Gardi v. United Healthcare Servs., Inc.
| Decision Date | 30 January 2020 |
| Docket Number | CASE NO. 19-80369-CIV-MARRA |
| Parties | Joseph GARDI, Plaintiff, v. UNITED HEALTHCARE SERVICES, INC. and HCA Inc., Defendants. |
| Court | U.S. District Court — Southern District of Florida |
Joseph Gardi, Medina, OH, pro se.
Maria T. Santi, Health and Medicine Law Firm, PLLC, Coral Gables, FL, for Plaintiff.
Andre Velosy Bardos, Gray Robinson, P.A., Tallahassee, FL, Daniel Alter, GrayRobinson PA, Fort Lauderdale, FL, Edward Keenan Cottrell, Smith Gambrell Russell, Jacksonville, FL, Randall A. Constantine, Pro Hac Vice, Smith, Gambrell & Russell, LLP, Atlanta, GA, for Defendants
This Cause is before the Court upon Defendant United Healthcare Services, Inc.'s ("United") Motion to Dismiss Counts II through VI of Plaintiff's Complaint (DE 13); Defendant HCA Inc.'s ("HCA") Motion to Dismiss Plaintiff's Complaint (DE 15); United's Motion to Strike Ryan N. Chae Affidavit and All References to It (DE 20); and HCA's Motion to Strike Ryan N. Chae Affidavit and All References to It (DE 21). Plaintiff Joseph Gardi ("Plaintiff") has filed responses in opposition to the above motions: Response in Opposition to HCA's Motion to Dismiss (DE 18), which attached the Affidavit of Ryan N. Chae ("Chae Affidavit") (DE 18-1); Response in Opposition to United's Motion to Dismiss (DE 19) which attached the Chae Affidavit (DE 19-1); and Plaintiff's Combined Response to Defendants' Motion to Strike (DE 25). Defendants filed replies in support of their motions. (DE 23, 24, 25, 26).
The Court has considered the motions and is otherwise fully advised in the premises.
Plaintiff Joseph Gardi, the Insurance Plan Beneficiary, files the instant action against United and HCA alleging violations of: 1) Consolidated Omnibus Budget Reconciliation Act of 1986, 29 U.S.C. § 1161 et seq. ("COBRA"); 2) the Employment Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. ("ERISA"); and 3) Medicare Secondary Payer laws, 42 U.S.C. § 1395y(b). (DE 1 at 1). Plaintiff is suing for damages, attorney's fees and costs, and other relief. (Id. ). Plaintiff's Complaint is comprised of six counts:
(Id. at ¶¶ 44-58, 59-63, 64-72, 73-79; 80-110, 111-16).
Plaintiff alleges that at all material times he was covered by the health insurance plan sponsored and self-funded by his ex-wife's employer, HCA, Inc. (DE 1 at ¶ 11). The Complaint alleges the plan, HCA Health and Welfare Benefits Plan (the "Plan"), had Defendant United Healthcare as the claims administrator. (Id. ). United, according to the Complaint, is and was a health insurance company authorized to provide health insurance coverage and to administer health benefits and related services. (Id. at ¶ 4).
As a result of Plaintiff's divorce, Plaintiff's coverage under the Plan ended on June 13, 2018 ("pre-Cobra period"). (Id. at ¶ 12). Plaintiff was granted Medicare Part A due to his disability on approximately July 1, 2016. (Id. at ¶ 13). Plaintiff alleges, however, that he did not utilize Medicare Part A, he has never had Medicare Part B, and at all times material, he alleges his primary health insurance plan was the HCA Health and Welfare Benefits Plan. (Id. ). Plaintiff alleges UHC always paid his claims without issue during the Pre-Cobra Period. (Id. ). Following the divorce, Plaintiff elected through COBRA to continue receiving medical benefits through the Plan. (Id. at ¶ 14). This COBRA coverage became effective on June 14, 2018 ("post-Cobra period"). (Id. ).
The Complaint states "[a]s for Plan and claim administration, the extent of each Defendant's involvement is not entirely clear at this juncture, but each Defendant was involved, in whole or in part." (Id. at ¶ 18).
The Complaint outlines three medically necessary treatments that Plaintiff alleges were impacted by Defendants' actions: 1) vitamins and minerals infusions; 2) Octagam
Immunoglobulin G (IGG) IV treatment; and 3) hyperbarics treatment. (Id. at ¶¶ 19-23, 24-35, 36-43). Plaintiff alleges that treatments were arbitrarily denied, which either forced him to forego treatments or required him to proceed with the treatments and pay out of pocket following delays. (Id. ). Plaintiff further alleges that Defendants failed to provide copies of the Summary Plan Description ("SPD") despite Plaintiff's repeated requests. (Id. ). The Court will address the Complaints factual allegations in greater detail as necessary below.
