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Surgery Center of Viera, LLC v. Rockwell Collins, Inc.

United States District Court, M.D. Florida, Orlando Division

January 31, 2018

SURGERY CENTER OF VIERA, LLC, Plaintiff,
v.
ROCKWELL COLLINS, INC., WELLMARK, INC., ROCKWELL COLLINS, INC. EMPLOYEE HEALTH PLAN and ROCKWELL COLLINS EMPLOYEE BENEFIT PLAN COMMITEE, Defendants.

          REPORT AND RECOMMENDATION

          DANIEL C. IRICK UNITES STATES MAGISTRATE JUDGE

         This cause comes before the Court for consideration following oral argument on the following motions:

         MOTION: DEFENDANTS, ROCKWELL COLLINS, INC.,

         ROCKWELL COLLINS, INC. EMPLOYEE HEALTH PLAN, AND ROCKWELL COLLINS EMPLOYEE BENEFIT PLAN COMMITTEE'S MOTION TO DISMISS (Doc. 29)

         FILED: November 13, 2017 THEREON it is RECOMMENDED that the motion be GRANTED.

         MOTION: DEFENDANTS BCBS' MOTION TO DISMISS (Doc. 44) FILED: November 13, 2017 THEREON it is RECOMMENDED that the motion be GRANTED.

         I. Introduction

         This matter is before the undersigned to consider two motions to dismiss the Amended Complaint for a failure to state a claim pursuant to Federal Rule of Civil Procedure 12(b)(6). Docs. 29; 44. For the reasons set forth in this Report, the undersigned respectfully recommends that the Amended Complaint be dismissed with prejudice because Plaintiff's ability to bring this Employee Retirement Income Security Act of 1974 (ERISA) action is precluded by a valid anti-assignment provision contained within the plan documents.

         II. Procedural Background

         On April 26, 2017, Plaintiff, the operator of a surgical center in Melbourne, Florida, filed a Complaint alleging three claims against Defendants pursuant to ERISA, all related to the treatment of a patient (Patient PD) by Plaintiff. Doc. 1. On July 19, 2017, Defendant Rockwell Collins, Inc. (Rockwell) filed a motion to dismiss (Doc. 12) the Complaint, along with a memorandum of law (Doc. 13) that contained, amongst other attachments, the ERISA plan at issue (Doc. 13-1). On August 16, 2017, Plaintiff filed the Amended Complaint (Doc. 27), which remains the operative complaint in this case. Shortly thereafter, the Court denied the first motion to dismiss as moot. Doc. 30.

         III. Allegations in the Amended Complaint

         According to the allegations in the Amended Complaint, which the Court takes as true for purposes of this Report, Rockwell provided healthcare insurance to its employees (including Patient PD) through a self-insured welfare benefit plans. Defendant Rockwell Collins Employee Benefit Plan Committee (Plan Administrator) was a committee of Rockwell employees appointed as Plan Administrator for the Plan. Defendant Wellmark, Inc., d/b/a Blue Cross and Blue Shield of Iowa (BCBS) was a healthcare insurance company that provided administrative services to Rockwell for the Plan. Defendant Rockwell Collins, Inc. Employee Health Plan (the Plan) was the self-insured employee welfare benefit plan sponsored by Rockwell and administered by BCBS and the Plan Administrator.[1]

         On November 7, 2014, Patient PD received medical services from Plaintiff. Patient PD was covered under the terms of the Plan. Plaintiff was an out of network provider in relation to the Plan. In exchange for medical services, Patient PD gave Plaintiff an assignment of benefits owed to Patient PD under the Plan. See Doc. 27-1. In relation to the assertion of any ERISA claim, Patient PD agreed in the assignment to “promptly furnish information to, and otherwise cooperate reasonably with Provider, in its assertion of any such claim.” Id. at 1. After providing medical services to Patient PD, Plaintiff submitted a bill to BCBS for the amounts charged to Patient PD, i.e. $254, 508.00.

         On January 29, 2015, BCBS notified Plaintiff that BCBS would only pay Plaintiff $30, 471.48 for the medical services provided to Patient PD. See Doc. 27-3. On February 11, 2015, Plaintiff filed an initial appeal of the claim denial. See Doc. 27-4. On May 11, 2015, Plaintiff filed a second appeal with BCBS and a request for documents. See Doc. 27-5. On July 5, 2016, Plaintiff filed a third and final appeal and request for documents, this time to Rockwell, the Plan Administrator, and BCBS. See Doc. 27-6. Plaintiff alleged that in response to Plaintiff's appeals, Defendants have not issued payment for the unpaid amounts and have not provided Plaintiff with the Plan documents. Thus, Plaintiff alleged that “Plaintiff has exhausted all of its administrative requirements under ERISA to the best of its ability, despite lack of meaningful access to Plan documents.”

         In the Amended Complaint, Plaintiff alleged three claims pursuant to ERISA. In Count I, Plaintiff brought a claim pursuant to ERISA § 502(a)(1)(b) and 29 U.S.C. § 1132(a)(1)(B), alleging that it is entitled to enforce the rights, terms, and conditions of the Plan as an assignee of Patient PD and, as such, Plaintiff is entitled to recover benefits due to Patient PD under the Plan. In the alternative, Plaintiff asserted that it is entitled to assert the rights of Patient PD under the Plan because Plaintiff is an authorized representative of Patient PD. Plaintiff further alleged that Defendants breached the terms of the Plan by, amongst other things, failing to make payments and failing to provide a full and fair review of the claim at issue. As a result, Plaintiff seeks damages in the amount of $224, 036.52 against Defendants. In Count II, Plaintiff brought a claim for breach of fiduciary duty pursuant to ERISA § 502(a)(3) and 29 U.S.C. § 1132(a)(3) against all Defendants. Again, Plaintiff sought relief both as an assignee and, alternatively, as a personal representative of Patient PD. In Count II, Plaintiff seeks “appropriate equitable relief and all other damages and costs the Court deems appropriate.” In Count III, Plaintiff brought a claim seeking civil penalties against Rockwell, the Plan, and the Plan Administrator (the Rockwell Defendants) pursuant to ERISA § 502(c) and 29 U.S.C. §1132(c)(1)(B) in relation to those Defendants alleged failure to provide requested documents, including the “master governing plan document.”

         IV. The Motions to Dismiss

         On August 30, 2017, the Rockwell Defendants filed a motion to dismiss the Amended Complaint. Doc. 29. The Rockwell Defendants attached to their motion, amongst other things, the Plan document. Doc. 29-1. The ...


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