Opinion
Civil Action No. 03-CV-04630.
September 29, 2004
ORDER
NOW, this 29th day of September, 2004, upon consideration of Defendant Intermedics, Inc.'s Motion to Dismiss Plaintiff's First and Second Causes of Action or, in the Alternative, Motion for Partial Summary Judgment, which motion was filed January 8, 2004; upon consideration of Plaintiff's Memorandum of Law in Opposition to Defendant Intermedics Inc.'s Motion to Dismiss or, in the Alternative, Motion for Summary Judgment, which response was filed January 26, 2004; upon consideration of Defendant Connecticut General Life Insurance Company's, Motion to Dismiss Plaintiff's Amended Complaint for Failure to State a Claim, which motion was filed November 25, 2003; upon consideration of Plaintiff's Answer to Defendant Connecticut General Life Insurance Company's Motion to Dismiss, which answer was filed December 12, 2003; upon consideration of Defendant Guidant Corporation's Motion to Dismiss Amended Complaint for Failure To State a Claim Pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure or, in the Alternative, Motion for Summary Judgment, which motion was filed November 26, 2003; upon consideration of Plaintiff's Memorandum of Law in Opposition to Defendant Guidant Corporation's Motion to Dismiss or, in the Alternative, Motion for Summary Judgment, which response was filed December 15, 2003; upon consideration of the briefs of the parties; upon consideration of plaintiff's Amended Complaint and the Exhibits attached thereto filed November 10, 2003,
IT IS ORDERED that all defendants' motions to dismiss are denied. IT IS FURTHER ORDERED that the alternative motions for summary judgment filed on behalf of defendants Guidant Corporation and Intermedics, Inc., are denied with leave to represent appropriate dispositive motions after the close of discovery.
On August 8, 2003 plaintiff Herbert Guss initiated this action by filing a four-count Complaint. On November 10, 2003 plaintiff filed a four-count Amended Complaint which is now the subject of motions to dismiss by defendants Guidant Corporation ("Guidant"), Connecticut General Life Insurance Company ("Connecticut General") and Intermedics, Inc., ("Intermedics"). In addition defendants Guidant and Intermedics have filed motions for summary judgment in the alternative to their motions to dismiss.
Because we conclude that a motion for summary judgment is inappropriate prior to the close of discovery, we decline to review or consider the numerous exhibits which defendants Guidant and Intermedics have filed with the court at this time. These exhibits were not made part of plaintiff's Complaint. We are constrained under the Rules of Civil Procedure and the standard of review for a motion to dismiss to limit ourselves to the Complaint and the exhibits attached thereto. We decline to consider defendants' summary judgment motion on less than a full record. We will permit the parties to conduct discovery, and after which, defendant will be free to file any appropriate dispositive motion.
This litigation involves a dispute regarding the amount of lifetime health care benefits remaining for plaintiff under an alleged employer welfare benefit plan purportedly governed by the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. §§ 1001 to 1461. For the reasons set forth below, we deny defendants' motions to dismiss.
A motion to dismiss under Rule 12(b)(6) of the Federal Rules of Civil Procedure examines the sufficiency of the Complaint.Conley v. Gibson, 355 U.S. 41, 45, 78 S. Ct. 99, 102, 2 L. Ed. 2d 80, 84 (1957). In determining the sufficiency of the Complaint the court must accept all plaintiff's well-pled factual allegations as true and draw all reasonable inferences therefrom in favor of plaintiff. Graves v. Lowery, 117 F.3d 723, 726 (3d Cir. 1997).
[T]he Federal Rules of Civil Procedure do not require a claimant to set out in detail the facts upon which he bases his claim. To the contrary, all the Rules require is "a short and plain statement of the claim" that will give the defendant fair notice of what the plaintiff's claim is and the grounds upon which it rests.Conley, 355 U.S. at 47, 78 S. Ct. at 103, 2 L. Ed. 2d at 85 (internal footnote omitted). "Thus, a court should not grant a motion to dismiss `unless it appears beyond a doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.'" Graves, 117 F.3d at 726 (citing Conley, 355 U.S. at 45-46, 78 S. Ct. at 102, 2 L. Ed. 2d at 84).
In their respective motions to dismiss, defendants contend that plaintiff is neither a participant, nor a beneficiary in an ERISA-governed health plan. In support of this contention, defendants rely on the alleged concession of plaintiff that he is not a participant in an ERISA-governed health plan and that plaintiff does not meet the definition of a beneficiary.
Plaintiff asserts that he is a beneficiary under an ERISA-governed group welfare benefit plan. (Amended Complaint at paragraph 63). Plaintiff further contends that he receives insurance cards, claim forms, literature and other information confirming his membership in the Guidant Health Plan. (Amended Complaint at paragraphs 33 through 35). Furthermore, plaintiff alleges that applying the standard of review to his Amended Complaint and the exhibits attached thereto precludes a finding that it appears beyond a doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief. We agree.
Upon review of plaintiff's Complaint, and taking all the well-pled allegations as true, we conclude that plaintiff has stated a claim upon which relief can be granted. It does not appear beyond a doubt that plaintiff can prove no set of facts in support of its claims which would entitle it to relief. Graves, supra. Specifically, we accept as true paragraphs 33 through 35 together with paragraph 65 of plaintiff's Amended Complaint.
In addition, plaintiff's Exhibit H to the Amended Complaint (a letter dated September 24, 2002) reveals that Coresource (a successor to a previous claims administrator Northwestern National Life) represented that the plaintiff's health plan was a self-funded employee welfare benefit plan sponsored and maintained by Sulzer Medical USA, Inc. (a predecessor company to which Intermedics became a wholly-owned subsidiary) and that the plan was governed exclusively by ERISA.
Based upon the combination of the previous claim administrator's representation that plaintiff's health benefits are governed by ERISA and the factual averments contained in plaintiffs Amended Complaint, we conclude that plaintiff has alleged sufficient facts to prove his claims.
Moreover, defendants in this matter are Guidant, the entity that maintains the group health plan at issue, Connecticut General, the third-party administrator of the group health plan, and Intermedics, the original entity through which plaintiff obtained benefits. Because all three defendants are important to the issues and claims raised by plaintiff's Amended Complaint, we conclude they are all proper parties in this matter.
Accordingly, we deny defendants' motions to dismiss.
IT IS FURTHER ORDERED that defendants shall have until October 25, 2004 to file an answer to plaintiff's Amended Complaint.