Thompson v. Transam Trucking Inc., Case No. 2:08-cv-927

CourtUnited States District Courts. 6th Circuit. United States District Courts. 6th Circuit. Southern District of Ohio
PartiesCYNTHIA J. THOMPSON, Plaintiff, v. TRANSAM TRUCKING, INC., et al., Defendants.
Docket NumberCase No. 2:08-cv-927
Decision Date08 June 2011

JUDGE GREGORY L. FROST

Magistrate Judge Terence P. Kemp

OPINION AND ORDER

This matter is before the Court on the Motion of Defendants Columbus Orthopaedic Group, Inc. and Robert Steensen, M.D. for Summary Judgment (ECF No. 88), Plaintiff Cynthia Thompson's Memorandum in Opposition to Defendants Columbus Orthopaedic Group's and Dr. Robert Steensen's Motion for Summary Judgment (ECF No. 91), and the Reply Memorandum of Defendants Columbus Orthopaedic Group, Inc. and Robert Steensen, M.D. in Support of Motion for Summary Judgment Filed January 13, 2011 (ECF No. 92). For the reasons that follow, the Court GRANTS the Motion of Defendants Columbus Orthopaedic Group, Inc. and Robert Steensen, M.D. for Summary Judgment.

I. Background

Plaintiff filed the complaint in this action on October 1, 2008 (ECF No. 4), and filed an amended complaint upon leave of Court on January 29, 2009 (ECF No. 16). The amended complaint names as defendants FMH Benefit Services, Inc. ("FMH"), TransAm Trucking, Inc., the TransAm Trucking, Inc. Employee Benefit Plan ("Health Plan Defendants"), Columbus Orthopaedic Group, Inc., and Robert Steensen, M.D. ("Physician Defendants").

Defendant TransAm Trucking, Inc. is the plan sponsor and administrator for Defendant TransAm Trucking's Employee Benefit Plan ("Plan"). The Plan is an employee welfare benefit plan and is subject to the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001, et seq. Defendant FMH supervises the claims for the Plan. Plaintiff was a participant in the Plan and was entitled to receive certain health care benefits under it.

On January 17, 2008, Plaintiff sought treatment for her knee from Defendant Robert Steensen, M.D., who practices with Defendant Columbus Orthopaedic Group, Inc. During this office visit and prior to rendering any medical care, Debie Spain, an employee of Columbus Orthopaedic, contacted FMH to obtain a pre-certification authorization code, which was provided by FMH. Plaintiff testified that Spain represented to her on that date that her knee surgery would be fully covered as an "in-network" expense and that she was told the same thing at another time when Plaintiff asked for confirmation of this information. Plaintiff testified that Spain specifically indicated that both Dr. Steensen and Mount Carmel West Hospital were preferred in-network providers.

On February 8, 2008, Plaintiff was admitted to Mount Carmel to undergo the knee surgery. At plaintiff's pre-surgery physical exam and on the day of surgery, Plaintiff asked representatives at Mount Carmel whether the hospital was an in-network provider.

In connection with the surgery, Plaintiff incurred medical bills totaling approximately $85,000.00 and submitted claims for payment of those bills to FMH. FMH paid 25% of the amount due to Mount Carmel, which is the out-of-network rate, and paid 80% of the amount due to Dr. Steensen, which is the in-network rate. Plaintiff filed this action to recover the medical costs she incurred at Mount Carmel that would have been paid if it had been considered to be anin-network provider or if the services were covered under the Plan's exception allowing in-network payment when the plan participant received in-network care at a non-network provider.

In the amended complaint (ECF No. 16), Plaintiff alleged claims for relief against the Physician Defendants based upon state law, which the Physician Defendants moved to have dismissed (ECF No. 30). This Court granted in part and denied in part the Physician Defendants' motion, granting it in regards to plaintiff's claim for professional negligence and denying it in regards to plaintiff's claims for negligent misrepresentation and promissory estoppel. (ECF No. 43.)

Plaintiff alleged these same state law claims against the Health Plan Defendants. Plaintiff, however, moved to dismiss her claims of negligent misrepresentation and professional negligence against the Health Plan Defendants, which this Court granted. (ECF No. 59.) Plaintiff also alleged claims against the Health Plan Defendants for entitlement to benefits under ERISA, 29 U.S.C. § 1132(a)(1)(B), failure to provide requested Plan documents required by ERISA, 29 U.S.C. § 1132(c), and for failure to provide notice of entitlement to continuing coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, 29 U.S.C. § 1161, et. seq. ("COBRA").

