United States District Court, S.D. New York
BRIDGET M. CURRAN, individually, and as natural Guardian of C.F.C., a minor, Plaintiff,
AETNA LIFE INSURANCE COMPANY, TRINET GROUP, INC., and THE TRINET OPEN ACCESS MANAGED CHOICE PLAN Defendants.
OPINION AND ORDER
NELSON S. ROMN, District Judge.
Bridget M. Curran brings this action on behalf of herself individually and as the natural guardian of her son, C.F.C., a minor ("Plaintiffs") against Defendants Aetna Life Insurance Company ("Aetna"), TriNet Group, Inc. ("TriNet"), and the TriNet Open Access Managed Choice Plan (the "Plan") (collectively, "Defendants"). On August 2, 2013, Plaintiffs filed an Amended Complaint as a matter of course. Before the Court is Plaintiffs' request to file a Second Amended Complaint. For the following reasons, Plaintiffs' motion is GRANTED in part and DENIED in part.
The Court assumes general familiarity with the facts of this case, which are set forth in greater detail in this court's Opinion & Order issued on November 11, 2013. To summarize, Plaintiff Bridget Curran was a member-participant and an insured under the Plan, as was her son, C.F.C., a minor. Aetna is the underwriter, insurer, and agent of the Plan and TriNet is the issuer and administrator of the Plan. On January 7, 2011, Plaintiff's minor son, C.F.C., underwent seoliosis surgery, which was performed by Dr. Rudolph F. Taddonio, an out-of-network health care provider. Dr. Taddonio submitted a Claim Form to Aetna following the surgery in the amount of $168, 500. Beginning in April 2011, and until September 2011, Aetna's website indicated under that it had approved a payment of $119, 658.42 for the scoliosis surgery and that such amount was to be "Paid by Plan." Dr. Taddonio ultimately received a total payment of $4, 443.99 from Aetna, which was made in two installments: $2, 988.70 was paid on March 10, 2011 and $1, 455.29 was paid on December 26, 2011. On May 31, 2011, Aetna notified Plaintiff by letter that it had made an error in approving the payment of $119, 658.42 and that a new case number was assigned to the claim.
Plaintiff submitted numerous letters to Aetna and TriNet in which she requested documentation relating to the claim approval and subsequent denial. Plaintiff specifically requested the documentation relating to the adverse determination. TriNet's response indicated that TriNet was not the claims fiduciary and that it had delegated all claims administration to Aetna, its insurance carrier.
The Plan terms and coverage information is contained in a Booklet-Certificate. Plaintiff was provided the Booklet-Certificate by TriNet. Together with "Additional Information, " the Booklet-Certificate constituted the Summary Plan Description ("SPD").
II. Procedural History
On January 14, 2013, Plaintiffs filed a Complaint against Aetna, TriNet, and the Plan. Defendants filed a motion to dismiss on May 8, 2013. That motion to dismiss was denied without prejudice by the Honorable Judge Karas for failure to comply with the court's individual practices. The case was then reassigned to the undersigned on July 25, 2013. On July 30, 2013, the parties participated in a pre-motion conference during which Defendants' proposed motion to dismiss was substantively discussed. Subsequently, before Defendants filed their motion to dismiss, Plaintiffs filed an Amended Complaint on August 2, 2013 ("First Amended Complaint" or "FAC"). Defendants' motion to dismiss was filed on October 15, 2013. The Court issued its decision on November 11, 2013, which dismissed Plaintiffs' third and fourth claims and Plaintiffs' second claim to the extent that it sought statutory damages. Defendants answered the Amended Complaint on December 2, 2013. At a conference before this Court on December 5, 2013, Plaintiffs sought leave to file a motion to amend her Complaint for the second time. Plaintiffs' motion to file a Second Amended Complaint ("Proposed Second Amended Complaint" or "PSAC") was filed on February 21, 2014.
III. Legal Standard for Motion to Amend
Under Fed.R.Civ.P. 15(a), a party may amend its pleading after a responsive pleading has been served "only by leave of court or by written consent of the adverse party. Fed.R.Civ.P. 15(a). "[T]he court should freely give leave when justice so requires." Fed.R.Civ.P. 15(a)(2). The court should grant leave to amend the complaint "[i]n the absence of any apparent or declared reason - such as 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, [or] futility of amendment.'" In re Alcon Shareholder Litigation, 719 F.Supp.2d 280, 281-82 (S.D.N.Y. 2010) (quoting Forman v. Davis, 371 U.S. 178, 182, 83 S.Ct. 227, 9 L.Ed.2d 222 (1962)). "A proposed amendment is futile if the proposed claim could not withstand a 12(b)(6) motion to dismiss." Fortune v. Grp. Long Term Disability Plan for Emps. of Keyspan Corp., 588 F.Supp.2d 339, 341 (E.D.N.Y. 2008), aff'd 391 F.Appx. 74, 80 (2d Cir. 2010) (citation omitted).
In this context, it is important to note that "pleading is not an interactive game in which plaintiffs file a complaint, and then bat it back and forth with the Court over a rhetorical net until a viable complaint emerges." In re Merrill Lynch Ltd. P'ships Litig., 7 F.Supp.2d 256, 276 (S.D.N.Y. 1997). "Rather, plaintiffs have the responsibility to plead their case adequately, without defendants' or the Court's assistance." Id.
a. Plaintiffs' Proposed Amended Second Cause of Action
Plaintiffs' Proposed Amended Complaint revises the second cause of action to assert statutory penalties under ERISA §502(c) pursuant to violations of ERISA §§ 502(a)(1)(B), 404(a)(1)(D), and 104(b)(4), which were not previously pleaded in either the Complaint or the First Amended Complaint. Plaintiffs' claim for ...