United States District Court, S.D. Ohio, Western Division
KARI EGBERS AND STEPHANIE WILLIAMS, On behalf of Themselves and All Others Similarly Situated Plaintiffs,
SENIOR LIFESTYLE CORPORATION, Defendant.
OPINION AND ORDER
Michael R. Barrett, Judge United States District Court
matter is before the Court on Defendant's Motion to
Dismiss Plaintiffs' Amended Complaint (Doc. 6).
Plaintiffs have filed a response (Doc. 19) and Defendant has
filed a reply (Doc. 21).
purposes of this Motion, the facts alleged in Plaintiffs'
Amended Complaint are accepted as true. Defendant operates
over 100 independent, assisted and memory communities across
the United States. (Doc. 5, ¶ 8). In 2002, in order to
provide health insurance coverage to its employees, Defendant
established the Senior Lifestyle Corporation Employees
Benefit Plan (the “Plan”). (Id. at
¶ 13). The Plan is self-funded by Defendant.
(Id. at ¶ 2). To fund the Plan, Defendant
collected payroll deductions from their employees, including
Plaintiffs. (Id. at ¶ 14). While Defendant
serves as the plan's sponsor and administrator, Key
Benefits Administrators, Inc. (“KBA”) is the
third-party administrator of the Plan. (Id. at
¶¶ 2-3). The Employee Contributions deducted from
payroll were retained in Defendant's corporate bank
account until they were remitted to KBA. (Id. at
¶ 14). In 2015, Defendant failed to remit Employee
Contributions to fund the Plan. (Id. at ¶¶
15-16). According to Plaintiffs, Defendant also failed to
remit Employer Contributions to KBA. (Id. at ¶
were both pregnant during the relevant time period.
(Id. at ¶¶ 18-19). Because Defendant
failed to provide adequate funds to pay Plaintiffs'
related medical claims, KBA did not pay the claims.
(Id. at ¶ 17). As a result, Plaintiffs allege
that during the relevant time period, the Plan's coverage
lapsed and thus, Plaintiffs paid for health insurance
coverage that was not provided and incurred medical expenses
that should have been covered by the Plan. Plaintiffs allege
Egbers specifically incurred approximately $2, 500 in medical
expenses. (Id. at ¶ 18). Plaintiffs allege
Williams incurred approximately $400, 000 in medical
expenses. (Id. at ¶ 19).
further allege they were told for months by Defendant that
they were working to fix the “2015 KBA claims
issue” and that the 2015 claims would eventually be
paid. (Id. at ¶ 24). The claims remain unpaid
by Defendant. According to Plaintiffs, they are being pursued
by professional debt collectors for the unpaid medical bills.
(Id. at ¶ 26).
result, Plaintiffs filed the instant action on behalf of
themselves and all others similarly situated, alleging
violations under the Employment Retirement Income Security
Act of 1974 (“ERISA”). Defendant filed a motion
to dismiss Plaintiffs' complaint. (Doc. 2). In response,
Plaintiffs filed an Amended Complaint. (Doc. 5). Defendant
now moves for dismissal of the Amended Complaint. (Doc. 6).
reviewing a Rule 12(b)(6) motion to dismiss for failure to
state a claim, this Court must “construe the complaint
in the light most favorable to the plaintiff, accept its
allegations as true, and draw all reasonable inferences in
favor of the plaintiff.” Bassett v. Nat'l
Collegiate Athletic Ass'n, 528 F.3d 426, 430 (6th
Cir. 2008) (internal quotations omitted). To properly state a
claim, a complaint must contain a “short and plain
statement of the claim showing that the pleader is entitled
to relief.” Fed.R.Civ.P. 8(a)(2). “[T]o survive a
motion to dismiss, a complaint must contain (1) ‘enough
facts to state a claim to relief that is plausible, ' (2)
more than ‘a formulaic recitation of a cause of
action's elements, ' and (3) allegations that suggest
a ‘right to relief above a speculative
level.'” Tackett v. M&G Polymers, USA,
LLC, 561 F.3d 478, 488 (6th Cir. 2009) (quoting Bell
Atlantic Corp. v. Twombly, 550 U.S. 544 (2007)).
“A claim has facial plausibility when the plaintiff
pleads factual content that allows the court to draw the
reasonable inference that the defendant is liable for the
misconduct alleged.” Ashcroft v. Iqbal, 556
U.S. 662, 678 (2009).
makes two primary arguments in favor of dismissal. First,
Defendant argues Plaintiffs' claims are “nothing
more than a repackaged claim for benefits” and thus,
Plaintiffs cannot obtain relief for their claims for breach
of fiduciary duty under § 502(a)(3). Second, Defendant
argues that the Amended Complaint must be dismissed because
Plaintiffs fail to state a claim for denial benefits under
Sixth Circuit has explained that § 502(a)(3) is a
“catchall provision” identical to 29 U.S.C.
§1132(a)(3), which allows for relief for breach of
fiduciary duty and other violations where § 1132 does
not provide an adequate remedy elsewhere. Wilkins v.
Baptist Healthcare System, Inc., 150 F.3d 609, 615 (6th
Cir. 1998) (citing Varity Corp. v. Howe, 516 U.S.
489, 512, 116 S.Ct. 1065 (1996).
to this case, 29 U.S.C. § 1132 provides as follows:
(a) Persons empowered to bring a civil action A civil action