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Dodson v. Aetna Life Insurance Co.

United States District Court, M.D. Alabama, Eastern Division

March 1, 2018

BRIAN DODSON, Plaintiff,



         Before the court is Defendant's Motion to Dismiss Plaintiff's State-Law Claims and to Strike Plaintiff's Jury Demand (Doc. 8). The District Judge has referred this matter to the undersigned Magistrate Judge “for further proceedings and determination or recommendation as may be appropriate.” Doc. 11. Despite the court's Order (Doc. 9) instructing Plaintiff to show cause why the motion should not be granted, Plaintiff has not filed a response in opposition to the motion. As such, the motion is ripe for recommendation to the District Judge. For the reasons that follow, the undersigned Magistrate Judge RECOMMENDS that Defendant's motion be GRANTED.

         I. BACKGROUND

         Plaintiff initiated this matter by filing a complaint in the Circuit Court of Tallapoosa County, Alabama, on April 20, 2017. Doc. 1-1. On May 26, 2017, Defendant removed the matter to this court pursuant to 28 U.S.C. § 1446(b), asserting that this court may exercise both federal question and diversity subject matter jurisdiction over the complaint. Doc. 1 at 2-3. On June 16, 2017, Defendant filed the instant motion to dismiss and motion to strike the jury demand. In short, Defendant argues that, because all of Plaintiff's claims are preempted by Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1001, et seq., Plaintiff's state-law claims must be dismissed for failure to state any claim upon which relief could be granted pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure, Plaintiff's demand for a jury trial must be stricken, and Plaintiff should be ordered to file an amended complaint seeking only the relief authorized under ERISA. Doc. 8 at1. On June 21, 2017, the undersigned entered an ORDER (Doc. 9) directing Plaintiff to “file a written response and show cause, if any there be, why the motion should not be granted.” Plaintiff's response was due on or before July 7, 2017. Plaintiff did not file a response to the motion.


         As noted previously, Defendant moves to dismiss the complaint pursuant to Rule 12(b)(6) of the Federal Rules. When ruling on a motion pursuant to Rule 12(b)(6), “the Court accepts the factual allegations in the complaint as true and construes them in the light most favorable to the plaintiff.” Speaker v. U.S. Dep't of Health & Human Servs. Ctrs. for Disease Control & Prevention, 623 F.3d 1371, 1379 (11th Cir. 2010). In order to state a claim upon which relief could be granted, a complaint must satisfy the pleading standard of Rule 8 of the Federal Rules of Civil Procedure.

         Rule 8 requires that a plaintiff submit a “short and plain statement of the claim showing that the pleader is entitled to relief.” Fed.R.Civ.P. 8(a)(2). “[T]he pleading standard Rule 8 announces does not require ‘detailed factual allegations, ' but it demands more than an unadorned, the-defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007)). In general, then, a pleading is insufficient if it offers only mere “labels and conclusions” or “a formulaic recitation of the elements of a cause of action[.]” Twombly, 550 U.S. at 555. See also Iqbal, 556 U.S. at 678 (quoting Twombly, 550 U.S. at 557) (a complaint does not suffice under Rule 8(a) “if it tenders ‘naked assertion[s]' devoid of ‘further factual enhancement.'”). Thus, in order to survive Defendant's motion to dismiss, Plaintiff's complaint “‘must contain sufficient factual matter, accepted as true, to ‘state a claim for relief which is plausible on its face.'” Urquilla-Diaz v. Kaplan Univ., 780 F.3d 1039, 1051 (11th Cir. 2015) (quoting Iqbal, 556 U.S. at 678). “A claim is factually plausible where the facts alleged permit the court to reasonably infer that the defendant's alleged misconduct was unlawful. Factual allegations that are ‘merely consistent with' a defendant's liability, however, are not facially plausible.” Id. (quoting Iqbal, 556 U.S. at 678).

         “Determining whether a complaint states a plausible claim for relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial experience and common sense.” Iqbal, 556 U.S. at 679. If there are “enough fact[s] to raise a reasonable expectation that discovery will reveal evidence” that supports the claims alleged in the complaint, then the claim is “plausible” and the motion to dismiss should be denied and discovery in support of the claims should commence. Twombly, 550 U.S. at 556. But, “Rule 8 . . . does not unlock the doors of discovery for a plaintiff armed with nothing more than conclusions.” Iqbal, 556 U.S. at 678-79. Ultimately, in assessing the plausibility of a plaintiff's claims, the court is to avoid conflating the sufficiency analysis with a premature assessment of a plaintiff's likelihood of success because a well-pleaded claim shall proceed “even if it strikes a savvy judge that actual proof of those facts is improbable, and ‘that a recovery is very remote and unlikely.'” Twombly, 550 U.S. at 556 (quoting Scheuer v. Rhodes, 416 U.S. 232, 236 (1974)).


         According to the complaint, the relevant facts, accepted as true for purposes of deciding the instant motion, are as follows: Defendant offered health insurance benefits to Plaintiff through Plaintiff's employer. Doc. 1-1 at ¶ 4. Plaintiff underwent “several” medical procedures, including procedures at Russell Medical Center in Alexander City, Alabama, and Trinity Medical Center, “or like or similar institutions, ” in Birmingham, Alabama. Id. at ¶¶ 5-7. Defendant “failed or refused to pay” medical bills resulting from the procedures. Id. at ¶¶ 8-10. In particular, Defendant failed or refused to pay a bill totaling $27, 619.90 for a procedure (a “fistula repair”) performed on May 18, 2015, at Trinity Medical Center. Id. at ¶¶ 13-16, 24. Plaintiff also requested that Defendant pay the outstanding medical bill for a procedure (a colonoscopy) performed on May 28, 2014, at Russell Medical Center. Id. at ¶¶ 17-18, 25.

         Plaintiff alleges that Defendant failed to pay for his medical procedures in violation of a “health insurance policy” issued by Defendant. See, e.g., Id. at ¶ 13. The “health insurance policy” is a “Benefit Plan” for which Defendant provides administrative services. See Doc. 8-2 at 1.[1] The Benefit Plan plainly advises that it is governed by ERISA, and further advises plan participants of the rights afforded to them by ERISA, including how to go about challenging the Plan Administrator's decisions related to coverage or other Plan terms and obligations. See, e.g., Doc. 8-2 at 76, 101-02.


         A. Motion to Dismiss Plaintiff's State Law Claims

         Plaintiff presents four state-law counts in his Complaint. In Count One, he alleges that Defendant “breached the insurance contract” by failing or refusing to pay his medical bills related to the procedures described previously in this Recommendation. Doc. 1.1 at ¶ 20. In Count Two, he alleges that Defendant acted in bad faith in failing to pay his claims for the same medical procedures. Id. at ¶ 31. In Count Three, Plaintiff alleges that, through the Plan, Defendant fraudulently represented to Plaintiff that he was insured for the medical procedures for which Defendant later failed or refused to pay. Id. at ΒΆΒΆ 35-40. Finally, in Count Four, Plaintiff alleges Defendant breached its duty to disclose certain material facts related to his coverage under the Plan, and that such breach, in the form ...

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