SKORUPSKI v. LOCAL 464A UNITED FOOD AND COMMERCIAL WORKERS WELFARE SERVICE BENEFIT FUND
D.N.J.3/20/2023
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NOT FOR PUBLICATION UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW JERSEY ROBERT SKORUPSKI, et al., Plaintiffs, Civil Action No: 22-3804 (SDW) (JBC) v. OPINION LOCAL 464A UNITED FOOD AND COMMERCIAL WORKERS WELFARE SERVICE BENEFIT FUND, et al., March 20, 2023 Defendants. WIGENTON, District Judge. Before this Court is Defendants Local 464A United Food and Commercial Workers Welfare Service Benefit Fund (âWelfare Fundâ) and the Joint Board of Trustees, United Food and Commercial Workers International Union Local 464Aâs (âDefendantsâ) Motion to Dismiss (D.E. 5 (âMotion to Dismissâ))1 Plaintiffs Robert Skorupski (âR. Skorupskiâ) and Stacy Skorupskiâs (âS. Skorupski,â together with R. Skorupski, âPlaintiffsâ) Complaint (D.E. 1 (âComplaintâ)), pursuant to Federal Rule of Civil Procedure (âRuleâ) 12(b)(6). In accordance with Rule 12(d), this Court converted Defendantsâ Motion to Dismiss into a motion for summary judgment under Rule 56. (D.E. 11.) Jurisdiction is proper pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e). Venue is proper pursuant to 28 U.S.C. § 1391 and 29 U.S.C. § 1132(e). This opinion is issued 1 Citations to âD.E.â refer to the docket entries for the Complaint and the partiesâ motion papers, including briefs, affidavits, declarations, and the documents attached thereto. without oral argument pursuant to Rule 78. For the reasons stated herein, Defendantsâ motion for summary judgment (D.E. 5, 13 (âMotion for Summary Judgmentâ)) is GRANTED. I. FACTUAL AND PROCEDURAL HISTORY2 This suit arises from the Welfare Fundâs refusal to pay Plaintiffsâ medical bills. Between March and December 2020, S. Skorupski suffered from bouts of severe abdominal pain, nausea, vomiting, and other symptoms. (D.E. 5-5 at 2â4.) After several hospitalizations and treatments for alcohol-induced pancreatitis, S. Skorupski was diagnosed with pancreatic duct disruption and thereafter underwent surgery, which cured her ailments. (Id.) S. Skorupskiâs treatments came at a substantial costâin total, Plaintiffs allegedly amassed $581,381.13 in medical bills. (D.E. 1 ¶¶ 11â12.) Because S. Skorupskiâs âtreatment of pancreatitis [w]as related to alcohol use or misuse, an exclusion of the Plan,â the Welfare Fund refused to pay Plaintiffsâ expenses. (D.E. 5-6 at 2; D.E. 5-8 at 2.) The Board upheld on appeal the decision to deny Plaintiffsâ claim for benefits. (D.E. 5-8 at 2.) Plaintiffs disagreed with that determination and filed the instant suit. (See generally D.E. 1.) A. The Welfare Fund R. Skorupski is a participant in the Welfare Fund, an employee welfare benefit fund governed by the Employee Retirement Income Security Act of 1974 (âERISAâ), 29 U.S.C. § 1001 et seq., and administered by the Board. (D.E. 13-1 ¶¶ 1, 3â4.) S. Skorupski, R. Skorupskiâs wife, is a beneficiary of the Welfare Fund. (Id. ¶ 1.) According to the Welfare Fundâs summary plan description, (D.E. 5-4 (the âPlanâ)), the Welfare Fund âprovide[s] generally for [beneficiariesâ] medical, surgical, hospital, maternity, X-ray, and laboratory, dental, vision, prescription drugs, 2 The facts derive largely from the Exhibits submitted with Defendantsâ Motion to Dismiss, which contains the full record of documents that the Welfare Fundâs Board of Trustees (âBoardâ) reviewed in denying Plaintiffsâ claim for benefits. (D.E. 5-3 ¶¶ 11, 14.) accident, dismemberment and death benefits,â (id. at 10). The Plan explains that â[t]he entire cost of the coverage is paid from the contributions that employers make to the [Welfare Fund].