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Eschleman v. Unitedhealth Group, Inc.

United States District Court, Sixth Circuit

September 10, 2013

LISA ESCHLEMAN, Plaintiff,
v.
UNITEDHEALTH GROUP, INC., et al. Defendants.

OPINION & ORDER

ALGENON L. MARBLEY, District Judge.

I. INTRODUCTION

This matter comes before the Court on Defendant United HealthCare Services, Inc.'s Motion to Dismiss ("Motion"). (Doc. 18.) For the reasons set forth herein, Defendant's Motion is GRANTED.

II. BACKGROUND

In September 2004, Plaintiff, Lisa Eschleman, underwent surgery to install a motor cortex stimulator in order to alleviate neuropathic facial pain after other medications and treatments had failed. Subsequent to the initial surgery, Eschleman learned that the battery for the stimulator would have to be replaced and she scheduled a surgery for this purpose. According to the Complaint, Defendant denied coverage for the battery replacement surgery because the treatment had not been "shown to be safe and effective" for Ms. Eschleman's medical condition. ( Complaint, Doc. 1 at ¶ 11.) On June 12, 2012, Lisa Eschleman filed this action against United Healthcare Services. The Plaintiff alleges Defendants denied her benefits in violation of the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1104, 1109, and 1132 ("ERISA").

Ms. Eschleman was employed by the State of Ohio at the time she filed the suit. (Doc. 1 at ¶ 6.) The State of Ohio has established an employee benefit plan for its employees called the "State of Ohio - Ohio Med Plan" (the "Plan"). The State of Ohio has contracted with United Healthcare to assist in administering the Plan. The Plan explicitly states that the State of Ohio remains solely responsible for:

• Enrollment and classification changes (including classification changes resulting in [the insured's] enrollment or the termination of [the insured's] coverage);
bull; The timely payment of Benefits; and
bulll; Notifying [the insured] of the termination or modifications to the Plan.[1]

III. STANDARD OF REVIEW

Subject matter jurisdiction is a threshold matter that a court must decide prior to considering a claim's merits. City of Health, Ohio v. Ashland Oil, Inc., 834 F.Supp. 971, 975 (S.D.Ohio 1993). Federal Rule of Civil Procedure 12(b)(1) provides that the defendant may file a motion to dismiss based on a "lack of jurisdiction over the subject matter." Fed.R.Civ.P. 12(b)(1). The plaintiff has the burden of proving jurisdiction when subject matter jurisdiction is challenged. Rogers v. Stratton Indus., 798 F.2d 913, 915 (6th Cir.1986). Attacks on subject matter jurisdiction may be either facial attacks or factual attacks. United States v. Ritchie, 15 F.3d 592, 598 (6th Cir. 1994). A facial attack challenges the legal sufficiency of the allegations in the complaint; whereas a factual attack tests "the factual existence of subject matter jurisdiction." Id. When considering a facial attack, unlike a factual one, the court "must take the material allegations of the petition as true and construe[] [them] in the light most favorable to the nonmoving party." Id.

IV. LAW & ANALYSIS

Defendant's Motion states two grounds for dismissal: (1) lack of subject matter jurisdiction; and (2) judgment on the pleadings. The Court first addresses the threshold issue of jurisdiction. Since the Court finds that subject matter ...


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