United States District Court, D. Utah, Central Division
MELISSA P., individually and as guardian of Sean P., Plaintiff,
AETNA LIFE INSURANCE COMPANY and LOCKHEED MARTIN CORPORATION GROUP BENEFITS PLAN, Defendants.
J. SHELBY DISTRICT JUDGE
MEMORANDUM DECISION AND ORDER GRANTING MOTION FOR
LEAVE TO FILE AMENDED COMPLAINT (ECF NO. 12)
J. FURSE UNITED STATES MAGISTRATE JUDGE
August 8, 2018, Plaintiff Melissa P. filed a Motion for Leave
to File Amended Complaint (“Motion”) to state her
claim under the Mental Health Parity and Addiction Equity Act
(“Parity Act”) more clearly. (ECF No. 12.)
Defendants Aetna Life Insurance Company and Lockheed Martin
Corporation Group Benefits Plan (collectively, the
“Aetna Defendants”) argue this
Court should deny Ms. P.'s Motion as futile.
(Defs.' Mem. in Opp'n to Pl.'s Mot. for Leave to
File Am. Compl. (“Opp'n”) 2, ECF No. 14.)
After considering the parties' briefing and oral
argument, the Court GRANTS Ms. P.'s Motion for Leave to
File an Amended Complaint.
Federal Rule of Civil Procedure 15(a), a district court
“should freely give leave when justice so
requires.” Fed.R.Civ.P. 15(a)(2). A district court may
refuse to grant “leave to amend only for such reasons
as ‘undue delay, bad faith or dilatory motive on the
part of the movant, repeated failure to cure deficiencies by
amendments previously allowed, undue prejudice to the
opposing party by virtue of allowance of the amendment, [or]
futility of [the] amendment.'” U.S. ex rel.
Ritchie v. Lockheed Martin Corp., 558 F.3d 1161, 1166
(10th Cir. 2009) (alterations in original) (quoting Foman
v. Davis, 371 U.S. 178, 182 (1962)). “A proposed
amendment is futile if the complaint, as amended, would be
subject to dismissal.” Watson ex rel. Watson v.
Beckel, 242 F.3d 1237, 1239-40 (10th Cir. 2001). In
considering futility, the Court employs the motion to dismiss
standard and takes all well-pled factual allegations as true.
See Ketchum v. Cruz, 961 F.2d 916, 920 (10th Cir.
1992) (stating “[t]he district court was clearly
justified in denying the motion to amend if the proposed
amendment could not have withstood a motion to dismiss or
otherwise failed to state a claim.”) (quoting
Schepp v. Fremont County, 900 F.2d 1448, 1451 (10th
AND PROCEDURAL HISTORY
March 12, 2018, Plaintiff Melissa P. filed a Complaint
alleging the Aetna Defendants violated 29 U.S.C. §§
1104 and 1133 when they failed to pay for her son's
medically necessary treatment. (Compl., ¶¶ 48-54,
ECF No. 2.) The Proposed Amended Complaint alleges the
following facts. Ms. P. participates in the Lockheed Martin
Corporation Group Benefits Plan (“the Plan”); her
son Sean is a beneficiary. (Proposed Am. Compl. (“Am.
Compl.”) ¶ 4, ECF No. 13.) The Employee Retirement
Income Security Act of 1974 (“ERISA”) governs the
Plan. (Id. at ¶ 3.) Aetna Life Insurance
Company (“Aetna”) “is the third-party
claims administrator for the Plan” who “denied
claims for coverage in connection with mental health care
provided to Sean.” (Id. at ¶ 7.)
received mental health treatment from Elevations/Seven Stars
Residential Treatment Center (“Elevations”).
(Id. at ¶ 5.) Aetna denied coverage for that
treatment after November 23, 2016 because Sean
“‘was not in psychiatric crisis and not suicidal,
violent, manic, psychotic, severely depressed or cognitively
impaired.'” (Id. at ¶ 33 (quoting May
1, 2017 letter to Ms. P. from Aetna).) Ms. P. alleges Aetna
“incorrectly applied criteria for acute care” to
deny payment for Sean's mental health treatment, when
Aetna should have applied the standard for sub-acute care
because Sean was admitted to a residential treatment
facility. (Id. at ¶ 38.) Aetna upheld its
denial of Sean's treatment at Elevations on the same
basis as its original denial (id. at ¶ 47), and
Ms. P. filed suit.
10, 2018, the Aetna Defendants responded to Ms. P.'s
Complaint by asserting “they complied with all of their
ERISA obligations with respect to the claims alleged”
and also denied Ms. P.'s allegations. (Answer
¶¶ 48-54, ECF No. 7.) On August 3, 2018 the Court
entered a Scheduling Order setting August 10, 2018 as the
final date to file a Motion to Amend Pleadings. (Scheduling
Order 2, ECF No. 11.) On August 8, 2018, Ms. P. filed the
instant Motion (Mot., ECF No. 12) and an Errata to her Motion
containing her Proposed Amended Complaint (see
Errata to Mot. to Amend (“Errata”), ECF No. 13).
