Traditions Senior Mgmt., Inc. v. United Health Adm'rs, Inc., Case No: 8:12-cv-2321-T-30MAP
| Court | United States District Courts. 11th Circuit. United States District Court of Middle District of Florida |
| Writing for the Court | JAMES S. MOODY |
| Parties | TRADITIONS SENIOR MANAGEMENT, INC., Plaintiff, v. UNITED HEALTH ADMINISTRATORS, INC., d/b/a UNITED HEALTH PLUS, GARDEN STATE HEALTHCARE ADMINISTRATORS, INC., JOSEPH SCHWARTZ, an individual, and OXFORD COVERAGE, INC., Defendants. |
| Docket Number | Case No: 8:12-cv-2321-T-30MAP |
| Decision Date | 27 June 2013 |
TRADITIONS SENIOR MANAGEMENT, INC., Plaintiff,
v.
UNITED HEALTH ADMINISTRATORS,
INC., d/b/a UNITED HEALTH PLUS,
GARDEN STATE HEALTHCARE ADMINISTRATORS, INC.,
JOSEPH SCHWARTZ, an individual, and OXFORD COVERAGE, INC., Defendants.
Case No: 8:12-cv-2321-T-30MAP
UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION
DONE and ORDERED: June 27, 2013
THIS CAUSE comes before the Court upon Defendants' Motion to Dismiss the Amended Complaint, Dkt. #30, the Plaintiff's Complaint, Dkt. #26, and Plaintiff's Response to Defendant's Motion to Dismiss, Dkt. #33. After reviewing these filings, the Court concludes the motion to dismiss should be granted in part and denied in part.
Traditions Senior Management, Inc. (TSM) alleges that in 2009, its insurance broker and advisor, Joseph Schwartz (Schwartz), advised TSM to accept an arrangement by which "Schwartz and his affiliated companies" -- United Health Administrators, Inc. (UHP), Garden State Health Care Administrators, Inc. (Garden), and Oxford Coverage, Inc. (Oxford) -- would take the risk and benefit of TSM becoming
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"self-insured." Dkt. #26, 3. "Schwartz and his affiliated companies" would collect premium payments and bear the risk of paying claims, even if the claims exceeded those premiums. Dkt . #26, 3-4. They would also keep premium payments in excess of covered claims. Dkt . #26, 3-4. TSM orally agreed to this arrangement, but no written contract was created. Dkt. #26, 3-4.
Under this plan, UHP was responsible for "processing and paying health benefits directly to the employees' health providers." Dkt. #26, 4. Garden received premiums and was responsible for proper distribution of employee health claims. Dkt. #26, 4. Oxford and Schwartz were "indemnifiers to pay covered health claims to the extent they exceeded the premiums paid by TSM." Dkt. #26, 4. Schwartz was also the president of Garden and Oxford. Dkt. #26, 3.
"TSM and the health facilities it managed paid premiums in excess of $4.7 million . . ." between September 2009 and August 2011. Dkt. #26, 4. UHP, Garden, and Oxford "were entrusted with [these] premiums . . . for the purpose of paying covered employee health insurance claims." Dkt. #26, 4. And TSM alleges that Schwartz "personally made the decisions regarding disbursement of the premiums." Dkt. #26, 7.
By the summer of 2011, "legitimate employee health claims were not being processed or paid." Dkt. #26, 5. "[A]t that time, the aggregate claims approached $1 million." Dkt. #26, 5. TSM demanded UHP, Garden, and Oxford process and pay the claims. Dkt. #26, 5. The companies initially agreed, but have since "failed and refused to do so without explanation." Dkt. #26, 5. Since that time, TSM claims to have paid "over $700,000 in employee health claims which were the responsibility of the Defendants." Dkt. #26, 5.
