Cole v. Travelers Ins. Co., CIV.A. 300CV957CFD.

• Decision Date: 13 June 2002
• Docket Number: No. CIV.A. 300CV957CFD.,CIV.A. 300CV957CFD.
• Citation: 208 F.Supp.2d 248
• Parties: Richard A. COLE, M.D., Plaintiff, v. TRAVELERS INSURANCE CO., et al., Defendants
• Court: U.S. District Court — District of Connecticut

208 F.Supp.2d 248

Richard A. COLE, M.D., Plaintiff, v. TRAVELERS INSURANCE CO., et al., Defendants

No. CIV.A. 300CV957CFD.

United States District Court, D. Connecticut.

June 13, 2002.

Richard A. Cole, Newburyport, MA, Pro se.

Peter M. Nolin, Gary Scott Klein, Sandak Hennessey & Greco, Stamford, CT, R. Cornelius Danaher, Jr., Danaher, Tedford, Lagnese & Neal, Hartford, CT, Kay Kyungsun Yu, Morgan, Lewis & Bockius LLP, Philadelphia, PA, Vaughan Finn, Shipman & Goodwin, Hartford, CT, for Defendants.

RULING ON MOTIONS TO DISMISS

DRONEY, District Judge.

On September 26, 2001, this Court granted the motions to dismiss the instant action by Erie Insurance Group Health Protection Plan ("Erie"), Maplevale Farms, Inc. Employee Benefit Plan ("Maplevale"), Cooperating Railway Labor Organizations Employee Benefit Plan ("CRLO"), NYNEX Medical Expense Plan ("NYNEX") and Travelers Insurance Company ("Travelers"). On October 1, 2001, the Court vacated that dismissal¹ and entered an order that the parties submit memoranda regarding whether the plaintiff's failure to comply with the 120 day service requirement of Federal Rule of Civil Procedure 4(m) should be a basis for dismissing this action. In light of those memoranda, as well as the defendants' previous filings, the motions to dismiss by Erie, CRLO, and Maplevale [Documents # 5, 31] are GRANTED, and the motions to dismiss by Travelers and NYNEX [Documents # 7, 19, 23] are GRANTED IN PART and DENIED IN PART.

I. Background

The plaintiff brings this action pursuant to the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001 et seq., claiming that the defendants failed to pay him for medical services that he rendered to plan beneficiaries in violation of ERISA § 502(a)(1)(B), 29 U.S.C. § 1132(a)(1)(B), and ERISA § 502(a)(3), 29 U.S.C. § 1132(a)(3). He also claims that the defendants' actions constituted breach of contract, fraud, and unjust enrichment in violation of Connecticut law.

The plaintiff practiced medicine in Erie, Pennsylvania.² On December 21, 1992, the plaintiff's license to practice medicine was suspended, following his conviction in federal court in November 1992 for unlawful distribution of a controlled substance, mail fraud, and tax evasion³. Six years later—to the day—the plaintiff filed a pro se action against Travelers and several employee benefit plans insured or administered by Travelers alleging similar claims to those alleged in the instant case.

The Court dismissed that action based on the plaintiff's failure to effect service of process as required by Federal Rule of Civil Procedure 4(h)(1). See Cole v. Travelers Ins. Co., No. 3:98 CV 2480(CFD), 2000 WL 502689, at *1 (D.Conn. Mar. 15, 2000). The dismissal, however, was without prejudice to the plaintiff refiling the action within sixty days. See id. at *3. The plaintiff then filed this pro se action on May 23, 2000.⁴ The plaintiff subsequently filed an amended complaint on August 3, 2000, dropping the defendant Turben Trucking Employee Benefit Plan and adding as a defendant, Cooperating Railway Labor Organizations Employee Benefit Plan. On October 4, 2001, the plaintiff submitted a motion for leave to file a second amended complaint [Doc.# 47-2], which the Court finds good cause to permit under Parker v. Columbia Pictures Industries, 204 F.3d 326, 340 (2d Cir.2000), and Fed.R.Civ.P. 16(b), and accordingly, is GRANTED.

According to the plaintiff's second amended complaint, he provided medical services for eight patients covered by the named employee benefit plans⁵ and that each of the plans either purchased insurance from Travelers or used Travelers as an administrator for its plan. The patients and the plans under which they were allegedly covered are as follows: Mary Berarducci (Erie), Crystal Gould (Maplevale), Roberta Joanethis (Ten Pin Lanes), Lori Katta (N.Y.NEX), Marshall Mease (Great Lakes), Linda Soto (Erie), Antoinette Telega (Erie), and Donald Turben (CRLO).⁶ Cole also contends that these patients assigned their rights to receive payment for the medical services to him, and that he submitted claims to the defendants for reimbursement for the medical services. However, he contends, the defendants never reimbursed him for the medical services that he provided.

Travelers, NYNEX, Erie, Maplevale, and CRLO have filed motions to dismiss. As noted earlier, on September 26, 2001, this Court granted the defendants' motions to dismiss, and on October 1, 2001, the Court vacated that dismissal.

