United States District Court, W.D. Oklahoma
TIMOTHY D. DeGIUSTI, CHIEF UNITED STATES DISTRICT JUDGE
Robert Ryland filed this action seeking to recover benefits
to which he claims he is entitled under his health insurance
policy. Plaintiff seeks recovery under the Employment
Retirement Income Security Act of 1974 (“ERISA”)
29 U.S.C. § 1001 et seq. He has raised specific
claims for wrongful denial of benefits and breach of
fiduciary duty. Defendant, Plaintiff's insurer, has filed
a Partial Motion to Dismiss [Doc. No. 18] as to the fiduciary
claim. Having reviewed the parties' submissions, the
Court finds the Motion should be granted.
First Amended Complaint [Doc. No. 13] alleges Plaintiff's
insurance policy provided coverage for mental health and
chemical dependency treatment. That coverage included
in-patient treatment at approved facilities. Id. at
4-5. In May of 2018, Plaintiff's son experienced a mental
health and substance abuse incident that eventually led to
his hospitalization at an in-patient facility. Id.
at 2-3. When Plaintiff sought payment for the treatment at
the in-patient facility, Defendant refused to pay, citing a
lack of medical necessity. Id. at 4. Plaintiff
sought relief through administrative remedies and then filed
this suit. Id. In the First Amended Complaint,
Plaintiff claims that Defendant arbitrarily and capriciously
denied coverage because his son's treatment was a medical
necessity and was covered under the policy. Id. at
5-6. Plaintiff also claims Defendant breached its fiduciary
duty by denying coverage. Id. at 6.
to Dismiss Standard
survive a motion to dismiss [under Rule 12(b)(6)], 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, 556 U.S.
662, 678 (2009) (quoting Bell Atlantic Corp. v.
Twombly, 550 U.S. 544, 570 (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.”
Id. “[W]here the well-pleaded facts do not
permit the court to infer more than the possibility of
misconduct, the complaint has alleged - but it has not
‘show[n]' - ‘that the pleader is entitled to
relief.'” Id. at 679 (quoting Fed.R.Civ.P.
8(a)(2)). Thus, in assessing plausibility, a court must first
disregard conclusory allegations and “next consider the
factual allegations in [the] complaint to determine if they
plausibly suggest an entitlement to relief.”
Id. at 681. The question to be decided is
“whether the complaint sufficiently alleges facts
supporting all the elements necessary to establish an
entitlement to relief under the legal theory proposed.”
Lane v. Simon, 495 F.3d 1182, 1186 (10th Cir. 2007)
(internal quotation omitted).
argues that the fiduciary claim must be dismissed because
Plaintiff cannot recover under a wrongful denial claim and an
equitable claim under ERISA. Plaintiff claims that he is
simply asserting alternative theories for relief as allowed
under federal pleading rules.
is correct that Fed.R.Civ.P. 8(d) allows for alternative
pleading. Alternative pleading allows plaintiffs to cover all
of their bases when factual or legal uncertainty creates
situations where a plaintiff could conceivably recover under
multiple legal theories. For instance, a plaintiff struck by
a defendant may be unsure as to whether the contact was
intentional or accidental. Federal pleading rules recognize
the possibility that the facts as eventually established
could cut either way and therefore allow a plaintiff to plead
that the contact was both intentional and accidental and
later narrow the claim as the facts merit. See Kikumura
v. Osagie, 461 F.3d 1269, 1296 (10th Cir. 2006),
overruled on other grounds, Robbins v.
Okla., 519 F.3d 1242, 1246 (10th Cir. 2008); see
also Boulware v. Baldwin, 545 Fed.Appx. 725, 729 (10th
Cir. 2013) (“Federal pleading rules have for a long
time permitted the pursuit of alternative and inconsistent
claims.”). The same is true when the facts are fairly
consistent but the legal conclusions could differ, as when a
plaintiff claims both that he is entitled to recovery from an
existing contract and that he is entitled to recover on the
basis of equity because a contract did not exist. In both
situations, the facts pleaded and legal standards create a
possibility for different outcomes, therefore alternative
pleading is allowed. But alternative pleading does not
absolve a plaintiff of the duty to present facts that would
state a claim on all theories. See Molitor v. Mixon,
No. CIV-16-1202-HE, 2016 WL 9050778 at *2 n.3 (W.D. Okla.