"A Rule 12(b)(6) motion to dismiss tests the sufficiency of the complaint against the legal standard set forth in Rule 8: ‘a short and plain statement of the claim showing that the pleader is entitled to relief.’ " Wilborn v. Jones , 761 F. App'x 908, 910 (11th Cir. 2019) (quoting Fed. R. Civ. P. 8(a)(2) ). When considering a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), the Court must "take the factual allegations in the complaint as true and construe them in the light most favorable to the plaintiff." Pielage v. McConnell , 516 F.3d 1282, 1284 (11th Cir. 2008).
"A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Ashcroft v. Iqbal , 556 U.S. 662, 678, 129 S.Ct. 1937, 173 L.Ed.2d 868 (2009). "[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." Id. (quoting Bell Atl. Corp. v. Twombly , 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007) ). Rivell v. Private Health Care Sys., Inc. , 520 F.3d 1308, 1309–10 (11th Cir. 2008) (quoting Twombly, 550 U.S. at 556, 127 S.Ct. 1955 ).
The identical Chae Affidavit was attached to Plaintiff's Responses in Opposition to the Defendants' Motions to Dismiss. (DE 18-1; 19-1). Defendants move to strike the Chae Affidavit as procedurally improper on a Motion to Dismiss because it invites the Court to consider facts beyond those alleged on the face of the Complaint and the documents attached thereto. (DE 20; DE 21).
Plaintiff responds that the Chae Affidavit refers to allegations made in Plaintiff's Complaint. (DE 25). Plaintiff urges the Court to consider the Affidavit an exception to the rule that Courts are constrained to the four-corners of the complaint because the document is: central to its claim; the contents are not in dispute; and the document is attached to the response to a motion to dismiss. (Id. at 5-6). Additionally, Plaintiff urges the Court to impose sanctions—including attorneys' fees—on Defendants for failing to make a reasonable or meaningful attempt to confer prior to filing the Motions to Strike. (Id. at 2-3).
1. Motion to Strike—Applicable Law:
The Eleventh Circuit has held "[o]rdinarily, we do not consider anything beyond the face of the complaint and documents attached thereto when analyzing a motion to dismiss." Fin. Sec. Assur., Inc. v. Stephens, Inc. , 500 F.3d 1276, 1284 (11th Cir. 2007). The court however, has "recognize[d] an exception, ... in cases in which a plaintiff refers to a document in its complaint, the document is central to its claim, its contents are not in dispute, and the defendant attaches the document to its motion to dismiss." Id. (citing Harris v. Ivax Corp., 182 F.3d 799, 802 n. 2 (11th Cir. 1999) ; Brooks v. Blue Cross & Blue Shield of Fla., Inc., 116 F.3d 1364, 1368–69 (11th Cir. 1997) ).
Plaintiff argues that the Motion to Strike should be denied because "[t]he Affidavit attached to Plaintiff's Responses to the Motions to Dismiss clarifies allegations already made in Plaintiff's Complaint and simply provides details related to these allegations." (DE 25 at 3). Plaintiff contends "paragraph 22 specifically incorporates the written request made by Ryan Chae to obtain a copy of the policy and/or SPD." (Id. ).
However, Plaintiff's Complaint does not explicitly make reference to Mr. Chae's Affidavit. Paragraph 22 of the Complaint states:
On or about April 13, 2018, and as a result of issuance of the Denial Letter, counsel for the Plan Beneficiary requested a copy of the Summary Plan Description ("SPD"). See Exhibit C . The SPD was thereafter requested multiple times by phone from United Healthcare and HCA. Both defendants failed to provide a copy of the SPD to the Plan Beneficiary. It was not until the undersigned submitted a request for documents and after multiple calls, that HCA provided the SPD on approximately September 25, 2018. Nevertheless, the copy provided was incomplete and only pages 1 through 148 were provided. See Exhibit D . The full complete copy was finally provided on or about November 2, 2018, by United Healthcare's legal counsel.
(DE 1 at 5-6) (emphasis in original).
In the context of a motion to strike documents attached in opposition to a motion to dismiss, the Complaint's vague allusions to efforts by Plaintiff's counsel contacting United and HCA do not constitute a reference to documents. See Brooks , 116 F.3d at 1369 (...
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