On August 22, 2018, the Aetna Defendants filed their
Opposition to Ms. P.'s Motion. (Opp'n, ECF No. 14.)
On September 5, 2018, Ms. P filed her Reply. (Pls.' Reply
to Defs.' Mem. in Opp'n to Pls.' Mot. for Leave
to File Am. Compl. (“Reply”), ECF No. 15.) On
October 4, 2018, the Aetna Defendants filed a Notice of
Supplemental Authority in Opposition to Ms. P.'s Motion.
(Defs.' Notice of Supp. Authority in Opp'n to
Pl.'s Mot. for Leave to File Am. Compl., ECF No. 18.) On
October 5, 2018, the undersigned held a hearing on Ms.
P's Motion. (See Minute Entry, ECF No. 19.)
filed a minimalist Motion asserting simply the “desire
to more fully and thoroughly articulate her allegation that,
among other things, the [Aetna] Defendants have violated the
Mental Health Parity and Addiction Equity Act in denying
coverage for her son, Sean's, medical treatment.”
(Mot. 1, ECF No. 12.) In support of her Motion, Ms. P. cited
to Rule 15(a)(2) and contended this Court should allow her to
file her Proposed Amended Complaint on the grounds a
“court should freely give leave when justice so
requires.” (Mot. 2, ECF No. 12.) Ms. P's Errata
included only the Proposed Amended Complaint. (Errata, ECF
No. 13). The Aetna Defendants complain that Ms. P. failed to
identify how justice warrants the amendment, what changes she
proposed to her Complaint, or any legal or factual basis for
granting her Motion. (Opp'n 2, ECF No. 14.) However, the
Aetna Defendants' real objection is that this Court
should deny Ms. P. leave to add a second cause of action
alleging a violation of the Parity Act because amendment
would prove futile. (Id. at 3-8.) While Ms. P's
Motion should have more clearly set forth the nature and
basis of the amendment, the parties adequately briefed and
argued the issue, and further amplification would not advance
the just, speedy, and inexpensive resolution of the case.
Aetna Defendants assert paragraphs 54-58 of Ms. P.'s
Proposed Amended Complaint only contain conclusory
allegations and fail to provide any factual allegations to
support her claim. (Opp'n 4-5, ECF No. 14.) The Aetna
Defendants further contend, to the extent Ms. P. alleges a
violation of the Affordable Care Act (“ACA”),
amendment would prove futile because the ACA does not
establish a private right of action. (Id. at 5.)
Lastly, the Aetna Defendants argue Ms. P.'s Parity Act
claim would prove futile because she fails to “identify
any treatment limitation that does not apply equally to
mental health and medical/surgical coverage.”
(Id. at 6.) In her Reply, Ms. P. asserts she does
not allege an ACA claim and requests the Court to consider
her Proposed Amended Complaint in its entirety. (Pls.'
Reply to Defs.' Mem. in Opp'n to Pl.'s Mot. for
Leave to File Am. Compl. (“Reply”) 2-3, ECF No.
15.) Upon reviewing her Proposed Amended Complaint, the Court
concludes amendment would not prove futile.
proposed amendment is futile if the complaint, as amended,
would be subject to dismissal.'” Lind v. Aetna
Health, Inc., 466 F.3d 1195, 1199 (10th Cir. 2006)
(quoting Bradley v. J.E. Val-Mejias, 379 F.3d 892,
901 (10th Cir. 2004)). To survive a motion to dismiss, a
plaintiff need only plead as much of her prima facie case as
possible based on the information in her possession. See
Khalik v. United Air Lines, 671 F.3d 1188, 1193-94 (10th
Cir. 2012) (acknowledging plaintiff may not know all details
of her claim against a large corporation at the pleading
stage but requiring plaintiff to plead the facts in her
possession that make her claim plausible). “[T]he
Twombly/Iqbal standard recognizes a plaintiff should
have at least some relevant information to make the claims
plausible on their face.” Id. at 1193.
Ms. P.'s proposed paragraph 38 describes an appeal letter
she wrote Aetna, it includes content that when read in
conjunction with paragraphs 57 and 58 sets forth a plausible
Parity Act claim. The crux of Ms. P.'s Parity Act claim,
as clarified at the motion hearing, centers on her contention
that skilled nursing facilities, rehabilitation hospitals, or
hospice care provide the analogue to residential treatment.
She further asserts the denial letter in this case shows
Aetna denied her son's claim based on criteria that ...