â (Id. at 3; D.E. 13-1 ¶ 5.) The Plan, however, excludes certain diagnoses and treatments from coverage, (D.E. 5-4 at 7â8)âfor example, the Plan does not cover â[h]ealthcare services provided in connection with or in treatment for alcoholism, alcohol abuse, and/or alcohol use or misuse . . . [and] any treatment for any condition that is related to such a primary, secondary or tertiary diagnosis or any other condition resulting therefrom,â (id. at 8; D.E. 13-1 ¶ 7). The Plan outlines procedures for beneficiaries and their assignees to submit claims for benefits and, if applicable, to appeal a denial of benefits. (D.E. 5-4 at 4â6; D.E. 13-1 ¶ 9.) When a beneficiary accrues medical bills, she, or her âauthorized representative[,] may file claims for benefits with the [Welfare Fund] . . . within 90 days following receipt of the healthcare service, treatment or product to which the claim relates.â (D.E. 5-4 at 4.) The Welfare Fund, then, must render a decision on the beneficiariesâ claims for benefits âwithin 30 days of receipt of such claims.â (Id. at 5.) Once a decision is reached, the Welfare Fund notifies the beneficiaries in writing. (Id.) If a beneficiary disagrees with the Welfare Fundâs benefits determination, the beneficiary âmust appeal the [Welfare Fundâs] decision within 180 days of receiving the notification of the [Welfare Fundâs] decision on the claim.â (Id.) The Board is tasked with resolving, âin accordance with the written terms of the Plan and the Trust Agreement,â any appeals about a beneficiaryâs claim, âincluding eligibility . . . and all other issues.â (Id. at 6.) âThe [Board has] the right, in [its] sole discretion, to interpret and construe the terms and provisions of the Plan and Trust documents.â3 (Id. at 6; D.E. 13-1 ¶ 6.) If the Board 3 Indeed, the Plan further imbues the Board with: full power and discretion to interpret the Plan and all documents, agreements, rules and regulations concerning the Plan, including, but not limited to, the eligibility of any person to participate in the upholds a denial of benefits on appeal, a beneficiary âha[s] the right to bring an action for benefits against the Plan under Section 502(a) of ERISA . . . within 1 year of the date of the denial of [the beneficiaryâs] claim.â (D.E. 5-4 at 6.) B. S. Skorupskiâs Treatment In late March 2020, S. Skorupski began intermittently experiencing several symptoms, including fever, nausea, diarrhea, vomiting, abdominal, and lower-back pain. (D.E. 5-5 at 2.) By early April 2020, S. Skorupskiâs symptoms had worsened. (Id.) In the weeks that followed, S. Skorupski attended at least two appointments with her general physician, Dr. MarĂa Pantano, who diagnosed S. Skorupski with a stomach virus. (Id. at 2â3.) S. Skorupskiâs symptoms did not improve. (Id.) On or around May 10, 2020, S. Skorupski called 9-1-1 after experiencing âexcruciating pain, along with vomiting (dry heaving) and diarrhea.â (Id. at 3.) S. Skorupski was transported by ambulance to the Emergency Room at Holy Name Medical Center, where doctors diagnosed her with pancreatitis ârelated to her alcohol consumption.â (Id. at 3, 6.) S. Skorupski admitted that, in the months before her symptoms began, she would consume a âusual nightcap,â consisting of vodka mixed with âseltzer or sugar[-]free iced tea,â (id. at 2); and during her May 2020 hospitalization, S. Skorupski told doctors that she drank â2-5 [ounces] of vodka before bedtime prior to admission,â (id. at 7). According to Plaintiffs, S. Skorupski ceased all alcohol consumption after her May 10, 2020 diagnosis. (Id. at 3.) Nonetheless, in the ensuing months, S. Plan and his or her entitlement to Plan benefits. The Boardâs interpretations and decisions concerning these matters are final and conclusive, so long as they are made in good faith and are not arbitrary or capricious. The provisions of the contracts between the Plan and any healthcare provider organizations are controlling and are incorporated herein by reference. (Id. at 3.) Skorupski had several more emergency visits to the hospital, during which doctors frequently related her symptoms to alcohol use or misuse. (Id. at 3â4, 6â7, 18, 22; D.E. 5-7 at 14â30.) Each time S. Skorupski was admitted to the hospital, doctors administered a similar treatment regime4; but each time she was discharged, she returned shortly thereafter with similar symptoms. (D.E. 5- 5 at 3, 14; D.E. 5-7 at 10â12.) In September 2020, Dr. Amrita Sethi performed an endoscopic procedure on S. Skorupski. (D.E. 5-5 at 4, 18â25.) Upon reviewing the results, Dr. John Poneros discovered a tear in S. Skorupskiâs pancreatic bile duct. (Id.) Doctors immediately performed a procedure to repair the torn pancreatic bile duct. (Id.) That procedureâalong with subsequent treatmentâremedied S. Skorupskiâs symptoms, and she has âfelt healthy since.