Patterson v. United Healthcare Ins. Co.
| Docket Number | 22-3167 |
| Decision Date | 01 August 2023 |
| Parties | Eric L. Patterson, Plaintiff-Appellant, v. United HealthCare Insurance Company; UnitedHealth Group, Inc.; United HealthCare Services, Inc.; Optum, Inc.; Swagelok Company; Kreiner &Peters Co., L.P.A.; Shaun D. Byroads; Daran Paul Kiefer, Defendants-Appellees. |
| Court | U.S. Court of Appeals — Sixth Circuit |
Argued: October 27, 2022
Appeal from the United States District Court for the Northern District of Ohio at Cleveland. No. 1:21-cv-00470-J. Philip Calabrese, District Judge.
ARGUED:
Patrick J. Perotti, DWORKEN &BERNSTEIN CO., L.P.A Painesville, Ohio, for Appellant.
Wesley E. Stockard, LITTLER MENDELSON, P.C., Atlanta, Georgia, for Appellees.
ON BRIEF:
Patrick J. Perotti, DWORKEN &BERNSTEIN CO., L.P.A., Painesville, Ohio, Benjamin P. Pfouts, KISLING, NESTICO & REDICK, Fairlawn, Ohio, for Appellant.
Wesley E. Stockard, LITTLER MENDELSON, P.C., Atlanta, Georgia, Noah G. Lipschultz, LITTLER MENDELSON, P.C., Minneapolis, Minnesota, James P. Smith, LITTLER MENDELSON, P.C., Cleveland, Ohio, Daran Kiefer, KREINER &PETERS CO., LPA, Cleveland, Ohio, for Appellees.
Before: SILER, NALBANDIAN, and READLER, Circuit Judges.
Eric Patterson was injured in an auto accident. Patterson's medical expenses were paid by his insurer, United. He also recovered for his injuries from the other driver. United claimed that Patterson's insurance plan obliged him to pay those monies to United. Eventually, the parties settled the matter, with Patterson agreeing to pay the plan $25,000. Patterson later obtained a copy of the plan document, which contained no provision for reimbursement rights. So he filed suit against United and related entities under the Employee Retirement Income Security Act of 1974 (ERISA). The district court dismissed some of Patterson's claims due to a lack of standing and the others because they failed to state a claim. We reverse in part and affirm in part.
The following facts are taken from Patterson's complaint. United, an umbrella term for several affiliated companies, provided medical insurance to Patterson and his wife through Patterson's employer, Swagelok Company. The plan in which the Pattersons enrolled was subject to ERISA. See 29 U.S.C. §§ 1101, 1103(a). Upon signing up, Patterson received from United a summary plan description, an ERISA-mandated synopsis of important plan terms. See id. § 1022(a). Yet he was not given a plan document, a companion instrument that typically contains all of a plan's governing language. See CIGNA Corp. v. Amara, 563 U.S. 421, 437 (2011). But see Bd. of Trs. v. Moore, 800 F.3d 214, 220 (6th Cir. 2015) ().
The summary plan description said that if a beneficiary recovered from a third party for an insured incident, the plan had a right to reimbursement. That language became noteworthy when Patterson was injured in a traffic accident with a tractor trailer. United covered his accident-related medical expenses, as it was obligated to do under the plan. United's agent and subsidiary, Optum, notified Patterson it would invoke the plan's reimbursement right if he recovered from the other driver. Patterson later sued the other driver's employer in state court for his injuries. In the same suit, Patterson joined the plan to obtain a declaratory judgment that the plan had no reimbursement right. During discovery, lawyers hired by United to represent the plan claimed that no plan document existed. Patterson recovered monies from the other driver's employer. When he did, he settled with the plan, agreeing to pay Optum $25,000, which he alleged was to be deposited into the plan's accounts.
Ordinarily, that would have been the end of the story. But when misfortune struck again only months later, a new chapter was added. Patterson's wife suffered injuries in a second traffic accident. The process repeated: United paid for her medical care, Optum notified the Pattersons it would seek some or all of any recovery from the other driver, and Patterson's wife sued the driver and sought a declaratory judgment in state court that United had no reimbursement right. But history did not repeat itself in all respects. After initially denying the existence of a plan document, as they did in the first state court case, the plan's attorneys produced one. The tendered plan document stated that it took precedence over the summary plan document in the event of a discrepancy between the two. And while the summary plan document included a reimbursement right, the plan document did not. On that basis, the state court entered summary judgment in Patterson's wife's favor on her declaratory judgment claim against the plan.