Nov. 21, 2016) (“[A] party may plead alternative
theories arising out of the same facts, but there must still
be some basis in those facts for concluding that a particular
claim or theory of recovery is plausibly supported by
them.”). The Court must therefore determine whether the
facts alleged in this case support the fiduciary claim.
viability of Plaintiff's fiduciary claim depends on the
structure and language of ERISA. ERISA was enacted to
“protect employee pensions and other benefits by
providing insurance . . ., specifying certain plan
characteristics in detail . . ., and by setting forth certain
general fiduciary duties applicable to the management of both
pension and nonpension benefit plans.” Varity Corp.
v. Howe, 516 U.S. 489, 496 (1996). ERISA provides for
civil enforcement of its provisions and allows certain
parties to bring a civil action for certain types of relief.
See 29 U.S.C. § 1132(a). The Supreme Court has
examined the structure of ERISA's civil enforcement
scheme and found it includes four subsections for specific
types of legal relief and two subsections that serve as
catch-all provisions under which a plaintiff can receive
“appropriate equitable relief for injuries caused by
violations that [§ 1132] does not elsewhere adequately
remedy.” Varity Corp., 516 U.S. at 512. If,
however, a plaintiff can obtain adequate relief under a
specific provision, equitable relief is not needed and is
therefore not appropriate. Id. at 515.
is no dispute that Plaintiff's wrongful denial claim
relates to one of the specific subsections, §
1132(a)(1), and his fiduciary claim relates to a catch-all
provision, § 1132(a)(3). Plaintiff also does not dispute
that he can only recover under one of those provisions.
facts in this case only support Plaintiff's wrongful
denial claim. Plaintiff alleges that Defendant breached its
fiduciary duty by wrongfully denying his benefits. That is a
claim that fits squarely within § 1132(a)(1).
Determining whether a beneficiary is entitled to benefits is
a fiduciary act, but relief for that type of fiduciary act is
available under § 1132(a)(1). See Varity Corp.,
516 U.S. at 511. Therefore, if the allegations are true,
§ 1132(a)(1) offers a complete remedy, meaning relief
under the equitable catch-all provision is not appropriate.
fails to offer any other allegations of fiduciary actions
that could give rise to equitable relief outside the context
of § 1132(a)(1). Plaintiff has not demonstrated - based
on the facts he alleges - any possibility that §
1132(a)(1) could not provide an adequate remedy for
Defendant's denial of benefits, meaning there is no
plausible claim for equitable relief. This is neither a
situation where the same set of facts can support two
different legal theories nor a situation where alternative
facts are alleged. Instead, Plaintiff has alleged one set of
facts that simultaneously states a claim under 1132(a)(1) and
precludes a claim under 1132(a)(3). Under these
circumstances, dismissal is appropriate. See Bonham v.
Jefferson Pilot Fin. Ins. Co., 2010 WL 1405448 at *4
(W.D. N.C. Mar. 31, 2010) (acknowledging that a plaintiff can
assert alternative claims for wrongful denial of benefits and
breach of fiduciary duty but dismissed the fiduciary claim
for failure to state a claim).
tries to avoid this result by arguing that he should be
allowed to seek more information to support his fiduciary
claim through discovery. This argument fails for two reasons.
First, Plaintiff cannot use discovery as a fishing expedition
in the hopes of supporting a claim that does not pass muster
at the pleading stage. See McDonald v. Beko Assocs.,
Inc., No. 08-CV-328 TS, 2008 WL 2952278 at *2 (D. Utah,
July 28, 2008). Second, and more importantly, Plaintiffs
fiduciary claim cannot be salvaged simply by adding specifics
to the existing allegations. Plaintiff would have to allege
that Defendant engaged in a completely different course of