â (Id. at 4, 15â17.) C. Defendants Deny Plaintiffsâ Claim for Benefits Between March and December 2020, Plaintiffs allegedly accrued $581,381.13 in medical bills. (D.E. 1 ¶¶ 11â12.). Plaintiffs submitted the bills to the Welfare Fund, but their claim for benefits was denied pursuant to an exclusion of the Plan. (D.E. 5-6 at 2.) Specifically, because S. Skorupskiâs diagnosis and subsequent treatment stemmed, at least in part, from alcohol use or misuse, the Welfare Fund refused to cover her medical bills. (Id.) Plaintiffs appealed that denial of benefits to the Board, but the Board upheld the decision. (Id.; D.E. 5-8 at 2.) On June 14, 2022, Plaintiffs filed the Complaint in which they allege that Defendants wrongfully denied Plaintiffsâ claim for benefits, breached their fiduciary duties to Plaintiffs, and violated ERISA and the terms of the Plan. (See generally D.E. 1.) On August 2, 2022, Defendants filed the Motion to Dismiss pursuant to Rule 12(b)(6). (D.E. 5.) In briefing the Motion to Dismiss, each party submitted exhibits for this Courtâs consideration. (D.E. 5, 6, 7.) On February 22, 2023, 4 According to Plaintiffs, S. Skorupskiâs hospital stays lasted six days on average. (D.E. 5-5 at 3.) this Court converted the Motion to Dismiss into a motion for summary judgment and, in accordance with Rule 12(d), permitted the parties an opportunity to âsubmit supplemental briefing regarding any additional materials relevant toâ the Motion for Summary Judgment.5 (D.E. 11.) The parties timely completed supplemental briefing. (D.E. 12, 13.) II. LEGAL STANDARD Summary judgment is appropriate âif the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.â Fed. R. Civ. P. 56(a). The âmere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment; the requirement is that there be no genuine issue of material fact.â Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247â48 (1986). A fact is only âmaterialâ for purposes of a summary judgment motion if a dispute over that fact âmight affect the outcome of the suit under the governing law.â Id. at 248. A dispute about a material fact is âgenuineâ if âthe evidence is such that a reasonable jury could return a verdict for the nonmoving party.â Id. The dispute is not genuine if it merely involves âsome metaphysical doubt as to the material facts.â Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). 5 This Court has discretion to accept and consider matters outside the pleadings and then convert the motion to dismiss into one for summary judgment. United States v. Est. of Elson, 421 F. Supp. 3d 1, 5 (D.N.J. 2019) (âThe decision whether to convert a motion to dismiss into a [motion for] summary judgment . . . is a discretionary one.â (citing Telfair v. Tandy, No. 08-731, 2009 WL 2132433, at *3 (D.N.J. July 13, 2009)). âThe reason that a court must convert a motion to dismiss to a summary judgment motion if it considers extraneous evidence submitted by the defense is to afford the plaintiff an opportunity to respond.â Bruni v. City of Pittsburgh, 824 F.3d 353, 360â61 (quoting Pension Benefit Guar. Corp. v. White Consol. Indus., Inc., 998 F.2d 1192, 1196 (3d Cir. 1993)). Accordingly, a district court must give the parties notice before it converts a motion to dismiss into a motion for summary judgment and renders a decision. Bruni, 824 F.3d at 360 (âIf other âmatters outside the pleadings are presented to and not excluded by the court, the motion must be treated as one for summary judgment under Rule 56.â When that occurs, â[a]ll parties must be given a reasonable opportunity to present all the material that is pertinent to the motion.