United States District Court, N.D. Alabama, Southern Division
BIRMINGHAM PLUMBERS AND STEAMFITTERS LOCAL UNION NO. 91 HEALTH AND WELFARE TRUST FUND, Plaintiff,
BLUE CROSS BLUE SHIELD OF ALABAMA, Defendant.
MEMORANDUM OPINION 
H. ENGLAND, III UNITED STATES MAGISTRATE JUDGE
Birmingham Plumbers and Steamfitters Local Union No. 91
Health and Welfare Trust Fund (the “Employer Health and
Welfare Trust Fund” or “Plaintiff”)
initiated this action against Defendant Blue Cross Blue
Shield of Alabama (“BCBS”) alleging a claim for
breach of fiduciary duty under the Employee Retirement Income
Security Act (“ERISA”) and a claim for breach of
contract based on the Administrative Services Agreement
(“ASA”) between BCBS and Birmingham Plumbers and
Steamfitters Local No. 91 (“Employer”). (Doc. 1).
BCBS has moved to dismiss the complaint pursuant to Federal
Rule of Civil Procedure 12(b)(6). (Doc. 8). The motion is
fully briefed and ripe for review. (Docs. 12 & 19). For
the reasons stated below, BCBS's motion to dismiss, (doc.
8), is GRANTED.
asserts that BCBS, in its role as third-party claims
administrator for the Employer's Group Medical Plan and
Group Dental Plan (the “Plan”), breached its
fiduciary duty and contractual duty by continuing to pay
claims for a Plan participant suffering from end stage renal
disease (“ESRD”) after the participant became
Medicare-eligible. (See doc. 1; doc. 8-1 at 14).
Specifically, Plaintiff alleges the Plan should have become a
secondary payer to Medicare after acting as primary payer for
the first thirty months of the participant's ESRD
treatment. (Id. at ¶ 22).
approximately November 2010, a Plan participant was diagnosed
with ESRD and began dialysis treatment. (Doc. 1 at ¶
24). Plaintiff alleges BCBS was aware of the ESRD diagnosis,
based on the fact BCBS paid the claim for dialysis and other
treatment. (Id. at ¶ 25). Plaintiff further
alleges that, because eligibility in the Plan is available
only to individuals or dependents of individuals that are
employed in the Plumbing and Steamfitting trade, BCBS knew
the participant was covered based on this employment and knew
or should have known the employee had participated in the
Plan for over ten years. (Id. at ¶¶
to the complaint, the Plan participant became eligible to
enroll in Medicare because of the ESRD diagnosis no later
than September 2013; however, the participant did not enroll
in Medicare. (Id. at ¶ 27). From September 2013
until December 2014, the Plan paid benefits for diagnosis and
treatment related to ESRD. (Id. at ¶ 28).
Plaintiff alleges BCBS was aware that the participant had
been diagnosed with ESRD, was aware that thirty months had
elapsed since the diagnosis, and was aware that the
participant had not enrolled in Medicare. (Id. at
¶ 29). Plaintiff further alleges BCBS knew or should
have known that the participant was eligible for Medicare.
Standard of Review
Federal Rule of Civil Procedure 8(a)(2), a pleading must
contain “a short and plain statement of the claim
showing the pleader is entitled to relief.”
“[T]he pleading standard Rule 8 announces does not
require 'detailed factual allegations, ' but it
demands more than an unadorned,
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citing
Bell Atlantic v. Twombly, 550 U.S. 544, 555 (2007)).
Mere “labels and conclusions” or “ a
formulaic recitation of the elements of a cause of
action” are insufficient. Iqbal, 556 U.S. at
678. (citations and internal quotation marks omitted).
“Nor does a complaint suffice if it tenders 'naked
assertion[s]' devoid of 'further factual
enhancement.” Id. (citing Bell Atl.
Corp., 550 U.S. at 557).
12(b)(6), Fed. R. Civ. P., permits dismissal when a complaint
fails to state a claim upon which relief can be granted.
“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.”
Iqbal, 556 U.S. at 678 (citations and internal
quotation marks omitted). A complaint states a facially
plausible claim for relief “when the plaintiff pleads
factual content that allows the court to draw the reasonable
inference that the defendant is liable for the misconduct
alleged.” Id. (citation omitted). The
complaint must establish “more than a sheer possibility
that a defendant has acted unlawfully.” Id.;
see also Bell Atl. Corp., 550 U.S. at 555
(“Factual allegations must be enough to raise a right
to relief above the speculative level.”). Ultimately,
this inquiry 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.
several instances throughout its response, Plaintiff urges
that the court must accept as true all allegations in the
complaint. (See doc. 12 at 3, 10, 16). Despite
Plaintiff's urging, this general rule is not an absolute.
The requirement the court accept the facts in the complaint
as true when evaluating a Rule 12(b)(6) motion to dismiss is
limited. The court is not required to ignore specific factual
details of the pleadings in favor of general conclusory
allegations and, as more relevant here, when exhibits
contradict the general and conclusory allegations of the
pleadings, the exhibits govern. Griffin Indus., Inc. v.
Irvin, 496 F.3d 1189, 1205-06 (11th Cir. 2007). This
means, to the extent any of Plaintiff's general and
conclusory allegations are inconsistent with the plain and
unambiguous language of the ASA, the ASA governs.
ERISA Fiduciary Duty Claim
of Plaintiff's complaint alleges a breach of fiduciary
duty claim. (Doc. 1 at 9). “To establish liability for
a breach of fiduciary duty under any of the provisions of
ERISA § 502(a), a plaintiff must first show that the
defendant is in fact a fiduciary with respect to the
plan.” Cotton v. Mass. Mut. Life Insur. Co.,
402 F.3d 1267, 1277 (11th Cir. 2005). Under ERISA, “a
person is a fiduciary with respect to the plan to the extent
. . . he has any discretionary authority or discretionary
responsibility in the administration of such plan. 29 U.S.C.
responsibilities may be divided up among various ERISA
fiduciaries. See 29 U.S.C. §1104(c)(1)
(“The instrument under which a plan is maintained may
expressly provide for procedures . . . for allocating
fiduciary responsibilities (other than trustee
responsibilities) among named fiduciaries. . . .”). In
such situations, each party “is a fiduciary only
‘to the extent' it performs a fiduciary
function.” Cotton, 402 F.3d at 1277 (quoting
definition of “fiduciary” from 29 U.S.C. §
1002(21)(a)). “As such, fiduciary status under ERISA is
not an “all-or-nothing concept, ' and ‘a
court must ask whether a person is a fiduciary with respect
to the particular activity at issue.'” Id.
(quoting Coleman v. Nationwide Ins. Co., 969 F.2d
54, 61 (4th Cir. 1992)). Subject to limited exceptions,
when fiduciary obligations are allocated among entities, a