KESSELMAN v. THE RAWLINGS CO., LLC No. 08 Civ. 7417(BSJ).
668 F.Supp.2d 604 (2009)
Warren KESSELMAN, et al., Plaintiffs, v. THE RAWLINGS COMPANY, LLC, et al., Defendants.
United States District Court, S.D. New York.
November 13, 2009.
Richard Wolfe Cohen, Peter Dexter St. Philip, Jr., Lowey Dannenberg Cohen & Hart, P.C., White Plains, NY, Neal S. Manne, Susman Godfrey L.L.P., Los Angeles, CA, Robert Rivera, Susman Godfrey LLP, Houston, TX, Tibor Ludovico Nagy, Jr., Susman Godfrey LLP, Bruce Harvey Schneider, Sandra June Rampersaud, Stroock & Stroock & Lavan LLP, Ronald E. Richman, Schulte Roth & Zabel LLP, Deidre Ann Grossman, Proskauer Rose LLP, Kevin Barry McHugh, Fiedelman & Garfinkel, Jason Paul Casero, McDermott, Will & Emery, LLP, New York, NY, Brian David Boyle, Theresa S. Gee, Robert Norris Eccles, O'Melveny & Myers LLP, Washington, DC, Cynthia Evans Neidl, Heather P. Behnke, Greenberg Traurig, LLP, Albany, NY, David Israel, Maria N. Rabieh, Sessions, Fishman, Nathan & Israel, L.L.P., Tampa, FL, for Defendants.
BARBARA S. JONES, District Judge.
In this action, Plaintiffs have brought a putative class action complaint against numerous Defendants
The Plaintiffs assert four "Counts" for relief. In Counts One, Two, and Three, Plaintiffs assert that Defendants' communications and assertions of reimbursement rights violated provisions of ERISA, specifically § 502(a)(1)(B) and § 502(c)(7). In Count Four, Plaintiffs assert these same acts by certain Defendants, the subrogation agents, violated the Fair Debt Collection Practices Act ("FDCPA"). Plaintiffs have voluntarily dismissed Count Three pertaining to violations of ERISA § 502(c)(7). For the reasons set forth below, Defendants' Motions to Dismiss all the remaining claims are GRANTED.
The Plaintiffs plead many common factual allegations. Each of the eight Plaintiffs
At the time of his or her accident, each Plaintiff was covered by a "No-Fault" insurance policy with a minimum coverage of $50,000 for economic losses. (Am. Compl. 1149.) Each Plaintiff "had a personal injury claim presented" by Michael Goldberg ("Goldberg")—who is also their attorney in this action—against person(s) allegedly responsible for his or her injuries which resulted in a recovery for "non-economic" loss. (Am Compl. 1150.) Each Plaintiffs plan contained a provision entitling the plan to reimbursement from the Plaintiffs third-party recovery. (Am. Compl. ¶ 52 (Kesselman), ¶ 56 (Aiello), ¶ 62 (Chait), 1168 (Haskell), ¶ 74 (Trinchese), ¶ 80(Ram), 1186 (Prescott) and 1190 (Jean-Pierre).) Each Plaintiff alleges that one or more of the Defendants notified him or her, or Goldberg, of their rights to reimbursement from Plaintiffs third-party tort recovery. (Am. Compl. ¶¶ 53, 58, 64, 70, 76, 83, 88, 93; See Am. Compl. Exs. 1-8.) As a
THE STANDARD AND THE SCOPE OF REVIEW
A complaint will be dismissed pursuant to Federal Rule of Civil Procedure 12(b)(6) if a Plaintiff "fail[s] to state a claim upon which relief can be granted." Fed. R.Civ.P. 12(b)(6). The Court must read the complaint generously, accepting the truth of and drawing all reasonable inferences from well-pleaded factual allegations. See York v. Ass'n of the Bar of the City of N.Y.,
In addition to the exhibits attached to the Amended Complaint, the parties have submitted numerous documents to the Court on this motion. It is well established that the Court can consider documents attached as exhibits to the complaint or incorporated by reference into the complaint, when ruling on a motion to dismiss. Gryl ex rel. Shire Pharms. Group PLC v. Shire Pharms. Group PLC,
Defendants argue that Plaintiffs' three remaining claims must be dismissed because Plaintiffs fail to state a claim upon which relief can be granted. The Court agrees that all of Plaintiffs' claims must be DISMISSED.
I. "Reimbursement" of Benefits (Count I)
The First Count is for "repayment" of benefits. (Am. Compl. ¶¶ 115-122). This claim is made pursuant to ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B), which authorizes a participant in or beneficiary of an ERISA plan to sue "to recover benefits due to him under the terms of his plan, to enforce his rights under the terms
In the Amended Complaint, this count appears to be brought on behalf of all Plaintiffs. However, Plaintiffs' counsel conceded at oral argument that Jean-Pierre was the only plaintiff to have ever made any payment out of her settlement to a subrogation agent or health insurance carrier, and therefore is the only claimant seeking repayment under ERISA § 502(a)(1)(B). (Oral Arg. Tr. 28, Oct. 21, 2009.) Consequently, as a preliminary matter, Count I is dismissed as to all Defendants other than Aetna and Rawlings, the health insurance carrier and subrogation vendor against whom Jean-Pierre brings her claim.