ââ (alteration in original) (quoting Fed. R. Civ. P. 12(d))). The moving party must show that if the evidentiary material of record were reduced to admissible evidence in court, it would be insufficient to permit the nonmoving party to carry its burden of proof. Celotex Corp. v. Catrett, 477 U.S. 317, 322â23 (1986). Once the moving party meets its initial burden, the burden then shifts to the nonmovant who must âset forth specific facts showing the existence of . . . an issue for trial.â Shields v. Zuccarini, 254 F.3d 476, 481 (3d Cir. 2001) (citing FED. R. CIV. P. 56(e)). âIn considering a motion for summary judgment, a district court may not make credibility determinations or engage in any weighing of the evidence; instead, the non-moving partyâs evidence âis to be believed and all justifiable inferences are to be drawn in his [or her] favor.ââ Marino v. Indus. Crating Co., 358 F.3d 241, 247 (3d Cir. 2004) (quoting Anderson, 477 U.S. at 255). The nonmoving party âmust present more than just âbare assertions, conclusory allegations or suspicionsâ to show the existence of a genuine issue.â Podobnik v. U.S. Postal Serv., 409 F.3d 584, 594 (3d Cir. 2005) (quoting Celotex Corp., 477 U.S. at 325). Further, the nonmoving party is required to âpoint to concrete evidence in the record [that] supports each essential element of its case.â Black Car Assistance Corp. v. New Jersey, 351 F. Supp. 2d 284, 286 (D.N.J. 2004) (citing Celotex Corp., 477 U.S. at 322â23)). If the nonmoving party âfails to make a showing sufficient to establish the existence of an element essential to that partyâs case, and on which . . . [it has] the burden of proof[,]â then the moving party is entitled to judgment as a matter of law. Celotex Corp., 477 U.S. at 322â23. In deciding the merits of a partyâs motion for summary judgment, the courtâs role is not âto weigh the evidence and determine the truth of the matter but to determine whether there is a genuine issue for trial.â Anderson, 477 U.S. at 249. The nonmoving party cannot defeat summary judgment simply by asserting that certain evidence submitted by the moving party is not credible. S.E.C. v. Antar, 44 F. Appâx 548, 554 (3d Cir. 2002) (citing Schoonejongen v. Curtiss- Wright Corp., 143 F.3d 120, 130 (3d Cir. 1998)). III. DISCUSSION The Welfare Fund is governed by ERISA, (D.E. 13-1 ¶ 3), and Plaintiffs accordingly assert several claims thereunder, (see generally D.E. 1). âSection 502(a)(1)(B) of ERISA creates a civil cause of action for a plan participant âto recover benefits due to him [or her] under the terms of his [or her] plan, to enforce his [or her] rights under the terms of the plan, or to clarify his [or her] rights to future benefits under the terms of the plan.ââ Fleisher v. Standard Ins. Co., 679 F.3d 116, 120 (3d Cir. 2012). Meanwhile, Section 502(a)(3) serves as a general ââcatchallâ . . . offering appropriate equitable relief for injuries caused by violations that § 502 does not elsewhere adequately remedy.â Varity Corp. v. Howe, 516 U.S. 489, 512 (1996); see also Fotta v. Trs. of United Mine Workers of Am., Health & Ret. Fund of 1974, 165 F.3d 209, 211 (3d Cir. 1998) (âERISA section 502(a)(3)(B) permits a plan beneficiary âto obtain other appropriate relief (i) to redress [violations of ERISA or of the terms of an ERISA plan] or (ii) to enforce any provisions of this subchapter or the terms of the plan.ââ (alteration in original) (quoting 29 U.S.C. § 1132(a)(3)(B))). Although the Complaint is unclear, Plaintiffs assert claims for benefits under Section 502(a)(1)(B) and seemingly for additional equitable relief under Section 502(a)(3).6 (D.E. 1 ¶¶ 15â16, 18â20.) A. 502(a)(1)(B) Claim Plaintiffs argue that a material dispute of fact exists with respect to the Welfare Fundâs determination âthat alcohol use, along with other factors, was a contributing factor or cause of her 6 The Complaint seeks relief on behalf of only the individual Plaintiffs. (See generally D.E. 1.) Therefore, Plaintiffs cannot bring claims under Section 502(a)(2), which âdoes not provide a remedy to individual beneficiaries.â Engers v. AT&T, 428 F. Supp. 2d 213, 235 (D.N.J. 2006) (citing Varity Corp., 516 U.S. at 515). medical conditions.