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.
15, 2017, Defendant Blue Cross Blue Shield of Alabama
(“BCBS” or “Defendant”) moved to
dismiss this action pursuant to Fed.R.Civ.P. 12(b)(6). (Doc.
8). On March 8, 2018, the undersigned granted the motion and
dismissed the case. (Docs. 26 & 27). On April 5, 2018,
Plaintiff Birmingham Plumbers and Steamfitters Local Union
No. 91 Health and Welfare Trust Fund (the
“Employer” or “Plaintiff) moved to alter or
amend the judgment pursuant to Fed.R.Civ.P. 59. (Doc. 28).
Defendant opposes that motion. (Doc. 31). For the reasons
stated more fully below, the motion is
Standard of Review
59(e) permits a party to move to alter or amend a judgment.
Fed.R.Civ.P. 59(e). “Reconsidering the merits of a
judgment, absent a manifest error of law or fact, is not the
purpose of Rule 59.” Jacobs v. Tempur-Pedic
Int'l, Inc., 626 F.3d 1327, 1344 (11th Cir. 2010).
To that end, “the only grounds for granting a Rule 59
motion are newly-discovered evidence or manifest errors of
law or fact.” Arthur v. King, 500 F.3d 1335,
1343 (11th Cir. 2007) (quoting In re Kellogg, 197
F.3d 1116, 1119 (11th Cir. 1999)) (internal alterations
omitted). For the purposes of the Rule, a manifest error of
law is “the wholesale disregard, misapplication, or
failure to recognize controlling precedent.” Benton
v. Burke, No. CV-11-S-493-NE, 2012 WL 1746122, at *1
(N.D. Ala. May 16, 2012) (quoting Oto v. Metropolitan
Life Insurance Co., 224 F.3d 601, 606 (7th Cir. 2000)).
“A Rule 59(e) motion cannot be used to relitigate old
matters, raise argument or present evidence that could have
been raised prior to the entry of judgment.”
Id. (quoting Michael Linet, Inc. v. Village of
Wellington, Fla., 408 F.3d 757, 763 (11th Cir. 2005))
(internal alterations omitted).
contends the undersigned erred as a matter of law by granting
the motion to dismiss. (Doc. 28 at 1). Specifically,
Plaintiff objects to “the determination that BCBS did
not have a duty or responsibility to determine a plan
participant's eligibility (or not) for Medicare as part
of the agreement between the parties.” (Doc. 29 at 2).
I.A. of BCBS's motion to dismiss is devoted to the
argument that “BCBS did not owe a fiduciary duty to
determine the participant's Medicare eligibility
status.” (Doc. 8 at 3-9). In that section, BCBS argues
the Administrative Services Agreement (“ASA”)
divided fiduciary obligations between the two parties, only
placing on BCBS the responsibility for claims administration
and administrative appeals. (Id. at 5).
Specifically, it stated that “there is no allegation
that it was BCBS's duty to track participants'
Medicare eligibility and the applicability of Medicare
Secondary Payer statutes; to the contrary, the terms of the
ASA expressly place that burden on the Employer.”
(Id. at 6). BCBS then identified several provisions
of the ASA that supported determining Medicare eligibility
was outside the scope of its fiduciary responsibilities.
(Id. at 6-7). In relevant part, one of these
provisions provides: “The Claims Administrator will
rely on eligibility information submitted by the Employer as
satisfying the terms of the Plan and the requirements of the
Medicare Secondary Payer (MSP) statutes and regulations . . .
.” (Id. At 6) (citing doc. 8-1 at 3, art. II
response to this argument, Plaintiff offered an alternative
explanation for the cited section of the ASA: that
“eligibility” refers only “to whether the
Plan, given the number of eligible covered lives, is to be
treated as a large employer or small employer, a critical
factor under some Medicare Secondary Payer rules.”
(Doc. 12 at 13). Plaintiff then stated:
In short, the issue in this case is not about whether the
Plan submitted participant eligibility information to BCBSAL
or whether the participant signed up for Medicare. The case
is about BCBSAL's knowledge that the participant was
eligible for ESRD Medicare benefits and despite that
knowledge it improperly processed claims for ESRD treatment
for approximately 15 months when the Plan had no obligation
to be the primary payer under the terms of the Plan and
Medicare. Because BCBSAL acted contrary to the plain terms of
the Plan and paid for benefits that the Plan had no
obligation to pay, BCBSAL improperly disposed of plan assets
. . . .
A close reading of Article II A.3.a. of the ASA confirm [sic]
this discussion. There is nothing in the language of the
sentence that BCBSAL relies on that can be interpreted as a
requirement that the Plan certify that the participant is
Medicare eligible or that he or she has signed up for
Medicare. At most, the language raises a “healthy
factual dispute” as to its meaning and how it is to be
applied under the Plan that cannot be resolved at a Motion to
Dismiss stage of the case . . . Therefore, since the Fund has
stated more than “enough facts to state a claim for
relief that is plausible on its face” BCBSAL's
motion to dismiss is due to be denied . . . .
(Id. at 14-15).
with these competing arguments, the undersigned accepted
BCBS's interpretation. First, the undersigned examined
Plaintiff's argument that the central issue was
“about ‘coordination of benefits' and
‘determining which of two insurance policies will bear
the brunt of a particular claim.'” (Doc. 26 at 6).
Because Plaintiff also alleged the participant failed to
enroll in Medicare after becoming eligible, (doc. 1 at ¶
27), the undersigned found Plaintiff's
“characterization of the argument in its brief . . .
misleading at best.” (Doc. 26 at 7). Instead, the
dispositive issue was whether it was BCBS's
responsibility to determine whether the participant was
eligible for Medicare. (Id.). But the undersigned
also determined Plaintiff did not allege in the complaint a
duty by BCBS to track Medicare eligibility, and the ASA's
plain language negated the existence of this duty.
(Id.). The undersigned rejected Plaintiff's
alternative large employer/small employer interpretation of
the ASA's reference to “Medicare Secondary Payer
(MSP) statutes and regulations” as unexplained,
unsupported, and unable to withstand scrutiny in light of the
ASA's provision entitling BCBS to “rely on
instructions, communications, or directions from the Employer
concerning Plan design, eligibility determinations, benefit
changes, and other areas of Plan administration for which the
Employer is responsible.” (Id. at 8-9) (citing
doc. 8-1 at 9, art. V. § C).
motion to alter or amend argues the undersigned erred by
“fail[ing] to recognize that it is exactly and
precisely the duty of BCBS to coordinate benefits between the
Plan and any other payer that might be responsible for
payment of benefits, including Medicare.” (Doc. 29 at
7). To support this, Plaintiff relies extensively on the
Plan's Benefits Booklet, which it attaches to its motion,
(see doc. 29-1),  and which it notes was referenced in
the Complaint, (see doc. 29 at 2 n.1) (citing doc. 1
at ¶ 13). Specifically, it points to several portions of
the Benefits Booklet it claims support that the duty to
determine Medicare eligibility is delegated to BCBS.
(See doc. 29 at 8-10). Additionally, it offers a new
interpretation of the ASA's Article II, § A.3 that
it says refutes that it was responsible for determining
Medicare eligibility. (Id. at 10-15).
Plaintiff's Basis for Rule 59 Relief ...