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To warrant dismissal of a complaint, under Rule 12(b)(6) of the Federal Rules of Civil Procedure, it must be "clear that no relief could be granted under any set of facts that could be proved consistent with the allegations." Blackston v. State of Alabama, 30 F.3d 117, 120 (11th Cir.1994), citing Hishon v. King & Spalding, 467 U.S. 69, 73, 104 S.Ct. 2229, 81 L.Ed.2d 59 (1984). On a motion to dismiss, this Court accepts as true all the allegations in the complaint and construes them in the light most favorable to the plaintiff. Jackson v. Bellsouth Telecomms., 372 F.3d 1250, 1262 (11th Cir.2004). Further, this Court favors the plaintiff with all reasonable inferences from the allegations in the complaint. Stephens v. Dep't of Health & Human Servs., 901 F.2d 1571, 1573 (11th Cir.1990) ("On a motion to dismiss, the facts stated in [the] complaint and all reasonable inferences therefrom are taken as true.").
In Bell Atlantic Corp. v. Twombly, the Supreme Court articulated the standard by which claims should be evaluated on a motion to dismiss:
While a complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual allegations, a plaintiff's obligation to provide the grounds of his entitlement to relief requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do. Factual allegations must be enough to raise a right to relief above the speculative level.
550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d 929 (2007) (internal citations omitted). Further, courts are not "bound to accept as true a legal conclusion couched as a factual allegation." Papasan v. Allain, 478 U.S. 265, 286, 106 S.Ct. 2932, 92 L.Ed.2d 209 (1986). See Electrostim Med. Services, Inc. v. Lindsey, 8:11-CV-2467-T-33TBM, 2012 WL 1560647 (M.D. Fla. 2012).
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To establish a claim for breach of fiduciary duty, a plaintiff must plead the "existence of a fiduciary duty, and the breach of that duty such that it is the proximate cause of the plaintiff's damages." Gracey v. Eaker, 837 So. 2d 348, 353 (Fla. 2002). The most difficult part of this analysis is determining if a fiduciary duty actually exists. A fiduciary duty is formed when a party is "under a duty to act for or to give advice for the benefit of another upon matters within the scope of that relation." Doe v. Evans 814 So.2d 370 (Fla. 2002) (citation omitted); Taylor Woodrow Homes Florida, Inc. v. 4/46-A Corp., 850 So.2d 536, 540 (Fla. 5th DCA, 2003). Likewise, ". . . a fiduciary relationship may be implied by law, and such relationships are 'premised upon the specific factual situation surrounding the transaction and the relationship of the parties.'" Doe v. Evans 814 So.2d 370, citing Capital Bank v. MVB, Inc., 644 So.2d 515, 518 (Fla. 3d DCA 1994).
As alleged in the complaint, Schwartz has a fiduciary duty to TSM in his capacity as an insurance broker and advisor. Southtrust Bank and Right Equipment Co. of Pinellas County, Inc. v. Export Ins. Services, Inc., 190 F.Supp.2d 1304 (M.D. Fla., 2002) (holding that an insurance broker and advisor has a fiduciary duty to his client, because of the trust implicit in such a relationship).
In his advisory role, TSM claims it trusted and sought advice from Schwartz for seven years, and Schwartz was personally responsible for disbursing and handling $4 million paid by TSM for the benefit of its employees, thus creating a fiduciary duty. Dkt. #26, 3. TSM also claims Schwartz exploited this position of trust by "intentionally
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diverting premiums paid by TSM to himself." Dkt. #26, 4-7. This claim establishes a sufficient factual basis for a breach of fiduciary duty and damages resulting from that breach. Gracey v. Eaker, 837 So. 2d 348, 353 (Fla. 2002). Thus, these alleged facts establish a legally plausible claim of breach of fiduciary duty against Schwartz.
In an "arms-length transaction," there is no duty to act for the benefit or protection of the other party. Taylor Woodrow Homes Florida, Inc. v. 4/46-A Corp., 850 So.2d 540-542, citing (citation omitted), citing Lanz v. Resolution Trust Corp., 764 F.Supp. 176, 179 (S.D.Fla.1991). A payment, series of payments, or a business relationship is not enough to create the trust and reliance necessary to form a fiduciary duty. See Doe v. Evans 814 So.2d 370; Taylor Woodrow Homes Florida, Inc. v. 4/46-A Corp., ...
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