Patterson sued United, Optum, Swagelok, and the plan's attorneys-but not the plan itself. The complaint alleged that defendants violated various ERISA duties owed to Patterson, entitling Patterson to the return of his $25,000. Extrapolating from his and his wife's experiences, Patterson also asserted the existence of a larger scheme to swindle beneficiaries out of their third-party recoveries. To end that practice and remedy its effects, Patterson asked for injunctive and monetary relief on the plan's and other beneficiaries' behalf.
Defendants moved to dismiss Patterson's complaint. While the motion to dismiss was under advisement, Patterson moved for leave to amend his complaint. The proposed amended complaint would have sought class status, narrowed the factual allegations and group of named defendants, and dropped several claims.
The district court dismissed the complaint. To its mind, Patterson had standing to sue only for his $25,000 payment to Optum, not for the injuries purportedly inflicted upon other insureds or for other forms of relief. And as to his claim seeking $25,000, the district court concluded, Patterson did not state a viable claim under any of ERISA's causes of action. The court also denied on futility grounds Patterson's motion for leave to amend. This appeal followed.
We review de novo the complaint's dismissal. Operating Eng'rs' Loc. 324 Fringe Benefit Funds v. Rieth-Riley Constr. Co., 43 F.4th 617, 621 (6th Cir. 2022). For jurisdictional and merits purposes alike, Patterson's well-pleaded factual allegations (and reasonable inferences from those allegations) are taken as true, and we ask whether those allegations move his claims across the line from possible to plausible to survive dismissal. Forman v. TriHealth, Inc., 40 F.4th 443, 448 (6th Cir. 2022) (citing Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)); Ass'n of Am. Physicians & Surgeons v. U.S. Food & Drug Admin., 13 F.4th 531, 54344 (6th Cir. 2021). We start with two jurisdictional issues raised by defendants: standing and Rooker-Feldman abstention. See Miller v. Bruenger, 949 F.3d 986, 990 (6th Cir. 2020).
A.1. First up is the threshold standing question. Like every other plaintiff in federal court, Patterson must establish standing to bring his claims. Glennborough Homeowners Ass'n v. USPS, 21 F.4th 410, 413-14 (6th Cir. 2021). That means Patterson must make out an injuryin-fact traceable to defendants' conduct that will likely be redressed by the requested relief. Id. at 414; Thole v. U.S. Bank N.A., 140 S.Ct. 1615, 1618 (2020). An injury-in-fact must be "concrete and particularized" and "actual or imminent, not conjectural or hypothetical." Lujan v. Defs. of Wildlife, 504 U.S. 555, 560 (1992) (cleaned up). Because standing is "not dispensed in gross," Patterson must establish his standing as to each claim and each type of relief sought. Universal Life Church Monastery Storehouse v. Nabors, 35 F.4th 1021, 1031 (6th Cir. 2022) (quoting Lewis v. Casey, 518 U.S. 343, 358 n.6 (1996)).
Our standing analysis centers on Patterson's purported loss of $25,000. Monetary loss is a concrete injury. TransUnion LLC v. Ramirez, 141 S.Ct. 2190, 2204 (2021). Defendants' behavior allegedly caused Patterson to lose those funds. And an award of $25,000 would redress his injury. The district court thus correctly found that Patterson has standing to sue for return of his $25,000 settlement payment. But his personal interest in this suit ends with that sum. Patterson has not alleged a plausible future injury entitling him to prospective injunctive relief. See Werner v. Primax Recoveries, Inc., 365 Fed.Appx. 664, 668 (6th Cir. 2010). For starters, the complaint does not clearly state whether Patterson remains a beneficiary of the plan. See id. Even if he is, he has not plausibly alleged that his experience-an accident, a recovery from the other driver, and a request by United for reimbursement-is certainly impending. See Clapper v. Amnesty Int'l USA, 568 U.S. 398, 409 (2013).
Likewise deficient are the other injuries adverted to in the complaint, allegedly consisting of third-party awards or settlements wrongfully taken from other plan beneficiaries and wasted or mismanaged plan assets. Two apparent problems arise with respect to those injuries. First, it is not entirely clear that Patterson would have standing to raise them on behalf of the plan or other beneficiaries. See Hollingsworth v. Perry, 570 U.S. 693, 708 (2013) ; Duncan v. Muzyn, 885 F.3d 422, 428 (6th Cir. 2018); Soehnlen v. Fleet Owners Ins. Fund, 844 F.3d 576, 583 (6th Cir. 2016) ...
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