â (D.E. 12 at 8.) That argument misconstrues this Courtâs standard of review. Because the Plan imbues the Board with âfull power and discretionâ to interpret the terms of the Plan and beneficiariesâ eligibility for benefits under the Plan, (D.E. 5-4 at 3), this Courtâs review of such actions by the Board is constrained to the deferential arbitrary and capricious standard. Fleisher, 679 F.3d at 120â21 (discussing the arbitrary and capricious standard of review of administrator actions); see also Lipstein v. UnitedHealth Grp., 296 F.R.D. 279, 293 (D.N.J. 2013) (âIn an ERISA case, where âthe administrator has discretionary authority to determine eligibility for benefits, . . . the decision must be reviewed under an arbitrary and capricious standard.ââ (alteration in original) (quoting Doroshow v. Hartford Life & Accident Ins. Co., 574 F.3d 230, 233 (3d Cir. 2009))). Similarly, âwhen an administrator acts pursuant to her authority âto construe the terms of the plan,â or âto act as a finder of facts,â [courts] also apply the arbitrary and capricious standard when reviewing those interpretations and factual findings.â Fleisher, 679 F.3d at 121 (internal citations omitted). The Third Circuit has explained that â[a]n administratorâs decision is arbitrary and capricious if it is without reason, unsupported by substantial evidence or erroneous as a matter of law.â Addington v. Senior Vice President Hum. Res. Consol. Energy, Inc., 841 F. Appâx 443, 447 (3d Cir. 2020) (citing Fleisher, 679 F.3d at 121). âSubstantial evidenceâ is defined as ârelevant evidence that âa reasonable mind might accept as adequate.ââ Id. (quoting Fleisher, 679 F.3d at 121). Crucially, the district courtâs âscope of review is narrow, and âthe court is not free to substitute its own judgment for that of the [administrator] in determining eligibility for plan benefits.'â Martorana v. Board of Trs. of Steamfitters Loc. Union 420 Health, Welfare & Pension Fund, 404 F.3d 797, 801 (3d Cir. 2005) (alteration in original) (quoting Mitchell v. Eastman Kodak Co., 113 F.3d 433, 439 (3d Cir. 1997)). As an initial matter, Defendantsâ interpretation of the Planâs exclusion for alcohol-induced conditions was not arbitrary and capricious. (D.E. 5-4 at 8.) The Plan expressly excludes from coverage â[h]ealth care services provided in connection with or in treatment for alcoholism, alcohol abuse, and/or alcohol use or misuse,â and âany treatment for any condition that is related to such a primary, secondary or tertiary diagnosis or any other condition resulting therefrom.â (Id.) The Board broadly interprets that exclusion to bar coverage when âalcohol use, along with other factors, is a contributing factor or cause of the condition.â (D.E. 5-3 ¶ 8.) That interpretation of the unambiguous Plan terms is ââreasonably consistentâ with the [P]lanâs text.â Bergamatto v. Bd. of Trs. of the NYSA-ILA Pension Fund, 933 F.3d 257, 264 (3d Cir. 2019) (quoting Dowling v. Pension Plan for Salaried Emps. of Union Pac. Corp. & Affiliates, 871 F.3d 239, 245 (3d Cir. 2017)). Likewise, Defendantsâ decision to deny Plaintiffsâ claim for benefits was not arbitrary and capricious, because it was supported by substantial evidence: S. Skorupski admitted that, before her symptoms began in March 2020, she drank a âusual nightcapâ containing vodka, (D.E. 5-5 at 2); during her May 2020 hospitalization, S. Skorupski told doctors that she consumed â2â5 [ounces] of vodka before bedtime prior to admission,â (id. at 7); and several of the medical reports filed by S. Skorupskiâs doctors indicate that her treatment was due, at least in part, to alcohol- induced pancreatitis, (id. at 6â7, 18, 22; D.E. 5-7 at 14â30). On appeal to the Board, Plaintiffs did not present any additional medical evidence to contradict the decision to deny Plaintiffsâ claim. Rather, in support of their appeal, Plaintiffs provided medical research from the internet, (D.E. 5- 5 at 27â45), along with supplemental letters from doctors suggesting that S. Skorupskiâs pancreatic duct disruption could have had other primary causes, (id. at 6, 7, 14). None of the additional