relief. ERISA permits a plaintiff to bring equitable claims under § 1132(a)(3), but only when she has no available remedy at law. In
The Fifth Circuit agrees. In
Plaintiff brings equitable claims for detrimental reliance, promissory estoppel or equitable estoppel, reformation, and unjust enrichment, as well as two claims of breach of fiduciary duty. As discussed above in section B.ii, because Plaintiff's claim is fundamentally that she was wrongfully denied benefits, she has an adequate remedy under § 1132(a)(1). Therefore, she is not permitted to bring alternative equitable claims. Plaintiff's equitable claims must be dismissed with prejudice.
Finally, Plaintiff argues that if Mr. Swenson "was not eligible for coverage under the plan," then he was not "a participant or beneficiary in an ERISA" plan, and Plaintiff's claims would not be governed by ERISA. Record Document 36, p. 10. This is both a misunderstanding of the cases and a mischaracterization of Plaintiff's own claims. Plaintiff cites for support a Fourth Circuit case in which the court found that ERISA did not preempt claims when a plaintiff was not a participant in an ERISA plan.
This case is different for two reasons. First, as the Court has repeatedly noted, the essence of Plaintiff's complaint is that she was wrongfully denied life insurance benefits by defendants. Plaintiff cannot both claim benefits are owed and also claim she has no colorable claim to benefits. Second, the facts here are not so inarguable as in
United of Omaha asserts that Plaintiff's state law claims should be dismissed because they are preempted by ERISA. Record Document 51-1, p. 8. The Court has not previously considered any of Plaintiff's claims against United of Omaha, because no copy of the United of Omaha policy or other evidence of the applicability of ERISA was presented. Record Document 35, p.9.
ERISA establishes an exclusive federal regulatory regime over employee benefit plans. When an employee benefit arrangement is an ERISA plan, ERISA preempts any state law claims that relate to the plan.
The Supreme Court distinguishes between stand-alone benefits and full-fledged plans; only the latter are governed by ERISA.
In
United of Omaha has, for a second time, submitted no facts in support of its claim that the plan it issued to Eldorado is an ERISA plan. Despite stating that it "hereby submits a copy of the policies issued by United of Omaha" to Eldorado, no such submission is attached to its motion, or contained in any other of its filings to date. Record Document 45-1, p. 4. Instead, United of Omaha argues only that "[t]his Court had already determined that Plaintiff's state law claims were preempted by ERISA and, as such, the state law causes of action asserted in the Amended Complaint should again be dismissed," wholly failing to note that those claims were dismissed only as to Lincoln National. Record Document 45-1, p. 4.
The only evidence relating to United of Omaha's plan comes from Plaintiff, who submitted the United of Omaha policy with her amended complaint. Record Documents 36-7, 36-8, and 36-9. However, the policy, standing alone, does not conclusively establish the existence of an ERISA plan. The policy sets out various benefits, procedures, and requirements, but it does not address the policy's administration or implementation by Eldorado. Plaintiff asserts that Eldorado was the United of Omaha plan administrator (Record Document 36, p. 30), and neither defendant disagrees. No further detail of this administration is provided. United of Omaha has not offered the sort of facts which would allow the Court to determine whether United of Omaha, through Eldorado, provided a plan within the meaning of ERISA, whether ERISA safe-harbor provisions apply, and whether Eldorado established or maintained the plan with the intent to benefit its employees. Without these facts, the Court cannot determine whether the United of Omaha plan is an ERISA plan. If ERISA does not apply, the Court may lack jurisdiction over this case, as no other basis for jurisdiction has been asserted.
Given this lack of information, United of Omaha's motion must be denied. United of Omaha is granted leave to reurge its motion within 60 days of the date of this order to state sufficient facts from which the Court may determine the applicability of ERISA to its plan. Plaintiff may, of course, oppose any reurged motion. If no motion is timely filed, Plaintiff's state law claims must be remanded for lack of subject matter jurisdiction.
Eldorado, like United of Omaha, argues that Plaintiff's state law claims are preempted by ERISA. Record Document 51-1, p. 13. Eldorado argues that when a plaintiff brings suit "complaining of a denial of coverage," and when the plaintiff "is entitled to such coverage only because of the terms of an ERISA-regulated employee benefit plan . . . then the suit falls within the scope of ERISA."
Here, Plaintiff disputes that the United of Omaha plan is an ERISA plan. In order to succeed on its preemption argument, Eldorado must first establish that the United of Omaha plan is an ERISA plan. As discussed above, the Fifth Circuit uses a three-factor test to determine whether an employee benefit arrangement is an ERISA plan.
In light of the light of the analysis above, Lincoln National's Motion To Dismiss [Record Document 37] is
United of Omaha's Motion To Dismiss [Record Document 45] and Eldorado's Motion To Dismiss [Record Document 51] are