Defendants Aetna and Rawlings argue that Jean-Pierre has not stated a viable claim for relief against them because she has not sufficiently pled exhaustion of administrative remedies, a prerequisite to bringing an ERISA action. The Court agrees.
"[T]he federal courts—including this Circuit—have recognized a `firmly established federal policy favoring exhaustion of administrative remedies in ERISA cases.'" Paese v. Hartford Life & Accident Ins. Co.,
In Paese v. Hartford Life & Accident Ins. Co., the Second Circuit held that the failure to exhaust administrative remedies does not deprive courts of subject matter jurisdiction, but is rather an affirmative defense. Contrary to Jean-Pierre's assertion, that holding, however, does not alter the "firmly established" policy that plaintiffs must exhaust administrative remedies in ERISA actions. Indeed, in cases following Paese, courts in this Circuit have explicitly noted that "Paese does not remove the requirement that the plaintiff exhaust his administrative remedies." Egan v. Marsh & McLennan Cos., Inc., 2008 WL 245511, 07 Civ. 7134, 2008 U.S. Dist. LEXIS 6647 (S.D.N.Y. Jan. 29, 2008)(dismissing a plaintiff's ERISA claim for failure to exhaust administrative remedies where plaintiff made no allegation that he exhausted any of his administrative remedies or that his pursuit of administrative remedies under the plans at issue would be futile)(quoting Novella v. Empire State Carpenters Pension Fund, No. 05 Civ. 2079, 2007 U.S. Dist. LEXIS 63540, 2007 WL 2417303, at *3 (S.D.N.Y. Aug. 28, 2007)); accord Merkent v. SI Bank &
The Amended Complaint states in an allegation common to all Plaintiffs "that all conditions precedent including the exhaustion of administrative remedies to maintaining this action have been performed or have occurred or are futile." (Am. Compl. ¶ 47.) This pleading is insufficient. It is well established that ERISA complaints containing bald assertions that administrative remedies have been exhausted do not withstand a 12(b)(6)motion. See Hoffman v. Empire Blue Cross & Blue Shield, No. 96-5448, 1999 WL 782518, *13 (S.D.N.Y. Sept. 28 1999); American Medical Ass'n v. United Healthcare Corp., No. 00-2800, 2008 WL 3914868, *13 (S.D.N.Y. Aug. 22, 2008) (dismissing ERISA claims that contained a "blanket assertion" of exhaustion of administrative remedies). While a plaintiff may be excused from exhausting administrative remedies where such exhaustion would be futile, the Second Circuit requires a "clear and positive showing that seeking review by [the defendant] would be futile ..." Jones v. UNUM Life Ins. Co. of Am.,
Jean-Pierre contends that her counsel's letters to Rawlings "disputing the claims and citing legal authority" and "requesting documentation from said Defendants to justify the claims" should be considered sufficient exhaustion of remedies. (See Pls. Opp. to Defs. Aetna, Rawlings, et al. 18.) Further, plaintiff argues that she was never told of her right and/or obligation to follow the detailed grievance procedure set forth in her plan.
Accordingly, Jean-Pierre's claim for repayment is dismissed for failure to exhaust administrative remedies and the Defendants' Motions to Dismiss the first count for repayment are GRANTED.
II. Declaratory Judgment (Count II)
Plaintiffs' second count is for "Declaratory Relief" for the ERISA violations alleged in the First Count. Specifically,
The Declaratory Judgment Act does not "provide an independent cause of action." In re Joint E. & S. Dist. Asbestos Litig.,
Nor would this action otherwise be ripe for declaratory adjudication under ERISA's provision granting a participant or beneficiary the right to "clarify his rights to future benefits under the terms of the plan ..." 29 U.S.C. § 1132(a)(1)(B). An action seeking to "clarify ... rights to future benefits" is still subject to the same exhaustion requirement as is an action to recover benefits due. See Kennedy v. Blue Cross & Blue Shield,
Defendants' Motion to Dismiss the Second Count is thereby GRANTED as to all Defendants.
III. ERISA § 502(c)(7)(Count III)
In the Third Count, Plaintiffs state that "Defendants failed to respond or comply with requests for documentation in violation of 29 U.S.C. 1132, et seq." and seeks, for each plaintiff, $100 per day, "as per ERISA 502(c)(7) ..." (Am. Compl. ¶ 131.) Plaintiffs have voluntarily withdrawn this
IV. The Fair Debt Collection Practices Act (Count IV)
The FDCPA prohibits a "debt collector" from using "any false, deceptive, or misleading representation or means in connection with the collection of any debt." 15 U.S.C. 1692e.