evidence presented by Plaintiffs, however, refuted the Boardâs finding that S. Skorupskiâs pancreatic duct disruption was caused, at least in part, by alcohol use or misuse.7 Plaintiffs contend that the supplemental letters submitted by S. Skorupskiâs doctors disprove the Boardâs determinations. (D.E. 7-1 ¶¶ 2, 4â11.) S. Skorupskiâs doctors, though, only offered possible, additional causes for Plaintiffsâ conditions.8 (D.E. 5-5 at 6â7, 14). Importantly, none of those supplemental letters stated that her conditions were not caused, at least in part, by alcohol use or misuse. When considering the vague opinions in the supplemental letters alongside the several medical records indicating that S. Skorupski had alcohol-induced pancreatitis, this Court cannot find that the Boardâs decision was âwithout reason, unsupported by substantial evidence or erroneous as a matter of law.â Addington, 841 F. Appâx 447 (citing Fleisher, 679 F.3d at 121). Consequently, Defendantsâ Motion for Summary Judgment will be granted as to Plaintiffsâ claim under Section 502(a)(1)(B). B. 502(a)(3) Claims To the extent Plaintiffs seek relief under Section 502(a)(3), those claims fail as a matter of law. Section 502(a)(3) permits beneficiaries of an ERISA plan to bring a civil action to remedy violations of ERISA or the plan terms, or to enforce any provisions of ERISA or the plan. 29 U.S.C. § 1132(a)(3); Natâl Sec. Sys., Inc. v. Iola, 700 F.3d 65, 86 (3d Cir. 2012). Plaintiffs may 7 Indeed, the medical research presented by Plaintiffs indicated that alcohol abuse causes pancreatitis, which in turn causes pancreatic duct disruption. (Id. at 27â45.) 8 For example, in a letter dated February 9, 2021, Doctors Addi Znamensky and Anna Lavotshkin wrote: At the time of [S. Skorupskiâs May 2020] admission [to the hospital,] it was thought that her pancreatitis was related to her alcohol consumption as stated in the notes âlikely related to alcohol.â However, other causes are strongly correlated with pancreatitis as well, including obesity and gastric bypass status as well as hyperlipidemia, especially elevated triglyceride levels. It is possible that these were the primary drivers in the onset of the patientâs pancreatitis. (D.E. 5-5 at 6.) also pursue claims under Section 502(a)(3) to redress an administratorâs breach of fiduciary duty. Bixler v. Cent. Pa. Teamsters Health & Welfare Fund, 12 F.3d 1292, 1298 (3d Cir. 1993) (ââSection 502(a)(3) authorizes the award of âappropriate equitable reliefâ directly to a participant or beneficiary to âredressâ âany act or practice which violates any provision of this titleââ including a breach of the statutorily created fiduciary duty of an administrator.â (alterations in original) (quoting Mass. Mut. Life. Ins. Co. v. Russell, 473 U.S. 134, 153 (1985) (Brennan, J., concurring))). The remedy for suits brought under Section 502(a)(3), however, is limited to âappropriate equitable relief,â which means âthose categories of relief that were typically available in equity.â Great-West Life & Ann. Ins. Co. v. Knudson, 534 U.S. 204, 210 (2002) (alteration in original) (quoting Mertens v. Hewitt Assocs., 508 U.S. 248, 256 (1993)). i. Violations of ERISA Plaintiffs contend that Defendantsâ decision to deny Plaintiffsâ claims âviolated . . . the terms of the Plan, and Ms. Skorupskiâs rights under the Plan and governing law.â (D.E. 1 ¶ 15.) As a result, Plaintiffs seek, inter alia, âa declaratory judgment to determine that the bills incurred by Mrs. Skorupski are covered under the Plan, . . . and to determine that the defendants are liable to pay her medical, hospital, and doctorâs bills.