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Arthur M. Hayden and Joy Lynn Hayden, As Co-Conservators and v. Blue Cross and Blue Shield of Texas; Health

January 19, 2011

ARTHUR M. HAYDEN AND JOY LYNN HAYDEN, AS CO-CONSERVATORS AND CO-GUARDIANS OF TODD LOWELL HAYDEN, PLAINTIFFS,
v.
BLUE CROSS AND BLUE SHIELD OF TEXAS; HEALTH CARE SERVICE CORPORATION ILLINOIS STATE PAC, NFP; AND NABORS INDUSTRIES, INCORPORATED, DEFENDANTS.



The opinion of the court was delivered by: Daniel L. Hovland, District Judge United States District Court

ORDER ON DEFENDANTS' PARTIAL MOTIONS TO DISMISS

Before the Court are the Defendants' "Partial Motion to Dismiss Plaintiffs' Amended Complaint" and "Partial Motion to Dismiss Plaintiffs' Second Amended Complaint" filed on September 30, 2011, and October 17, 2011, respectively. See Docket Nos. 63 and 72. The Plaintiffs filed a response on November 7, 2011. See Docket No. 76. For the foregoing reasons, the Court grants in part and denies in part the Defendants' motions.

I. BACKGROUND

The plaintiffs, Arthur M. Hayden and Joy Lynn Hayden, are co-conservators and co-guardians of their adult son, Todd Lowell Hayden. Todd Hayden was severely injured in an all-terrain-vehicle (ATV) accident on June 13, 2009. His injuries included serious brain damage which required, and continues to require, significant medical and rehabilitative care. Medical expenses have exceeded $700,000 and continue to mount. At the time of the accident, Todd Hayden was an employee of Defendant Nabors Industries, Inc ("Nabor Industries"). Todd Hayden was covered by a group health plan through his employer which plan was administered by the Defendant, Blue Cross and Blue Shield of Texas. Nabors Industries is the plan administrator for the plan. Nabors Industries has delegated certain authority to Blue Cross and Blue Shield of Texas in order that it might act as claims administrator with the authority to deny claims in whole or in part.

The Haydens repeatedly contacted Blue Cross and Blue Shield of Texas after their son's accident in order to obtain health insurance benefits for him under the health insurance policy. Blue Cross and Blue Shield of Texas did pay a portion of the medical bills related to the accident but on March 2, 2010, denied coverage based on a policy exclusion for accidents involving alcohol. Blue Cross and Blue Shield of Texas explained "[t]he group will not pay for any accidents where alcohol or drugs were involved." See Docket No. 1-5. The Haydens maintain that Todd Hayden's blood alcohol level in the emergency room was only .026 and that such a small level of alcohol is so minimal as to be inconsequential and would not constitute a justifiable basis for denial of health care benefits.

On June 28, 2010, the Haydens filed suit in federal court alleging state law claims for breach of contract (Count I), declaratory judgment (Count II), waiver and estoppel (Count III), bad faith failure to pay health insurance benefits (Count IV), and unfair and deceptive insurance acts and practices (Count V). The complaint also contains a claim to recover benefits under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. § 1001 et seq., (Count VI) and a reservation of rights to amend the complaint to seek exemplary damages.

In lieu of an answer, the Defendants filed a motion to dismiss the state law claims on August 26, 2010. See Docket No. 8. The Defendants argued that the state law claims (Counts I, II, III, IV, and V) were preempted by ERISA. On November 2, 2010, the Court granted the Defendants' motion to dismiss, finding ERISA preempted the state law claims. See Docket No. 15.

On September 16, 2011, the Haydens filed an "Amended Complaint and Jury Demand." See Docket No. 58. In the amended complaint, the Haydens added the following to their original complaint: factual allegations, a paragraph requesting attorney's fees under their ERISA claim (Count VI), and causes of action for pre-judgment and post-judgment interest (Count VII), out-of-pocket expenses (Count VIII), and for payment of insurance benefits in accordance with the North Dakota Rate Equalization system (Count IX). See Docket No. 58, pp. 16-18. The Haydens also re-alleged the state law claims that were previously dismissed on November 2, 2010. See Docket No. 58, pp. 10-15. On September 30, 2011, the Defendants filed "Defendants' Partial Motion to Dismiss Plaintiffs' Amended Complaint." See Docket No. 63. The Defendants contend that the state law claims and all other claims not based on violations of ERISA must be dismissed. The Defendants also sought, in the alternative, a more definite statement of the allegations in Count IX under Fed. R. Civ. P. 12(e).

On October 3, 2011, the Haydens filed a "Second Amended Complaint and Jury Demand."

See Docket No. 65. In the second amended complaint, the Haydens added to the amended complaint more detailed descriptions of the alleged ERISA violations (Count VI). See Docket No. 65, pp. 16-18. On October 17, 2011, the Defendants filed "Defendants' Partial Motion to Dismiss Plaintiffs' Second Amended Complaint." See Docket No. 72. In the motion to dismiss, the Defendants seek to again dismiss the state law claims, request a more definite statement of the Plaintiffs' allegations in paragraph LVI of the second amended complaint, and request the Court to dismiss Plaintiffs' claims to the extent they are preempted by ERISA. See Docket No. 73.

II. STANDARD OF REVIEW

When considering a motion to dismiss, the Court must construe the complaint liberally and assume all factual allegations to be true. Faibisch v. Univ. of Minn., 304 F.3d 797, 802 (8th Cir. 2002); Goss v. City of Little Rock, Ark., 90 F.3d 306, 308 (8th Cir. 1996). Dismissal will not be granted unless it appears beyond a reasonable doubt that the plaintiff can prove no set of facts that would entitle her to relief. Faibisch, 301 F.3d at 802.

Rule 12(b)(6) of the Federal Rules of Civil Procedure mandates the dismissal of a claim if there has been a failure to state a claim upon which relief can be granted. When considering a motion to dismiss under Rule 12(b)(6), the court must accept all factual allegations in the complaint as true. "However, the complaint must contain sufficient facts, as opposed to mere conclusions, to satisfy the legal requirements of the claim to avoid dismissal." Levy v. Ohl, 477 F.3d 988, 991 (8th Cir. 2007) (quoting DuBois v. Ford Motor Credit Co., 276 F.3d 1019, 1022 (8th Cir. 2002)). The court may generally only look to the allegations contained in the complaint to make a Rule 12(b)(6) determination. McAuley v. Fed. Ins. Co., 500 F.3d 784, 787 (8th Cir. 2007). "[I]n considering a motion to dismiss, the district court may sometimes consider materials outside the pleadings, such as materials that are necessarily embraced by the pleadings and exhibits attached to the complaint." Mattes v. ABC Plastics, Inc., 323 F.3d 695, 697 n.4 (8th Cir. 2003) (citing Porous Media Corp. v. Pall Corp., 186 F.3d 1077, 1079 (8th Cir. 1999)). "A complaint ...


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