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Lewis v. Aetna Insurance Agency

May 6, 2010


The opinion of the court was delivered by: J. Phil Gilbert District Judge


This matter comes before the Court on Defendants' amended Motion to Dismiss (Doc. 56),*fn1 which includes and incorporates a memorandum in support thereof. Plaintiffs filed a Response (Doc. 62) thereto, to which Defendants filed a Reply (Doc. 63).

The Court notes that said reply brief, which consists of seven pages of substantive argument, violates the Court's Local Rules. S.D. Ill. L. R. 7.1(d) ("Reply briefs shall not exceed 5 pages."). Defendants are cautioned that page limits and similar restrictions are strictly enforced by this Court, and future filings that do not comport with the Local Rules will be stricken.

For the following reasons, the Court, inter alia, DENIES the instant motion (Doc. 56).


I. Facts

For purposes of a motion to dismiss, courts must accept all factual allegations in the complaint as true and draw all reasonable inferences from those facts in favor of the plaintiff. Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007); Tricontinental Indus., Ltd. v. PricewaterhouseCoopers, LLP, 475 F.3d 824, 833 (7th Cir. 2007). The Court, accepting all of Plaintiffs' factual allegations as true and drawing all reasonable inferences in their favor, finds as follows:

Plaintiffs Herbert and his wife, Annie, Lewis (hereinafter individually referred to as "Herbert" and "Annie" and collectively referred to as "the Lewises") were participants in a health insurance plan sponsored by Herbert's employer, Defendant Sherwin Williams.*fn2 This plan, termed the (Defendant) Sherwin Williams Salaried Medical Plan (hereinafter "the Plan"), named Sherwin Williams as its administrator and Defendant Aetna Insurance Agency, Inc. (hereinafter "Aetna") as its fiduciary in charge of reviewing claims filed thereunder. To retain coverage under the Plan, the Lewises were to pay deductibles, copayments, and coinsurance. At all times relevant to this litigation, Herbert fulfilled all of his payment obligations under the Plan.

On December 17, 2006, Annie was thrown from a horse while horseback riding, causing her clavicle and ribs to fracture as well as severe swelling in her upper extremities. She was subsequently treated by numerous healthcare providers, her medical bills ultimately totaling $38,165.92.

Citing a pre-existing condition and maintaining that Annie had failed to verify that she had no other insurance, Aetna denied the Lewises' claims for benefits as to said amount, and the majority of the medical bill went unpaid. In a letter dated December 2, 2008, the Lewises' attorney asked Aetna to explain the basis of its denial, but neither Aetna nor Sherwin Williams responded in writing within 60 days. On February 6, 2009, the Lewises' attorney submitted further correspondence to Aetna but again did not receive a written response. Herbert and Annie have been sued by the medical providers and had judgments entered against them; as a result, they have since been forced to begin making payments for Annie's treatment.

II. Relevant Procedural Posture

On July 7, 2009, the Lewises filed suit in Clay County, Illinois, asserting a sole claim for breach of contract against Aetna. Aetna thereafter removed the matter to this Court on the grounds that the Lewises' claims were preempted by the Employee Retirement Income Security Act of 1974 (hereinafter "ERISA"), 29 U.S.C. § 1001, et seq. The Lewises eventually filed an Amended Complaint (Doc. 27), which remains the operative complaint in this litigation. This complaint not only added Sherwin Williams and the Plan as defendants but pled six separate claims for relief. These claims are as follows: engagement in arbitrary and capricious actions by Aetna (Count I); violation of ERISA § 502(a)(1)(B), codified at 29 U.S.C. § 1132(a)(1)(B), by the Plan (Count II), and; violation of ERISA § 502(c)(1), codified at 29 U.S.C. § 1132(c)(1), by Aetna and Sherwin Williams (Counts III-VI).*fn3 With respect to Counts III-VI, Plaintiffs seek the maximum statutory penalty and attorneys' fees and costs.

Defendants now move to dismiss Counts III-VI of the amended complaint for failure to state a claim upon which relief can be granted pursuant ...

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