On May 8, 2009, the Health Plan Defendants filed the Health Plan Defendants' Motion for Summary Judgment and for Judgment on the Pleadings (ECF. No. 39), and on July 31, 2009, Plaintiff filed Plaintiff's Motion for Leave to File Sur-Reply Instanter (ECF. No. 54). After consideration of both of those motions, this Court issued an Opinion and Order in which it indicated that it could not appropriately decide the motions because the parties had failed to file the administrative record, which it ordered the parties to do. (ECF. No. 59.) The parties timelycomplied with the Court's order, jointly filing the administrative record. (ECF No. 60.)

Once the administrative record was filed, the Court again reviewed the Health Plan Defendants' Motion for Summary Judgment and for Judgment on the Pleadings and plaintiff's Motion for Leave to File Sur-Reply Instanter. On January 5, 2010, the Court issued an Opinion and Order in which it denied the Health Plan Defendants' Motion for Summary Judgment and for Judgment on the Pleadings, denied as moot plaintiff's Motion for Leave to File Sur-Reply Instanter, remanded the action to the Plan administrator with instructions to conduct a timely, full and fair review of plaintiff's benefits claim, and administratively closed the case pending completion of the administrative appeal process. (ECF. No. 61.) The Court also directed the parties to contact the Court within one week of the final administrative decision so that, if necessary, the case could be restored to the active docket.

On April 8, 2010, the parties contacted the Court to inform it that the administrative process was complete and that FMH had upheld the denial of plaintiff's request for benefits. The Court scheduled a status conference for April 14, 2010. (ECF. No. 62.) As a result of the conference, the Court restored this case to its active docket, entered judgment against Plaintiff and in favor of the Health Plan Defendants on Plaintiff's claim for relief filed under COBRA, directed the parties to supplement the administrative record filed before this Court, and set forth a schedule to accommodate the discovery and briefing of the remaining issues that were before the Court. (ECF. No. 63.)

The issues remaining before the Court were (1) review of the benefits denial; (2) plaintiff's promissory estoppel claim against the Health Plan Defendants; (3) plaintiff's claim that the Health Plan Defendants failed to provide requested Plan documents; and (4) Plaintiff'snegligent misrepresentation and promissory estoppel claims against the Physician Defendants. The parties agreed that after this Court determined the first three issues, which deal only with the Health Plan Defendants, it would schedule a status conference to determine how the fourth issue, dealing only with the Physician Defendants, would be addressed.

Plaintiff filed a motion for judgment on the administrative record (ECF No. 73) and the Health Plan Defendants filed supplements (ECF Nos. 72, 78) to their previously filed dispositive motion (ECF No. 39). On October 26, 2010, the Court issued an Opinion and Order in which it granted judgment on the administrative record to the Health Plan Defendants, granted summary judgment to the Health Plan Defendants on Plaintiff's promissory estoppel claim, and denied summary judgment on Plaintiff's non-disclosure claim. (ECF No. 82.)

On December 6, 2010, this Court held a status conference with Plaintiff and the Physician Defendants, setting forth a schedule to address the remaining claims against these defendants. Pursuant to that schedule, the Physician Defendants filed a motion for summary judgment that is now ripe for review.

II. Standard

Summary judgment is appropriate "if the movant shows that there is not genuine dispute as to any material fact and that the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). The Court may therefore grant a motion for summary judgment if the nonmoving party who has the burden of proof at trial fails to make a showing sufficient to establish the existence of an element that is essential to that party's case. See Muncie Power Prods., Inc. v. United Techs. Auto., Inc., 328 F.3d 870, 873 (6th Cir. 2003) (citing Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986)).

The "party seeking summary judgment always bears the initial responsibility of informing the district court of the basis for its motion, and identifying those portions" of the record which demonstrate "the absence of a genuine issue of material fact." Celotex Corp., 477 U.S. at 323. The burden then shifts to the nonmoving party who "must set forth specific facts showing that there is a genuine issue for trial." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 250 (1986) (quoting Fed. R. Civ. P. 56(e)). The Court must view the evidence in the light most favorable to the nonmoving party and must draw all reasonable inferences in favor of that party. Id. (citing Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986)); Hamad v. Woodcrest Condo. Ass'n, 328 F.3d 224, 234 (6th Cir. 2003). A genuine issue of material fact exists "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Muncie Power Prods., Inc., 328 F.3d at 873 (quoting Anderson, 477 U.S. at 248). Consequently, the central issue is " 'whether the evidence presents a sufficient disagreement to...

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