United States District Court, D. Utah
IHC HEALTH SERVICES, INC., dba LOGAN REGIONAL HOSPITAL, Plaintiff,
CITIBANK NMTC CORPORATION and ANTHEM BLUE CROSS AND BLUE SHIELD, Defendants.
MEMORANDUM DECISION AND ORDER GRANTING MOTION TO
DISMISS PLAINTIFF'S SECOND AND THIRD CAUSES OF
N. Parrish District Judge.
matter comes before the court on a motion to dismiss filed by
defendants Citibank NMTC Corporation (“Citi”) and
Anthem Blue Cross and Blue Shield (“Anthem”) on
November 9, 2018. (ECF No. 8). Plaintiff IHC Health Services,
Inc. (“IHC”) responded in opposition on December
7, 2018 (ECF No. 19). Defendants replied on December 21,
2018. (ECF No. 23). On the basis of the parties' briefs,
a review of relevant law, and for the reasons below,
defendants' motion to dismiss is granted.
sponsors and is the named administrator of a group health
plan regulated by the Employee Retirement Income Security Act
(“ERISA”). Citi contracts with Anthem for Anthem
to provide claims administration services to the plan's
participants and beneficiaries. J.O., a beneficiary of the
plan, received spinal cord stimulation to treat pain caused
by degenerative joint disease at IHC's Logan Regional
Hospital in September and October of 2015. Before the
procedure, J.O. executed a Consent and Condition of Service
form containing an assignment of benefits (“AOB”)
provision that assigns to IHC the benefits owed to J.O. under
any insurance policy.
billed $56, 471.80 for J.O.'s treatment. Anthem paid $20,
668.67, but denied the remainder on grounds that the
treatment was not medically necessary. IHC appealed, but
Anthem did not alter its initial determination. In 2016, IHC
sent two requests for the summary plan description and the
plan document, but erroneously sent those requests to a
claims administration entity not connected to this plan. On
July 6, 2018, IHC sent a request for that same information to
Anthem, but received no response.
September 4, 2018, IHC filed a complaint asserting three
causes of action under ERISA: (1) for recovery of plan
benefits under 29 U.S.C. § 1132(a)(1)(B); (2) for breach
of fiduciary duty under § 1132(a)(2); and (3) for
statutory penalties for failure to provide plan information
as requested under § 1132(c)(1). Defendants seek
dismissal of the second and third causes of action.
response to defendants' motion, IHC concedes that it
cannot maintain its breach of fiduciary duty claim
“because it is duplicative of the first cause of action
for plan benefits.” (ECF No. 19 at 2). Thus, IHC's
second cause of action is dismissed, and the court need only
resolve defendants' motion insofar as it seeks dismissal
of IHC's third cause of action.
third cause of action seeks statutory penalties under §
1132(c)(1), which provides that:
Any administrator . . . who fails or refuses to comply with a
request for any information which such administrator is
required by this subchapter to furnish to a participant or
beneficiary . . . by mailing the material requested . . .
within 30 days after such request may in the court's
discretion be personally liable to such participant or
beneficiary in the amount of up to $100 a day from the date
of such failure or refusal . . . .
contend that IHC-a healthcare provider that is neither a
beneficiary nor a participant of the plan-does not have
standing to assert a claim for statutory penalties.
Defendants further argue that even if IHC possessed
derivative standing to bring that claim by virtue of a valid
assignment of benefits, all of IHC's requests for plan
information were sent either to third parties with no
connection to the plan, or to Citi's claims
administrator, Anthem. Thus, defendants argue, the plan's
named administrator, Citi, has received no request for plan
information, and therefore cannot be liable under §
explained below, the court agrees with defendants that IHC
has no standing to assert this claim. As a result, the court
does not reach defendants' argument regarding substantive
liability under subsection (c).
IHC is Without Standing to Assert a Claim under ...