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Carolina Zalduondo v. Aetna Life Insurance Company

May 23, 2012

CAROLINA ZALDUONDO, PLAINTIFF,
v.
AETNA LIFE INSURANCE COMPANY, DEFENDANT.



The opinion of the court was delivered by: Royce C. Lamberth, Chief Judge

MEMORANDUM OPINION

Before the Court are two motions filed by plaintiff Carolina Zalduondo ("plaintiff"). The first is a Motion for Reconsideration [17] asking for a reversal of this Court's February 27, 2012, interlocutory Order [13] dismissing plaintiff's breach of fiduciary claim. The second is plaintiff's Motion for Leave to file a Second Amended Complaint [18]. Upon consideration of the motions [17, 18], the oppositions [21, 22], the replies [24, 25], the entire record herein and the applicable law, the Motion for Reconsideration [17] and the Motion for Leave to file a Second Amended Complaint [18] are denied. However, eight paragraphs in the Second Amended Complaint, specifically paragraphs 4, 5, 23, 24, 33, 34, 37, and 38, will be deemed incorporated into plaintiff's Amended Complaint [5]. Having now demonstrated exhaustion, plaintiff will be allowed to proceed on her claims for denial of benefits and for the improper refusal to pay for her procedure at Aetna's ("defendant") in-network rate.

I. FACTUAL BACKGROUND

The facts of this case are set out in this Court's prior opinion, Zalduondo v. Aetna Life Ins. Co., --- F. Supp 2d ----, 2012 WL 612811 (D.D.C. Feb. 27, 2012), and so only the applicable facts are set out here. Underlying this action was defendant Aetna Life Insurance Company's decision not to pay for plaintiff's hip operation. Am. Compl. [5] ¶¶ 26-30, Mar. 14, 2011. Plaintiff's Amended Complaint sought relief under § 502 of the Employee Retirement Income Security Act ("ERISA"), codified as 29 U.S.C. § 1132. Id. 2. Specifically, plaintiff brought claims under § 1132(a)(1)(B) for the improper denial of benefits and for Aetna's refusal to pay her surgeon at the company's in-network rate, and under § 1132(a)(2) for breach of fiduciary duty. Am. Compl. [5] ¶¶ 38-49, Prayer for Relief A. Plaintiff clarified her pleadings in her Opposition Motion, claiming that § 1132(a)(3) provided an alternative basis of relief. Pl.'s Opp'n [7] 4, Apr. 19, 2011.

By way of this Court's February 27, 2012, Order and Memorandum Opinion, all of plaintiff's claims save one were dismissed. Order [13]; Mem. Op. [14] 10. Relief under § 1132(a)(2) was held inapplicable because § 1132(a)(2) authorizes plan participants to sue when then plan has suffered a loss due to a breach of fiduciary duty, and in this case the only alleged injury is to the plaintiff. Id. 8. This Court likewise held that § 1132(a)(3) could not survive the defendant's 12(b)(6) motion because, as a general rule in this Circuit, "a claim under § 1132(a)(3) cannot stand where plaintiff has an adequate remedy for her injuries under § 1132(a)(1)(B)." Id. 9. As for plaintiff's claims under § 1132(a)(1)(B), this Court held that the facts plead did not establish plaintiff's exhaustion of administration remedies as required by ERISA, and thus the pleadings were factually insufficient to establish a denial of benefits claim. Id. 7. However, plaintiff was allowed to proceed on her claim that Aetna improperly refused to pay for her medical treatment at the company's in-network rate. Id.

Plaintiff subsequently filed two motions on March 8, 2012: a Motion for Reconsideration asking the Court's to review and reverse its ruling as to her claim under § 1132(a)(3), and a Motion for Leave to file a Second Amended Complaint. Mot. Recons. [17]; Mot. Leave 2d Am. Compl. [18]. Plaintiff's Second Amended Complaint attempts to do four things: first, plaintiff pleads additional facts to demonstrate her exhaustion of administrative remedies in support of her denial of benefits claim under § 1132(a)(1)(B); second, plaintiff wishes to amend her complaint so as to clarify to the Court that she intended to seek relief under § 1132(a)(3); third, she seeks to add WPP Group Medical Plan ("Plan"), and WPP Group USA, Inc. ("Plan Administrator"), as defendants; and fourth, plaintiff seeks relief for breach of fiduciary duties from both the Plan and Plan Administrator. Pl.'s Supp. Mem. [18-1] 2-4; 2d Am. Compl. [18-2] ¶¶ 4-5, 23-38, 43-57.

