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Lisa O. v. Blue Cross of Idaho Health Service Inc.

United States District Court, D. Idaho

February 14, 2014

LISA O., individually and as guardian of H. H., a minor, Plaintiff,
v.
BLUE CROSS OF IDAHO HEALTH SERVICE INC., and HEALTHWISE, INC., Defendants.

ORDER ON REPORT AND RECOMMENDATION

EDWARD J. LODGE, District Judge.

On October 15, 2013, United States Magistrate Larry M. Boyle issued a Report and Recommendation ("Report"), recommending that Defendant's Motion for Summary Judgement be granted. (Dkt. 52.) Any party may challenge the Magistrate Judge's proposed recommendation by filing written objections within fourteen days after being served with a copy of the Report. 28 U.S.C. § 636(b)(1)(C). The district court must then "make a de novo determination of those portions of the report or specified proposed findings or recommendations to which objection is made." Id. The district court may accept, reject, or modify in whole or in part, the findings and recommendations made by the Magistrate Judge. Id .; see also Fed.R.Civ.P. 72(b).

Plaintiffs, Lisa O. and H.H., filed objections to the Report arguing it erred in finding that Lisa O. does not have standing to bring her claims, misconstrued the language of the release, improperly enforced contract language in violation of ERISA, and the resulting decision improperly deters ERISA participants from bringing claims. (Dkt. 55.) The Defendant, Healthwise, Inc., also filed objections to the Report requesting certain corrections or clarifications. (Dkt. 53.) Both sides have responded to the others' objections. (Dkt. 58, 59.) The Court has considered the parties' contentions and conducted a de novo review of the record and, upon that basis, finds as follows.

STANDARD OF REVIEW

Pursuant to 28 U.S.C. § 636(b)(1)(C), this Court "may accept, reject, or modify, in whole or in part, the findings and recommendations made by the magistrate judge." Where the parties object to a report and recommendation, this Court "shall make a de novo determination of those portions of the report which objection is made." Id. Where, however, no objections are filed the district court need not conduct a de novo review. To the extent that no objections are made, arguments to the contrary are waived. See Fed.R.Civ.P. 72; 28 U.S.C. § 636(b)(1) (objections are waived if they are not filed within fourteen days of service of the Report and Recommendation). "When no timely objection is filed, the Court need only satisfy itself that there is no clear error on the face of the record in order to accept the recommendation." Advisory Committee Notes to Fed.R.Civ.P. 72 (citing Campbell v. United States Dist. Court, 501 F.2d 196, 206 (9th Cir.1974)).

In this case, both parties have filed objections and, therefore, the Court has conducted a de novo review of those portions of the Report. The Court has also reviewed the entire Report as well as the record in this matter for clear error on the face of the record and finds as follows.

DISCUSSION

1. Plaintiffs' Objections

A. Standing

The Report concludes Lisa O. does not personally have independent standing under § 1132(a)(1)(B) to claim benefits are directly due to her under the terms of the group medical insurance plan (the Plan) or to enforce her own rights to benefits. (Dkt. 52 at 7.) Instead, the Report finds, Lisa O. has only a subrogation right to her daughter's, H.H., claim for benefits. Lisa O. objects to this conclusion maintaining that she has standing to bring her claim both individually and as the representative or guardian of H.H. because she paid the expenses for H.H.'s medical treatments which are the subject of the claim. (Dkt. 55 at 6-7.)[1] Healthwise counters that the Report correctly concluded that Lisa O. does not have standing. (Dkt. 59.)

ERISA requires both statutory standing and constitutional standing. As to statutory standing, to state a viable claim for relief under ERISA, "a plaintiff must fall within one of ERISA's nine specific civil enforcement provisions, each of which details who may bring suit and what remedies are available." Paulsen v. CNF Inc., 559 F.3d 1061, 1072 (9th Cir. 2009). Only three of these provisions authorize private civil enforcement actions. Under § 1132(a)(1)(B), a health benefit plan participant or beneficiary may sue "to recover benefits due to him [or her] under the terms of the 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." 29 U.S.C.A. § 1132(a)(1)(B).[2]

Standing to bring a civil action under § 1132(a)(1)(B) against an ERISA plan is available only to those parties listed in § 1132(a), namely: a plan "participant, " "beneficiary, " or "fiduciary, " or by the Secretary of Labor. A "participant, " is defined as an "employee or former employee of an employer, or any member or former member of an employee organization." 29 U.S.C.A. § 1002(7) (1999). A "beneficiary" is "a person designated by a participant or by the terms of an employment benefit plan, who is or may become entitled to a benefit thereunder." 29 U.S.C.A. § 1002(8) (1999). Section 1132(a) also authorizes a plan participant to bring an action for breach of fiduciary duties, to enjoin violations of ERISA or the plan, or to obtain other equitable relief. 29 U.S.C. § 1132(a)(2) & (3); see also Paulsen, 559 F.3d at 1084.

Lisa O. argues that as the Plan participant she has a legal right to bring this action directly under ERISA § 1132(a)(1)(B). (Dkt. 55.) Healthwise counters that the Report correctly concluded that Lisa O. can only assert a derivative ERISA claim here as a subrogee of H.H. based on the reasoning in Wills v. Regence Bluecross Blueshield of Utah, 2008 WL 4693581, *9 (D. Utah 2008). (Dkt. 59 at 6.)

This Court finds that under § 1132(a), Lisa O. has statutory standing under ERISA to sue directly as the Plan participant for recovery of benefits due under the Plan, to enforce her rights under the terms of the Plan, or to clarify rights to future benefits. 29 U.S.C. § 1132(a)(1)(B). The ERISA claim raised in this case is made pursuant to § 1132(a)(1)(B) for recovery of the money paid by Lisa O. as the Plan participant on behalf of the Plan beneficiary, H.H., during the time period the Plan was in effect. (Dkt. 18.) "Participants are among those parties expressly entitled to bring suit under ERISA." Leeson v. Transamerica Disability Income ...


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