United States District Court, D. Utah
IHC HEALTH SERVICE, INC. dba INTERMOUNTAIN MEDICAL CENTER, Plaintiff,
SWIRE PACIFIC HOLDINGS, INC., dba SWIRE COCA-COLA USA, Defendant.
MEMORANDUM DECISION AND ORDER GRANTING IN PART AND
DENYING IN PART DEFENDANT'S MOTION TO DISMISS
N. Parrish District Judge
the court is a Motion to Dismiss filed by defendant Swire
Pacific Holdings Inc. on April 26, 2018. ECF No. 17.
Plaintiff IHC Health Service, Inc. filed an opposition to
that motion on May 17, 2018, ECF No. 25, to which defendant
replied on May 31, 2018, ECF No. 26. For the reasons below,
defendant's motion is granted in part and denied in part.
Swire Pacific Holdings, Inc., dba Swire Coca-Cola USA
(“Swire”) funds a health insurance plan (the
“plan”) regulated by the Employee Retirement
Income Security Act (“ERISA”), of which M.O. is a
participant. Swire, as the plan administrator, “has the
final authority for the administration and interpretation of
the Plan documents.” ECF No. 25-1 at 59. Swire is
additionally the plan's named fiduciary, which ERISA
defines as the entity with the “authority to control
and manage the operation and administration of the
plan.'” In re Luna, 406 F.3d 1192, 1201
(10th Cir. 2005).
plan document designates Regence BlueCross and BlueShield of
Utah (“Regence”) as the plan's claims
administrator, declaring that Regence “is a Plan
fiduciary for purposes of paying claims.” ECF No. 25-1
IHC Health Services, Inc., (“IHC”), operates
hospitals in the Intermountain area, including Intermountain
Medical Center in Salt Lake City, Utah. IHC provided medical
treatment to M.O. at the Intermountain Medical Center from
January 14, 2015, through January 20, 2015. IHC billed $82,
202.13 for the treatment provided. M.O. signed an Assignment
of Benefits (“AOB”) in favor of IHC. As a result,
IHC “stands in the shoes” of M.O. as beneficiary
of the plan, and is thus authorized to appeal, negotiate, or
otherwise seek payment of benefits from the plan for
M.O.'s treatment. Pursuant to the AOB, IHC submitted a
timely claim to Regence seeking payment of benefits. Regence
paid $50, 143.31, but denied the remainder of the claim on
grounds that M.O.'s treatment exceeded usual, customary,
and reasonable costs. IHC satisfied the plan's exhaustion
requirement through multiple appeals, but Regence did not
alter its initial determination.
January 22, 2018, IHC filed a complaint asserting two causes
of action under ERISA: (1) for recovery of plan benefits
under 29 U.S.C. § 1132(a)(1)(B); and (2) for breach of
fiduciary duty under 29 U.S.C. §§ 1132(a)(2), (3).
ECF No. 2.
Motion to Dismiss Standard
Rule 12(b)(6), a defendant may move to dismiss a claim when
the plaintiff fails to state a claim upon which relief can be
granted. The court's function on a Rule 12(b)(6) motion
is to “assess whether the plaintiff's complaint
alone is legally sufficient to state a claim for which relief
may be granted.” Dubbs v. Head Start, Inc.,
336 F.3d 1194, 1201 (10th Cir. 2003) (quoting Miller v.
Glanz, 948 F.2d 1562, 1565 (10th Cir. 1991)).
court reviewing the sufficiency of a complaint presumes all
of plaintiff's factual allegations are true and construes
them in the light most favorable to the plaintiff.”
Hall v. Bellmon, 935 F.2d 1106, 1108 (10th Cir.
1991) (citing Scheuer v. Rhodes, 416 U.S. 232
(1974)). “To survive a motion to dismiss, a complaint
must contain sufficient factual matter, accepted as true, to
‘state a claim to relief that is plausible on its
face.'” Ashcroft v. Iqbal, 556 U.S. 662,
678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550
U.S. 544, 570 (2007)).
Count I-Recovery of Plan Benefits
U.S.C. § 1132(a) enumerates “[p]ersons empowered
to bring a civil action” under ERISA. Subsection (a)(1)
authorizes a plan's participant or beneficiary to bring a
civil action “to recover benefits due to him under the
terms of his plan[.]” § 1132(a)(1)(B). But while
other provisions in § 1132 indicate against
whom certain actions may be brought, subsection (a)(1)
contains no specification of the entities that may be
properly sued thereunder. As evidenced by the parties'
briefing for this motion, Congress's failure to so
specify has led to a variegated body of law regarding which
entities are proper defendants to an action under subsection
(a)(1), in turn creating uncertainty for prospective
litigants and opportunities for dilatory procedural motions.
this uncertainty, Swire-the plan's sponsor,
administrator, and named fiduciary-argues that it is not a
proper defendant to an action seeking recovery of plan
benefits. Specifically, Swire argues that IHC's
complaint must be dismissed because it fails to allege any
facts to suggest that Swire, rather than its ...