Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_12-cv-00707/USCOURTS-azd-2_12-cv-00707-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1132 E.R.I.S.A.-Employee Benefits

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Michael LaSpina and Christina LaSpina,

on behalf of their minor child, A.L., 

Plaintiffs, 

vs.

Anthem Blue Cross Life & Health Ins.

Co.; Anthem UM Services, Inc., 

Defendants. 

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No. CV-12-0707-PHX-FJM

ORDER

Plaintiffs Michael and Christina LaSpina filed this action under the Employee

Retirement Income Security Act (“ERISA”), as a result of defendants’ denial of benefits

under their health insurance plan (“Plan”) for autism treatment known as applied behavioral

analysis (“ABA”) for their minor child, A.L. Defendants denied coverage for ABA treatment

based on their conclusion that the services were subject to the Plan exclusion for educational

services. In their three-count amended complaint, plaintiffs assert a claim for payment of

past and future medical benefits under 29 U.S.C. § 1132(a)(1)(B) (Count I); breach of

fiduciary duty under § 1132(a)(2) (Count II); and injunctive relief under § 1132(a)(3) (Count

III). 

We have before us defendants’ motion to dismiss Counts II and III (doc. 23),

plaintiffs’ response (doc. 25), and defendants’ reply (doc. 26). 

Count II – 29 U.S.C. § 1132(a)(2)

29 U.S.C. § 1132(a)(2) authorizes the Secretary, a participant, fiduciary, or

beneficiary to bring a claim for breach of fiduciary duty against a plan fiduciary who has

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violated 29 U.S.C. § 1109. Plaintiffs allege that defendants breached their fiduciary duties

by wrongfully denying coverage for ABA treatment, operating the Plan in a manner

inconsistent with ERISA, and failing to act in the best interest of the Plan participants and

beneficiaries. Amended Compl. ¶ 70. 

In drafting § 1132(a)(2), Congress was “primarily concerned with the possible misuse

of plan assets, and with remedies that would protect the entire plan, rather than with the

rights of an individual beneficiary.” Mass. Mut. Life Ins. Co. v. Russell, 473 U.S. 134, 141,

105 S. Ct. 3085, 3090 (1985) (holding that recovery for a violation of 29 U.S.C. § 1109

“inures to the benefit of the plan as a whole”). Therefore, to state a claim under § 1132(a)(2),

a plaintiff must “allege that the fiduciary injured the benefit plan or otherwise jeopardized

the entire plan or put at risk plan assets.” Wise v. Verizon Commc’ns Inc., 600 F.3d 1180,

1189 (9th Cir. 2010) (quotation omitted). Section 1132(a)(2) does not provide a remedy “for

injuries suffered by individual participants.” Id.

Plaintiffs’ claim arises, not out of conduct that damaged the Plan as a whole, but out

of the denial of benefits to a particular claimant. Their argument that defendants’ denial of

A.L.’s benefits necessarily “implicate[s] a systematic method for how they administer all

claims for ABA” services,” thereby injuring the Plan as a whole, was rejected by the Ninth

Circuit in Wise. See id. (holding that there are “no factual allegations that the Plan

Administrators violated their duties with respect to anything other than Wise’s individual

claim”). Similarly, here, plaintiffs have not alleged any facts tending to show that

defendants’ actions injured the Plan as a whole, or otherwise compromised Plan assets.

Plaintiffs’ conclusory assertion that the desired remedy would benefit the Plan as a whole is

undermined by the nature of the remedy sought–compensation to Plan participants for

improperly denied benefits. Because plaintiffs’ remedy in Count II would inure to the benefit

of Plan participants rather than to the Plan itself, we conclude that plaintiffs have failed to

state a claim under § 1132(a)(2). Therefore, Count II is dismissed. 

Count III – 29 U.S.C. § 1132(a)(3)

Section 1132(a)(3) allows a participant, beneficiary, or fiduciary to bring a civil action

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to (a) enjoin any act or practice which violates ERISA or terms of the plan, or (b) to obtain

“other appropriate equitable relief.” Section 1132(a)(3) is characterized as a “catchall” or

“safety net” provision designed to “offer[] appropriate equitable relief for injuries caused by

violations that [§1132] does not elsewhere adequately remedy.” Wise, 600 F.3d at 1190

(quoting Varity Corp. v. Howe, 516 U.S. 489, 512, 116 S. Ct. 1065, 1078 (1996)).

Therefore, relief afforded by § 1132(a)(3) is limited to those plan participants who are unable

to avail themselves of remedies otherwise available under § 1132. Varity Corp., 516 U.S.

at 512, 116 S. Ct. at 1978. When plaintiffs sue for the payment of benefits under §

1132(a)(1)(B) and also include a claim for relief under § 1132(a)(3), courts routinely dismiss

the § 1132(a)(3) claim. See, e.g., Wise, 600 F.3d at 1190. 

In Count III, plaintiffs allege that, by refusing to provide coverage for ABA treatment

to A.L., defendants have failed to provide them with “full and fair review” of their claim.

First, the allegation that defendants did not fully review the claim is contradicted by other

allegations in the complaint. Amended Compl. ¶¶ 35-51 (describing defendants’ review of

plaintiffs’ original claim, as well as their first and second level appeals). In addition, §

1132(a)(1)(B), which plaintiffs assert in Count I, authorizes a participant to sue “to enforce

his rights under the terms of the plan.” Therefore, relief under § 1132(a)(1)(B) includes an

order requiring defendants to provide a “full and fair review” of plaintiffs’ claim in

accordance with the Plan terms. Because the relief plaintiffs seek in Count III—a

reexamination of their claim denial—is duplicative of the relief sought in Count I, Count III

is dismissed. 

Conclusion

IT IS ORDERED GRANTING defendants’ motion to dismiss Counts II and III of

the first amended complaint (doc. 23).

DATED this 23rd day of August, 2012.

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