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B.R & W.R. v. Beacon Health Options

United States District Court, N.D. California

May 31, 2017

B.R & W.R., Plaintiff,
v.
BEACON HEALTH OPTIONS, et al., Defendants.

          ORDER RE: MOTION TO DISMISS Re: Dkt. No. 26

          MARIA-ELENA JAMES United States Magistrate Judge

         INTRODUCTION

         Pending before the Court is Defendant SAG-AFTRA Health Fund's[1] (“SAG-AFTRA”) Motion to Dismiss Plaintiffs' First Amended Complaint (“FAC”) pursuant to Federal Rule of Civil Procedure (“Rule”) 12(b)(6). FAC, Dkt. No. 21; Mot., Dkt. No. 26. Plaintiffs B.R. and W.R. filed an Opposition (Dkt. No. 27) and SAG-AFTRA filed a Reply (Dkt. No. 28). The Court finds this matter suitable for disposition without oral argument and VACATES the June 8, 2017 hearing. See Fed. R. Civ. P. 78(b); Civ. L.R. 7-1(b). Having considered the parties' positions, the relevant legal authority, and the record in this case, the Court GRANTS SAG-AFTRA's Motion for the following reasons.

         BACKGROUND

         As it must on a motion to dismiss, the Court takes as true the following well-pleaded allegations of the FAC:

         B.R. and W.R.[2] bring claims for legal and equitable relief under the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1132(a)(1)(B), (a)(3), and (c)(1). FAC ¶ 1. Plaintiffs allege SAG-AFTRA sponsored an employee welfare benefit plan within the meaning of ERISA (the “SAG Plan”), and that B.R. and W.R. participated in the SAG Plan. Id. ¶¶ 1, 3-6. The SAG Plan is a self-funded ERISA Plan. Id. ¶ 5.

         W.R. has a long and severe history of mental illness, for which he has received extensive treatment, including medication and in-patient and residential treatment. Id. ¶¶ 16-34. Plaintiffs submitted claims for W.R.'s medically-necessary mental health care treatment provided by two residential treatment facilities, Ascend Recovery and Spring Lake Ranch. Id. ¶¶ 15, 34, 37. Plaintiffs allege the administrator of the SAG Plan[3] denied these claims at the initial and multiple appeals levels, and that SAG-AFTRA denied all further appeals. Id. ¶¶ 35-37. Plaintiffs contend SAG-AFTRA's denial of W.R.'s mental health claims violates the terms of the SAG Plan, ERISA, and Plaintiffs' rights thereunder. Id., Claim for Relief.

         LEGAL STANDARD

         Rule 8(a) requires that a complaint contain a “short and plain statement of the claim showing that the pleader is entitled to relief.” Fed.R.Civ.P. 8(a)(2). A complaint must therefore provide a defendant with “fair notice” of the claims against it and the grounds for relief. Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007) (internal quotations and citation omitted).

         A court may dismiss a complaint under Rule 12(b)(6) when it does not contain enough facts to state a claim to relief that is plausible on its face. Id. at 570. “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). “The plausibility standard is not akin to a ‘probability requirement, ' but it asks for more than a sheer possibility that a defendant has acted unlawfully.” Id. (quoting Twombly, 550 U.S. at 557). “While a complaint attacked by a Rule 12(b)(6) motion to dismiss does not need detailed factual allegations, a plaintiff's obligation to provide the ‘grounds' of his ‘entitle[ment] to relief' requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do. Factual allegations must be enough to raise a right to relief above the speculative level.” Twombly, 550 U.S. at 555 (internal citations and parentheticals omitted).

         In considering a motion to dismiss, a court must accept all of the plaintiff's allegations as true and construe them in the light most favorable to the plaintiff. Id. at 550; Erickson v. Pardus, 551 U.S. 89, 93-94 (2007); Vasquez v. Los Angeles Cty., 487 F.3d 1246, 1249 (9th Cir. 2007). In addition, courts may consider documents attached to the complaint. Parks Sch. of Bus., Inc. v. Symington, 51 F.3d 1480, 1484 (9th Cir. 1995) (citation omitted).

         If a Rule 12(b)(6) motion is granted, the “court should grant leave to amend even if no request to amend the pleading was made, unless it determines that the pleading could not possibly be cured by the allegation of other facts.” Lopez v. Smith, 203 F.3d 1122, 1127 (9th Cir. 2000) (en banc) (internal quotations and citations omitted). However, the Court may deny leave to amend for a number of reasons, including “undue delay, bad faith or dilatory motive on the part of the movant, repeated failure to cure deficiencies by amendments previously allowed, undue prejudice to the opposing party by virtue of allowance of the amendment, [and] futility of amendment.” Eminence Capital, LLC v. Aspeon, Inc., 316 F.3d 1048, 1052 (9th Cir. 2003) (citing Foman v. Davis, 371 U.S. 178, 182 (1962)).

         DISCUSSION

         SAG-AFTRA moves to dismiss the FAC on the ground that it fails to state a claim under ERISA. Furthermore, SAG-AFTRA contends Plaintiffs cannot state a claim based on the denial of payment because the SAG Plan ...


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