The opinion of the court was delivered by: JOAN H. LEFKOW, District Judge
MEMORANDUM OPINION AND ORDER
Plaintiff, Maureen Heroux ("Heroux"), filed a six-count Second
Amended Complaint against defendants, Humana Insurance Company
("Humana"), The Duval Group Ltd. ("Duval"), and the Duval Group
Plan, alleging violations of the Employee Retirement Income
Security Act ("ERISA"), 29 U.S.C. §§ 1101 et seq. Humana has
moved pursuant to Rule 12(b)(6), Fed.R.Civ.P., to dismiss
Counts I and III of Heroux's Second Amended Complaint for failure
to state a claim upon which relief may be granted. The court has
jurisdiction over the claims pursuant to 28 U.S.C. § 1331 and
29 U.S.C. § 1132. For the reasons set forth below, defendant's
motion is granted in part and denied in part.
MOTION TO DISMISS STANDARDS
A motion to dismiss under Federal Rule of Civil Procedure
12(b)(6) challenges the sufficiency of the complaint for failure
to state a claim upon which relief may be granted. General Elec.
Capital Corp. v. Lease Resolution Corp., 128 F.3d 1074, 1080
(7th Cir. 1997). Dismissal is appropriate only if it appears beyond a doubt
that the plaintiff can prove no set of facts in support of its claim that would entitle it to relief. Conley v. Gibson,
355 U.S. 41, 45-46 (1957); Kennedy v. Nat'l Juvenile Det.
Ass'n, 187 F.3d 690, 695 (7th Cir. 1999). In ruling on the
motion, the court accepts as true all well pleaded facts alleged
in the complaint, and it draws all reasonable inferences from
those facts in favor of the plaintiff. Jackson v. E.J. Brach
Corp., 176 F.3d 971, 977 (7th Cir. 1999); Zemke v. City of
Chicago, 100 F.3d 511, 513 (7th Cir. 1996).
ALLEGATIONS OF THE COMPLAINT*fn1
Heroux was employed by Duval from February 14, 1998 until April
19, 2002. (Second Amended Complaint at ¶ 6, hereinafter "¶ ___").
As part of her employment with Duval, Heroux received health
insurance coverage consisting of medical and drug coverage for
illness or injury through the Duval Group Plan (the "Plan"). (¶
7). The Plan is an employee welfare plan within the meaning of
ERISA, adopted by Duval prior to April 2002. (¶ 3). Duval is the
Plan's fiduciary and administrator under ERISA. (¶ 5).
Upon Heroux's departure from her employment with Duval, Duval
purported to offer Heroux a three-month severance package that
continued her health insurance benefits. (¶ 6). Duval led Heroux
to believe that upon her leaving her employment, her medical
insurance was being continued under the provisions of the
Consolidated Omnibus Budget Reconciliation Act ("COBRA"). (¶ 10).
In order to maintain her health insurance coverage, Heroux made
regular payments amounting to over $4,000 to Duval from the end
of her employment through and including April of 2003. (¶¶ 11, 21).
In a letter dated April 10, 2003, Duval specifically requested
payment from Heroux for insurance. (Compl. Ex. B).*fn2 The
letter informed Heroux that her health insurance coverage was
expiring on April 30, 2003 and that Duval had not yet received
payment for the month of April. Id. The letter notified Heroux
that if Duval did not receive payment by April 15, 2003, Duval
would end the policy effective March 31, 2003. Id. Duval wrote
a check in the amount of $445.00 on April 11, 2003, which Duval
cashed on April 18, 2003. (Compl. Ex. C).*fn3 Duval paid for
Heroux's share of its group insurance policy through April 2003. (¶ 12).
II. The Relationship Between Humana and the Plan
Initially, the Group Insurance Policy (the "Policy") for the Plan
identified Humana's predecessor, Employee Health Insurance Company, as its
"Administrator."*fn4 (¶ 4). The Policy defined "Administrator" as
"[Humana], who performs administrative functions for the Policyholder."
(Def. Motion to Dismiss, Ex. A at Duval 0006).
On June 1, 2000, the Policy was amended to redefine Humana as
"Insurer" and "Trust Administrator."*fn5
(Def. Motion to
Dismiss, Ex. A at Duval 0023-24). "Insurer" was defined as follows:
[Humana] in its capacity as administrator for claims
determination and ERISA claims review fiduciary
exercising its discretionary authority to: (1)
interpret policy provisions; (2) make decisions
regarding eligibility for coverage and benefits; and
(3) resolve factual questions relating to coverage
and benefits. [Humana] shall not be construed to be a
fiduciary of the plan other than as described in this
definition. [Humana] is not the Plan Administrator of
the plan as that term is defined by ERISA.
(Def. Motion to Dismiss, Ex. A at Duval 0024). "Trust
Administrator" was defined as Humana "in its capacity of
performing administrative functions for the Policyholder." (Def.
Motion to Dismiss, Ex. A at Duval 0024). Plaintiff alleges that
Humana had authority to control and manage operation and
administration of the Plan, in addition to possessing the
discretion to grant or deny claims. (¶ 4). Plaintiff further
alleges that Duval relied upon Humana's expertise in the control
and management of operation of the Plan, thereby rendering Humana
a fiduciary under ERISA. (¶ 4).
III. Heroux's Claims Against Humana
The cover pages of the Certificate of Insurance for the health
insurance provided under the Plan to Heroux state that Duval is
the employer, Heroux is the employee, and that the policyholder
is the Trustee of the Employers Health Insurance Benefits Trust.
(¶ 8). The certificate does not state the name of the subject
plan. (¶ 8). During her employment with Duval, Heroux did not
receive a summary plan description document, which is required
under ERISA § 1022(b) to be provided and to include
identification of the Plan. (¶ 9). Heroux received no other
document while employed at Duval that identified the Plan. (¶ 9). Duval had informed Humana of Duval's representations to Heroux
regarding Heroux's severance package and COBRA coverage. (¶ 23).
In a letter dated March 21, 2003, Humana approved back surgery
and related services for Heroux as medically necessary and
approved under Heroux's insurance plan. (Compl. Ex. D). Relying
upon this letter, Heroux had back surgery at a cost in excess of
$140,000 in April 2003. (¶¶ 14, 21). After April 30, 2003, Duval
claimed that Heroux's insurance coverage had expired prior to
April 2003 and attempted to return the ...