II. PLAINTIFF'S MOTION FOR RECONSIDERATION

A. Reconsideration Under Federal Rule of Civil Procedure 54(b).

Federal Rule of Civil Procedure 54(b) allows the trial court to modify or reverse its interlocutory decisions at any time prior to the entry of a final judgment. Cobell v. Norton, 355 F. Supp. 2d 531, 539 (D.D.C. 2005). While this rule provides a procedural mechanism for courts to reconsider their prior opinions, the actual language of Rule 54(b) sets forth little guidance as to when such review is appropriate. To fill this gap, courts in this Circuit have held that "relief upon reconsideration . . . pursuant to Rule 54(b) is available 'as justice requires,'" Hoffman v. District of Columbia, 681 F. Supp. 2d 86, 90 (D.D.C. 2010) (quoting Childers v. Slate, 197 F.R.D. 185, 190 (D.D.C. 2000)), but have cautioned that, as a general rule, courts should not revisit their prior decisions "in the absence of extraordinary circumstances such as where the initial decision was clearly erroneous and would work a manifest injustice," Lederman v. United States, 539 F. Supp. 2d 1, 2 (D.D.C. 2008) (quoting Christianson v. Colt Indus. Operating Corp., 486 U.S. 800, 817, (1988)). "[A]sking 'what justice requires' amounts to determining, within the Court's discretion, whether reconsideration is necessary under the relevant circumstances." Cobell, 355 F. Supp. 2d at 539. Justice may require reconsideration when (1) "there was a patent misunderstanding of the parties," (2) "where a decision was made that exceeded the issues presented," (3) "where a court failed to consider controlling law," or (4) "where a significant change in the law occurred after the decision was rendered." Pueschel v. Nat'l Air Traffic Controllers' Ass'n, 606 F. Supp. 2d 82, 85 (D.D.C. 2009).

B. The Court Denies Plaintiff's Motion for Reconsideration.

Plaintiff argues that this Court should reverse on reconsideration its February 27 ruling as to plaintiff's claim under § 1132(a)(3) because, plaintiff asserts, at "least one case in this circuit has been decided in the time between the plaintiff's Sur-Reply and the time the Court issued is Order, which supports Plaintiff's position . . . ." Pl.'s Supp. Mem. [17-1] 3. Namely, plaintiff asserts that one of the cases that the Court cited in its Memorandum Opinion, Clark v. Feder, Semo & Bard, P.C., 527 F. Supp. 2d 112, 116 (D.D.C. 2007) ("Clark I"), was "reversed in light of the Supreme Court's decision in Amara" prior to the Court's Order [13].*fn1 Id. 3-4 (citing Clark v. Feder, Semo & Bard, P.C., 808 F. Supp. 2d 219, 225 (D.D.C. 2012) ("Clark VI").*fn2 Plaintiff further asserts that the Court in Clark VI allowed a similarly situated plaintiff to proceed in the alternative under both § 1132(a)(1)(B)and § 1132(a)(3) "until all material facts were resolved concerning whether there was an adequate remedy under the Plan . . . the opposite of what this Court decided in its February 27, 2012 Opinion." Id. 4. In support of her argument, plaintiff also cites Kenseth v. Dean Health Plan, Inc., 610 F.3d 452 (7th Cir. 2010); N. Cypress Med. Ctr. Operating Co. v. Cigna Healthcare, 782 F. Supp. 2d 294, 309 (S.D. Tex. 2011); Fredericks v. Hartford Life Ins. Co., 488 F. Supp. 2d 210, 213 (N.D.N.Y. 2007), none of which are controlling in this Circuit. Id. 4-5. Plaintiff claims that she should be allowed to proceed in the alternative because "the Plan may not properly provide for the benefits she is seeking." Id. 5.

Plaintiff has not demonstrated that the Court's decision was clearly erroneous or unjust, or that her case falls into the category of "extraordinary circumstances" justifying reversal. Lederman, 539 F. Supp. 2d at 2. She has not argued that this Court patently misunderstood the parties, that our decision exceeded the issues presented or that this Court failed to consider controlling law. Pueschel,606 F. Supp. 2d at 85. At best, plaintiff argues that the Court's decision in Clark VI, along with the cases cited from other circuits, demonstrates that a "significant change in the law occurred after the decision was rendered." Id. However, plaintiff's argument fails for three important reasons.

Most obviously, Plaintiff fails to cite a single case decided after this Court's February 29, 2012, Order. Plaintiff posits that a single case, Clark VI, decided before this Court issued its Order, supports plaintiff's position, namely that she should be allowed to simultaneously pursue claims under § 1132(a)(1)(B) and 1132(a)(3) until it is clear to the plaintiff that there is an "adequate remedy under the Plan [or not]," at which time she will presumably elect to pursue a claim under one of the two statues. Pl.'s Supp. Mem. [17-1] 3. Plaintiff's motion implies without accusation that this Court either failed to consider recent case law before deciding plaintiff's motion or that this Court decided plaintiff's motion before publication of Clark VI in September 2011, yet intentionally failed to publish the decision for more than five months. Unless some space-time warping event has caused time to run in reverse, plaintiff is unable to show, based on the information proffered, that a significant change in the law occurred after this Court's decision.

Second, plaintiff's reading of the Clark VI is overbroad. Plaintiff asserts that the ruling in Clark VI allowed plaintiff Clark to proceed to trial under both §§ 1132(a)(1)(B) and 1132(a)(3), but only recover under one of the statutes, which she would elect after trial. Pl.'s Reply [25] ¶3, Apr. 13, 2012. The language of the case belies plaintiff's interpretation. Judge Bates made clear that the plaintiff could not "proceed" under both statues, a fact repeated no less than three times throughout the opinion. 808 F. Supp. 2d at 224-26, 234. This Court understands Judge ...


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