VINCENT L. BRICCETTI, District Judge.
Plaintiff Richard Caunitz, proceeding
Before the Court is IBM's motion to dismiss the complaint for failure to state a claim under Fed. R. Civ. P. 12(b)(6). (Doc. #6).
For the reasons set forth below, the motion is GRANTED.
The Court has subject matter jurisdiction under 28 U.S.C. § 1331.
For purposes of deciding the pending motion, the Court accepts as true all well-pleaded allegations in the complaint and draws all reasonable inferences in plaintiff's favor.
Plaintiff worked for IBM for 27 years, until he retired in 1995. He is currently employed by the County of Rockland.
Plaintiff alleges that before 2014 he "was eligible for all retiree IBM health care benefits." (Compl. at 5).
IBM's 2015 Benefits Plan for Retired Employees (the "Plan") provides an HRA benefit to its "Medicare-eligible retirees" who "enroll in individual medical or prescription drug coverage" through a "Medicare marketplace" operated by a separate entity, Towers Watson's OneExchange ("OneExchange"). (Lauri Decl. Ex. B at 171).
The parties agree plaintiff is enrolled in Medicare Part A but not Part B. Further, plaintiff is not enrolled in TRICARE for Life, nor is he eligible to obtain services from the VA.
Nevertheless, on December 4, 2014, plaintiff submitted a request for reimbursement of $2,374 in medical insurance premiums he paid in 2014. On January 2, 2015, OneExchange denied his request. Over the next several months, plaintiff appealed that decision first to OneExchange, then to the Appeals Administrator, and then to the IBM Employee Services Center Plan Administrator. In each instance, his request was denied.
By letter dated September 8, 2015, the Plan Administrator advised plaintiff he (the Plan Administrator) had "conducted a final review of your appeal regarding your eligibility for" the HRA, and concluded plaintiff's request "must be denied." (Compl. at 7). The letter informed plaintiff that because his "health plan is subject to [ERISA], you may have the right to bring a civil action under section 502(a) of ERISA to challenge this decision." Plaintiff thereafter commenced this lawsuit.
In deciding a Rule 12(b)(6) motion, the Court evaluates the sufficiency of the operative complaint under the "two-pronged approach" articulated by the Supreme Court in
To survive a Rule 12(b)(6) motion, the allegations in the complaint must meet a standard of "plausibility."
The Court must liberally construe submissions of
IBM contends it is "not a proper Defendant because it is not the Plan or the Plan Administrator." (Def. Br. at 6).
The Court agrees.
"In a recovery of benefits claim, only the plan and the administrators and trustees of the plan in their capacity as such may be held liable."
Here, the Plan specifically designates as Plan Administrator "a committee which consists of three or more executive level employees appointed by action of the IBM Retirement Plans Committee." (Lauri Decl. Ex. B at 222).
As a result, the Plan, the Plan Administrator, and any trustees of the Plan are the proper defendants here, not IBM.
Accordingly, plaintiff's claim against IBM for improper denial of benefits must be dismissed for failure to sue the proper party.
Even assuming plaintiff had sued the proper defendant, plaintiff's claim under ERISA Section 502(a)(1)(B) must still be dismissed for failure to state a claim upon which relief can be granted. Fed. R. Civ. P. 12(b)(6).
The Court reviews the plan administrator's decision
Here, the Plan provides, "[t]he Plan Administrator retains exclusive authority and discretion to interpret the terms of the benefit plans described herein." (Lauri Decl. Ex. B at 1). As a result, the arbitrary and capricious standard of review applies.
Plaintiff admits the Plan that applied to his claim for reimbursement required participants to be enrolled in both Medicare Part A and Part B unless certain exceptions applied. Plaintiff further admits he is not enrolled in Medicare Part B and none of the exceptions applies. In other words, plaintiff himself admits he has not met the qualifications for coverage under the Plan. Therefore, the Plan Administrator's decision was not only not arbitrary or capricious, it was a correct interpretation of the Plan. Denial of plaintiff's claim for reimbursement was thus warranted.
Accordingly, plaintiff's complaint fails to state a claim under ERISA Section 502(a)(1)(B).
Plaintiff also alleges the refusal to reimburse him for his medical costs amounts to "discriminat[ion]" based on his "voluntary and permissible choice to not participate in Medicare Part B while other IBM retirees are receiving full reimbursement for their health care premiums through the HRA." (Compl. at 5). He alleges IBM is discriminating against him because it gives certain individuals, namely those who are enrolled in Medicare Part A and Part B and those who receive TRICARE or VA coverage, a benefit IBM does not give to plaintiff. (
Plaintiff misunderstands the employer's obligations under ERISA.
ERISA "does not regulate the substantive content of welfare-benefit plans."
It was IBM's decision, for whatever unspecified reason, to provide benefits only to those retirees who are enrolled in both Medicare Part A and Part B or who fall into certain limited exceptions. The fact that certain retirees may benefit and others may not under the Plan does not state a claim for discrimination under ERISA or any other statute.
Accordingly, plaintiff's discrimination claim must be dismissed.
Rule 15(a)(2) of the Federal Rules of Civil Procedure instructs that courts "should freely give leave" to amend a complaint "when justice so requires." In addition, liberal application of Rule 15(a) is warranted with respect to
However, leave to amend may "properly be denied for . . . futility of amendment."
Here, after IBM filed its motion to dismiss, the Court
Accordingly, under the circumstances, the Court declines to grant plaintiff leave to amend.
The motion to dismiss is GRANTED.
The Clerk is instructed to terminate the motion (Doc. #6) and close this case.
SO ORDERED.