â (D.E. 1 ¶ 16.) Plaintiffsâ claim fails for several reasons. First, Plaintiffs have failed to identify any specific provision of ERISA or terms of the Plan that Defendants have allegedly violated.9 Second, even if Plaintiffsâ claims pursuant to Section 502(a)(3) had merit, Plaintiffs seek only monetary relief. Plaintiffs cannot disguise their claim for damages under 502(a)(1)(B) as one for declaratory relief under 502(a)(3). Indeed, the Supreme 9 To the extent Plaintiffs argue that exclusions for conditions caused by alcohol use or misuse violate ERISA, Plaintiffs have not pointed to any statutory or other authority on point. Court has squarely held that âan injunction to compel the payment of money past due under a contract, or specific performance of a past due monetary obligation,â does not constitute âappropriate equitable reliefâ for purposes of Section 502(a)(3). Knudson, 534 U.S. at 210â11. Where, as here, plaintiffs âare seeking legal reliefâthe imposition of personal liability on respondents for a contractual obligation to pay moneyâ§ 502(a)(3) does not authorize this action.â Id. at 221. Therefore, Defendantsâ Motion for Summary Judgment will be granted as to Plaintiffsâ claims brought under Section 502(a)(3) to remedy alleged violations of ERISA. i. Breach of Fiduciary Duty Plaintiffsâ claim for breach of fiduciary duty under Section 502(a)(3) fails for similar reasons. Again, the Complaint does not identify any fiduciary duty that Defendants allegedly breached. (See, e.g., id. (âDefendants breached . . . all fiduciary duties arising under ERISA by denying the payment of medical bills and expenses submitted by plaintiff, Stacy Skorupski as aforesaid.â)) And, in any event, the Complaint seeks only monetary relief for Defendantsâ breach of the unspecified duty. (Id. ¶ 20 (âPlaintiffs bring this action to obtain a declaratory judgment to determine that the bills incurred by Mrs. Skorupski are covered under the Plan . . . and to determine that the [D]efendants are liable to pay her medical, hospital, and doctorâs bills referred to above.â)). Thus, Plaintiffsâ breach of fiduciary duty claim is indistinguishable from Plaintiffsâ claim for benefits. See, e.g., Lipstein, 296 F.R.D. at 299; see also Harrow v. Prudential Ins. Co. of Am., 279 F.3d 244, 254 (3d Cir. 2002) (âA claim for breach of fiduciary duty is âactually a claim for benefits where the resolution of the claim rests upon an interpretation and application of an ERISA- regulated plan rather than an interpretation and application of ERISA.ââ (quoting Smith v. Sydnor, 184 F.3d 356, 362 (4th Cir. 1999))); see also Knudson, 534 U.S. at 221 (âBecause [Plaintiffs] are seeking legal reliefâthe imposition of personal liability on [Defendants] for a contractual obligation to pay moneyâ§ 502(a)(3) does not authorize this action.â). Accordingly, Defendantsâ Motion for Summary Judgment will be granted as to Plaintiffsâ claim for breach of fiduciary duty.10 IV. CONCLUSION For the reasons set forth above, Defendantâs Motion for Summary Judgment is GRANTED. An appropriate order follows. ___/s/ Susan D. Wigenton_____ SUSAN D. WIGENTON, U.S.D.J. Orig: Clerk cc: James B. Clark, U.S.M.J. Parties 10 In their brief in opposition to Defendantsâ Motion to Dismiss, Plaintiffs improperly requested leave to file an amended complaint, (D.E. 7 at 10), and improperly filed a cross motion seeking leave to file an amended complaint, (see generally D.E. 8). As Magistrate Judge Clark explained, âPlaintiffsâ motion to amend fail[ed] to comply with Local Civil Rule 7.1. . . .â (D.E. 10 at 1.) This Court notes, too, that Plaintiffsâ submission did not comply with Local Rule 15.1, which requires Plaintiffs to attach âa form of the amended [complaint] that shall indicate in what respect(s) it differs from the pleading which it proposes to amend, by bracketing or striking through materials to be deleted and underlining materials to be added.â L. Civ. R. 15.1(a)(2). Even if Plaintiffs had complied with the relevant Local Rules, their proposed Amended Complaint (D.E. 8-1 at 3â9) would be futile for the reasons already stated in this Opinion. Specifically, Plaintiffsâ proposed amendments to the âWherefore Clause,â (id. at 7, 9; D.E. 7 at 10), would amount to no more than âlawyerly inventivenessâ to rephrase their âclaim for legal relief . . . in terms of an injunction.â Knudson, 534 U.S. at 211 n.1. Section 502(a)(3) plainly does not authorize such an action. Id. at 221.
Case Information
- Court
- D.N.J.
- Decision Date
- March 20, 2023
- Status
- Precedential