II. Motion to Dismiss Standard

When considering a Rule 12(b) motion to dismiss, the Court accepts as true all factual allegations in the complaint and draws inferences from these allegations in the light most favorable to the plaintiff. See Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974); Easton v. Sundram, 947 F.2d 1011, 1014-15 (2d Cir.1991), cert. denied, 504 U.S. 911, 112 S.Ct. 1943, 118 L.Ed.2d 548 (1992). Dismissal is warranted only if, under any set of facts that the plaintiff can prove consistent with the allegations, it is clear that no relief can be granted. See Hishon v. King & Spalding, 467 U.S. 69, 73, 104 S.Ct. 2229, 81 L.Ed.2d 59 (1984); Frasier v. Gen. Elec. Co., 930 F.2d 1004, 1007 (2d Cir.1991). "The issue on a motion to dismiss is not whether the plaintiff will prevail, but whether the plaintiff is entitled to offer evidence to support his or her claims." United States v. Yale New Haven Hosp., 727 F.Supp. 784, 786 (D.Conn. 1990) (citing Scheuer, 416 U.S. at 232, 94 S.Ct. 1683). Thus, a motion to dismiss should not be granted "unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief." Sheppard v. Beerman, 18 F.3d 147, 150 (2d Cir.1994) (citations and internal quotation marks omitted), cert. denied, 513 U.S. 816, 115 S.Ct. 73, 130 L.Ed.2d 28 (1994).

In its review of a motion to dismiss, the Court may consider "only the facts alleged in the pleadings, documents attached as exhibits or incorporated by reference in the pleadings and matters of which judicial notice may be taken." Samuels v. Air Transport Local 504, 992 F.2d 12, 15 (2d Cir.1993). "While the pleading standard is a liberal one, bald assertions and conclusions of law will not suffice" to overcome a motion to dismiss. Leeds v. Meltz, 85 F.3d 51, 53 (2d Cir.1996).

III. Discussion

The defendants have moved to dismiss on the following grounds: (1) the plaintiff's ERISA claims are barred by the applicable statutes of limitation; (2) the plaintiff's state law claims are preempted by ERISA; (3) the plaintiff lacks standing to sue under ERISA; (4) the plaintiff has failed to exhaust his administrative remedies; and (5) venue is improper in this district.

A. Statutes of Limitation

With regard to their contention that Cole's ERISA claims are barred by the applicable statutes of limitation, the defendants contend that Cole submitted claims for reimbursement for the medical services he provided to the eight patients covered by the defendant plans, which were denied. They also contend that Cole failed to appeal those denials within the plans' procedures for doing so, or to commence this action challenging the denials within the applicable statutes of limitation.⁷ In response, Cole claims that the defendants never administratively denied his claims for reimbursement and thus, that the statutes of limitation have not begun to run.

1. Statute of Limitations for Section 502(a)(1)(B) Claims

"As ERISA does not prescribe a limitations period for actions under § 1132, the controlling limitations period is that specified in the most nearly analogous state limitations statute." Miles v. New York State Teamsters Conference Pension & Ret. Fund Employee Pension Benefit Plan, 698 F.2d 593, 598 (2d Cir.1983). The state limitations statute most analogous to § 502(a)(1)(B) claims for wrongful denial of benefits is that for contract actions. See id. at 598 (applying New York's six-year statute of limitations for contract actions).

The defendants contend that Connecticut's six-year statute of limitations for contract actions applies because Cole chose to file this action in Connecticut.⁸ See Conn. Gen.Stat. § 52-576.⁹ Cole does not dispute the application of Connecticut's six-year statute of limitations. However, as indicated, he contends that the statute of limitations has not begun to run because the defendants never denied his requests for reimbursement.

An ERISA cause of action under § 502(a)(1)(B) accrues, and thus the statute of limitations begins to run, when an employee benefit plan clearly and unequivocally repudiates a beneficiary's claim for benefits under the plan. See Carey v. International Brotherhood of Electrical Workers Local 363 Pension Plan, 201 F.3d 44, 50 (2d Cir.1999). The beneficiary also must have actual or constructive notice of the repudiation of his or her claim. See id. at 48-49 n. 4. In addition, although a limitations period generally begins to run when an employee benefit plan denies a beneficiary's formal application for benefits, a repudiation may occur regardless of whether the beneficiary has filed a formal application for benefits. See id. at 47, 49.

ERISA regulations in place at the time of the events giving rise to this action further provided that a claim for benefits that has not been formally denied by an employee benefit plan within ninety days from the date of submission is deemed denied as a matter of law. See 29 C.F.R. § 2560.503-1(e)(1)-(3) (1993). In addition the regulations provided that if a review of a denial is requested, the benefit plan must render a decision within sixty days or the claim is deemed denied on review. See 29 C.F.R. § 2560.503-1(h) (1993).¹⁰

In this case, as indicated, Cole has alleged that he provided medical services for eight patients covered by the defendant employee benefit plans. Cole has provided some documentation relating to his treatment...