15 U.S.C. § 1692 a(6) see Franceschi v. Mautner-Glick Corp.,
Plaintiffs' Fourth Count alleges that Defendants Rawlings, HRI, and Ingenix ("Subrogation Agent Defendants") violated the FDCPA, 15 U.S.C. § 1692 et seq. (Am. Compl. ¶ 32.) In the Amended Complaint, Plaintiffs allege that the Subrogation Agent Defendants—acting on behalf of health insurance carriers
The Subrogation Agent Defendants point to several provisions of the FDCPA to argue that they are not covered by the Act. The Court agrees that these Defendants fall within the exception to the definition of a debt collector carved out by Section 1692a(6)(F)(ii) of the statute. As a result, the Court will not reach the additional bases for the Defendants' argument pertaining to dismissal of the FDCPA claim.
Section 1692a(6)(F)(iii) exempts from the definition of "debt collector"
§ 1692 a(6)(F)(iii). Thus, the FDCPA is inapplicable to "collection efforts by those who obtained the right to payment on the debt before the debt was in default." Franceschi, 22 F.Supp.2d at 253; See also Healy v. Jzanus Ltd., No. 02 CV 1061, 2006 VJL 898067, at *5 (E.D.N.Y.
In this case, Plaintiffs do not allege the existence of any debt that was in default at the time it was obtained by the Subrogation Agent Defendants. The earliest date the Plaintiffs' debts could have been in default was the date they first received payment from any third parties in connection with their motor vehicle accidents. See e.g. Hamilton v. Trover Solutions, Inc., No. Civ. A. 01-650, 2003 WL 21105100 at 3-4 (E.D.La. May 13, 2003) (holding that "it was not possible for [plaintiff] to be in default until he began receiving payments from third parties," and therefore finding that HRI, a co-Defendant in this case, was not a "debt collector" under the FDCPA); see also Dantin v. Rawlings Co., L.L.C., No. 03-116-A, 2005 WL 6075786 (M.D.La. Apr. 13, 2005) (holding that Rawlings—a co-Defendant in the present action—is not a "debt collector" within the meaning of the FDCPA).
In this case, the documents supporting the Plaintiffs' claim—namely the letters attached to the Plaintiffs' Amended Complaint and the settlement dates provided to the Court by Plaintiffs' counsel
Plaintiffs do not address why the exemption contained in Section 1692a(6)(F)(iii) should not be invoked. Plaintiffs do not contest the "in default" and "obtained" dates asserted by Defendants. Rather, Plaintiffs recite the statutory definition of "debt collector," and summarily conclude that the Subrogation Agent Defendants are in the business of collecting debts and are "debt collectors." In support of their position, Plaintiffs rely upon the Fifth Circuit's opinion in Hamilton v. United Healthcare of Louisiana, Inc.,
In Hamilton I, the plaintiff was in a motor vehicle accident and sued HRI for attempting to enforce a health insurer's subrogation and reimbursement rights. The district court granted HRI's motion to dismiss on the basis that Hamilton's alleged debt was not a "debt" under the FDCPA, but it did not initially rule on the issue of whether HRI was a "debt collector" under the statute. Id. at 393-94. The Fifth Circuit reversed, holding that the alleged debt was a "debt" for FDCPA purposes. Id. at 391-393. The Fifth Circuit then remanded, noting that "[r]esolution of the `debt collector issue in this case is clearly tied to a determination of the circumstances surrounding the inception of the debt. Accordingly, we REMAND to the district court for further consideration.'" Id. at 394. On remand, the district court found that HRI—the same Defendant as in the present action—is not a "debt collector" under the FDCPA because it obtains the debt prior to the time it is in default, thereby qualifying under the exemption under clause (F)(iii) of 15 U.S.C. § 1692a(6). Hamilton v. Trover Solutions, Inc., No. Civ. A. 01-650, 2003 WL 21105100 (E.D.La. May 13, 2003).
In Hamilton v. Trover Solutions, Inc., 104 Fed.Appx. 942 (5th Cir.2004)("Hamilton II") the Fifth Circuit affirmed the district court's summary judgment ruling "[f]or the reasons given by the district court." Id. at 944. Thus, the Hamilton cases provide no support for Plaintiffs' position, but rather support the Defendants' view that the Subrogation Agent Defendants are exempt from the definition of "debt collector."
Lastly, Plaintiffs request limited discovery pertaining to the whether the Subrogation Agent Defendants are in the business of collecting debts on behalf of their clients, health insurance carriers. In this case, additional discovery is not necessary because the key facts necessary for the resolution of the FDCPA claim are undisputed. Specifically the parties do not dispute: (1) the nature of the contract relationship between the subrogation agents and the health insurance carriers;
For the reasons set forth above, Defendants' Motions to Dismiss are GRANTED and this action is hereby DISMISSED in its entirety without prejudice. The Clerk of the Court is directed to close this case.
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