369 F.Supp.2d 61 (2005) | Cited 1 time | D. Maine | May 10, 2005


Plaintiff Maine Coast Memorial Hospital (hereinafter"Hospital") commenced this action against Defendant Norma Sargentin the District Court of the State of Maine to recover forallegedly unpaid medical bills. Defendant Sargent filed aThird-Party Complaint against her employer, Wal-Mart Stores, Inc.(hereinafter "Wal-Mart"), and Harvard Pilgrim Health Care(hereinafter "Harvard Pilgrim"), alleging that these entities areresponsible for paying her medical bills. Wal-Mart is the sponsorof a Health and Welfare Plan offered to Wal-Mart employees. Following removal,the Court granted Wal-Mart's Motion to Dismiss (Docket Item No.18), leaving Harvard Pilgrim as the lone Third-Party Defendant inthis case.

Now before the Court is Harvard Pilgrim's Motion to Dismiss(Docket Item No. 21). In its Motion, Harvard Pilgrim states thatthe claims asserted against it should be dismissed for threereasons: (1) Harvard Pilgrim is not the appropriate Defendant forThird-Party Plaintiff's claims; (2) Third-Party Plaintiff hasfailed to exercise the administrative remedies afforded by thePlan; and (3) Third-Party Plaintiff has failed to allege that sheis an "eligible employee" under the Plan. For the reasons setforth below, the Court will grant Harvard Pilgrim's Motion.

I. Applicable Legal Standard

Harvard Pilgrim's Motion to Dismiss invokes Fed.R.Civ.P.12(b)(6). Harvard Pilgrim is entitled to dismissal for failure tostate a claim only if "it appears to a certainty that theplaintiff would be unable to recover under any set of facts."State St. Bank & Trust Co. v. Denman Tire Corp., 240 F.3d 83,87 (1st Cir. 2001). The Court must "accept as true thewell-pleaded factual allegations of the complaint, draw allreasonable inferences therefrom in the plaintiff's favor, anddetermine whether the complaint, so read, sets forth factssufficient to justify recovery on any cognizable theory."TAG/ICIB Servs. v. Pan Am. Grain Co., 215 F.3d 172, 175 (1stCir. 2000).

II. Harvard Pilgrim as a Proper Defendant

Under the Employee Retirement Income Security Act,29 U.S.C. §§ 1001 et seq. (hereinafter "ERISA"), Ms. Sargent may commence acivil action "to recover benefits due to [her] under the terms of[her] plan, to enforce [her] rights under the terms of the plan, or to clarify [her] rights to future benefits under theterms of the plan." Id. § 1132(a)(1)(B). Ms. Sargent seeksdamages equal to any damages found owing by her to PlaintiffHospital. As such, she is seeking benefits that she contends werewrongfully withheld under the terms of the Plan. ERISA providesthat "[a]ny money judgment under this title against an employeebenefit plan shall be enforceable only against the plan as anentity and shall not be enforceable against any other personunless liability against such person is established in hisindividual capacity under this title." Id. § 1132(d)(2)(emphasis added).

Ms. Sargent contends that Harvard Pilgrim is a proper Defendantbecause it is the Administrator of the Plan. See AmendedThird-Party Complaint (Docket Item No. 19) ¶¶ 2, 7. HarvardPilgrim denies this allegation and has provided the Court withthe Wal-Mart 2004 Associate Guide (attached as Exhibit A toThird-Party Defendant Harvard Pilgrim's Motion to Dismiss), whichcontains the Summary Plan Description.1 Harvard Pilgrimsuggests this document supports its contention that it is not thePlan Administrator. The Court notes that the Plan Administratornamed in the Summary Plan Description is the AdministrativeCommittee, Associates' Health and Welfare Plan. Nowhere isHarvard Pilgrim listed as an administrator or fiduciary in theSummary Plan Description. For alternative support of her position, Ms. Sargent hasprovided the Court with a letter to her from Harvard Pilgrimdated October 3, 2000 (attached as Exhibit A to Third-PartyPlaintiff's Response to Harvard Pilgrim's Motion to Dismiss(Docket Item No. 22)), approving coverage for certain claims.Plaintiff contends, without citing any authority, that thisletter suggests that Harvard Pilgrim is acting as a fiduciary.The Court finds no merit to this position. The Court once againreiterates that the "`the proper party defendant in an actionconcerning ERISA benefits is the party that controlsadministration of the plan.'" Terry v. Bayer Corp.,145 F.3d 28, 36 (1st Cir. 1998) (quoting Garren v. John Hancock Mut. LifeIns. Co., 114 F.3d 186, 187 (11th Cir. 1997)). Because HarvardPilgrim does not control the administration of the Plan at issue,and because it is not a fiduciary, Ms. Sargent's Complaint failsto state a claim against Harvard Pilgrim.2

III. Motion for Stay

In her Response to Harvard Pilgrim's Motion to Dismiss, Ms.Sargent anticipates the likelihood that the Court will remandthis case to state court due to the absence of any remainingfederal claim if the Court grants Harvard Pilgrim's Motion toDismiss. In such a scenario, Ms. Sargent requests that the Courtstay its remand order for fifteen days to allow Ms. Sargent theopportunity to amend her Complaint to state a claim against aproper Plan Defendant. The Court is satisfied that a fifteen daystay of a remand order will not prejudice any party to this case. IV. Conclusion

For the reasons set forth above, it is ORDERED thatThird-Party Defendant Harvard Pilgrim's Motion to Dismiss be, andit is hereby, GRANTED and the Third-Party Complaint againstHarvard Pilgrim be, and it is hereby, DISMISSED. It is FURTHERORDERED that all further proceedings in this case are STAYEDfor a period of fifteen days from the date this Order is docketedto allow Third-Party Plaintiff the opportunity to amend herComplaint.

1. Ordinarily, in deciding a motion to dismiss, a court maynot consider any document outside of the complaint, or notexpressly incorporated therein, unless the motion is convertedinto one for summary judgment. Watterson v. Page, 987 F.2d 1, 3(1st Cir. 1993). There is a narrow exception "for documents theauthenticity of which are not disputed by the parties; forofficial public records; for documents central to plaintiffs'claim; or for documents sufficiently referred to in thecomplaint." Id.; see also Young v. Lepone, 305 F.3d 1, 11 (1stCir. 2002) ("when the factual allegations of a complaint revolvearound a document whose authenticity is unchallenged, thatdocument effectively merges into the pleadings and the trialcourt can review it in deciding a motion to dismiss under Rule12(b)(6).") (citations and internal quotation marks omitted). Ms.Sargent has not objected to the authenticity of the Plan sectionsprovided by Harvard Pilgrim, and the Court is satisfied that theprovisions of the Plan submitted by Harvard Pilgrim are centralto Third-Party Plaintiff's claim.

2. Because the Court rules that Harvard Pilgrim is not aproper Defendant, it does not reach the issues of exhaustion ofadministrative remedies or whether Ms. Sargent is an eligibleemployee under the Plan.

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