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DeBartolo v. United Healthcare Services

August 27, 2010

DEBARTOLO
v.
UNITED HEALTHCARE SERVICES, INC.



Name of Assigned Judge Sitting Judge if Other or Magistrate Judge Amy J. St. Eve than Assigned Judge

DOCKET ENTRY TEXT

The Court grants Defendant's 12(b)(6) motion to dismiss [15]. Count I is dismissed without prejudice and Counts II, III, and IV are dismissed with prejudice. All pending dates and deadlines are stricken.

O[ For further details see text below.] Notices mailed by Judicial staff.

STATEMENT

Before the Court is Defendant United Healthcare Services, Inc.'s ("Defendant") Federal Rule of Civil Procedure 12(b)(6) motion to dismiss Plaintiff Dr. Hansel M. DeBartolo's ("Plaintiff") complaint. For the following reasons, the Court grants Defendant's motion to dismiss.

BACKGROUND

For the purpose of resolving the motion to dismiss, the Court assumes the following allegations are true. Plaintiff is a physician who maintains a medical practice in Sugar Grove, Illinois. (R. 14, Amended Compl., ¶ 1.) Defendant maintains a medical welfare government benefit plan pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. ("ERISA"), and has discretionary authority over the management and disposition of the assets of the plan. Id. at ¶¶ 2-3.

Prior to providing medical services beginning on January 12, 2000, Defendant verified that it covered J.S. as an insured. Id. at ¶ 7. After this confirmation, J.S. assigned his rights to benefit payments from Defendant to Plaintiff and, in exchange, Plaintiff furnished medical treatment to J.S. Id. Beginning January 12, 2000, and continuing through February 28, 2000, Defendant acknowledged the assignment and forwarded partial payments to Plaintiff for the medical services Plaintiff provided to J.S. Id. at ¶ 8. Defendant, however, denied all other claims by Plaintiff for treatment furnished to J.S., which total $581 in benefit payments. Id.

On or about March 21, 2000, Plaintiff requested in writing a copy of the medical benefit plan from Defendant. Id. at ¶ 11, Ex. B. To date, Defendant has not responded to Plaintiff's request. As a result of Defendant's failure to pay the $581 owed to Plaintiff, Defendant has deprived Plaintiff of the benefit of the medical services provided to J.S. Id. at ¶ 13.

In his complaint, Plaintiff alleges that Defendant: (i) violated ERISA, 29 U.S.C. § 1332(a)(1)(B), for failure to pay benefits, (ii) violated ERISA, 29 U.S.C. § 1132(c)(1)(B), for failure to provide a copy of the plan, (iii) is estopped from refusing to comply with J.S.'s assignment of benefits to Plaintiff, and (iv) misrepresented coverage of J.S. to Plaintiff. Id. at ¶¶ 9-24.

LEGAL STANDARD

"A motion under Rule 12(b)(6) challenges the sufficiency of the complaint to state a claim upon which relief may be granted." Hallinan v. Fraternal Order of Police of Chicago Lodge No. 7, 570 F.3d 811, 820 (7th Cir. 2009). Pursuant to Rule 8(a)(2), a complaint must include "a short and plain statement of the claim showing that the pleader is entitled to relief." Fed. R. Civ. P. 8(a)(2). As the Seventh Circuit recently explained, this "[r]ule reflects a liberal notice pleading regime, which is intended to 'focus litigation on the merits of a claim' rather than on technicalities that might keep plaintiffs out of court." Brooks v. Ross, 578F.3d 574, 580 (7th Cir. 2009) (quoting Swierkiewicz v. Sorema N.A., 534 U.S. 506, 514, 122 S.Ct. 992, 152 L.Ed. 2d 1 (2002)). This short and plain statement must "give the defendant fair notice of what the claim is and the grounds upon which it rests." Bell Atlantic v. Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed. 2d 929 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47, 78 S.Ct. 99, 2 L.Ed. 2d 80 (1957)). Under the federal notice pleading standards, a plaintiff's "factual allegations must be enough to raise a right to relief above the speculative level." Twombly, 550 U.S. at 555. Put differently, a "complaint must contain sufficient factual matter, accepted as true, to 'state a claim to relief that is plausible on its face.'" Ashcroft v. Iqbal, 129 S.Ct. 1937, 1949 (2009) (quoting Twombly, 550 U.S. at 570); see also Cooney v. Rossiter, 583 F.3d 967, 971 (7th Cir. 2009) (amount of factual allegations required to state a plausible claim for relief depends on complexity of legal theory). "[W]hen ruling on a defendant's motion to dismiss, a judge must accept as true all of the factual allegations contained in the complaint." Erickson v. Pardus, 551 U.S. 89, 94, 127 S.Ct. 2197, 167 L.Ed. 2d 1081 (2007); Justice v. Town of Cicero, 577 F.3d 768, 771 (7th Cir. 2009) (court construes complaint in light most favorable to plaintiff drawing all reasonable inferences in plaintiff's favor).

ANALYSIS

In its motion, Defendant contends that each of Plaintiff's four claims are time-barred. While "dismissal under Rule 12(b)(6) on statute of limitations grounds is considered 'irregular'... dismissal is appropriate where a plaintiff pleads itself out of court by establishing that a defendant is entitled to a statute of limitations defense." Hakim v. Accenture United States Pension Plan, 656 F. Supp. 2d 801, 816-17 (N.D. Ill. 2009) (citing United States v. Northern Trust Co., 372 F.3d 886, 888 (7th Cir. 2004)); see also United States v. Lewis, 411 F.3d 838, 842 (7th Cir. 2005) (motion to dismiss appropriate where ...


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