Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_05-cv-01229/USCOURTS-cand-3_05-cv-01229-6/pdf.json

Nature of Suit Code: 110
Nature of Suit: Insurance
Cause of Action: 29:1132 E.R.I.S.A.: Employee Benefits

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For the Northern District of California

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States District C

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For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

RICHARD P. WELLS, et al.,

Plaintiff,

 v.

CALIFORNIA PHYSICIANS’ SERVICE,

dba BLUE SHIELD OF CALIFORNIA,

Defendant.

 /

No. C 05-01229 CRB

ORDER

Now pending before the Court is defendants’ motion to dismiss the First Amended

Complaint. After carefully reviewing the papers filed by the parties, the Court GRANTS the

motion in part, and DENIES the motion in part.

Plaintiffs’ second, third and fourth claims for relief are DISMISSED with prejudice. 

These claims seek compensatory damages that are not recoverable under ERISA. See Bast v.

Prudential Ins. Co. of America, 150 F.3d 1003, 1008 (9th Cir. 1998); McLeod v. Lithoprint

Inc., 102 F.3d 376, 377 (9th Cir. 1996). Plaintiffs’ characterization of their claims as seeking

equitable relief is immaterial. “In determining whether an action for equitable relief is

properly brought under ERISA, [courts] look to the substance of the remedy sought . . . rather

than the label placed on that remedy.” Westaff (USA) v. Arce, 298 F.3d 1164, 1166 (9th Cir.

2002).

Case 3:05-cv-01229-CRB Document 36 Filed 10/11/05 Page 1 of 2
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Defendant’s motion to dismiss the first claim for injunctive relief is DENIED. 

Defendant concedes that plaintiffs can seek injunctive relief under section 502(a)(3). See

McLeod, 102 F.3d at 377-78. 

Defendant has not established that plaintiffs do not have standing as a matter of law. 

Section 502(a)(3) provides that “A civil action may be brought–by a participant, beneficiary

or fiduciary (A) to enjoin any act or practice which violates any provision of this subchapter

or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such

violations or (ii) to enforce any provisions of this subchapter or the terms of the plan. 

Plaintiffs are themselves beneficiaries of the plan and they are seeking to enjoin acts that they

allege violate ERISA; thus, under the language of the statute they appear to have standing.

None of the cases cited by defendant are ERISA cases. Further, defendant has not addressed

the other injunctive relief sought by plaintiffs; namely, requiring defendant to provide

beneficiaries with certain information when it denies claims that it has previously approved. 

Defendant has also not established that plaintiffs have not and cannot allege that

defendant has a policy of denying coverage for the Taxol protocal. The First Amended

Complaint alleges that defendant continues to deny coverage for such treatment by

misrepresenting that such treatment is “experimental” and by failing to expeditiously process

claims for the Taxol protocal. That defendant eventually reversed its decision (although its

reversal was too late) does not mean that it does not have a policy of initially denying such

claims on the ground that it is an experimental procedure. 

IT IS SO ORDERED.

Dated: October 11, 2005

 

CHARLES R. BREYER

UNITED STATES DISTRICT JUDGE

Case 3:05-cv-01229-CRB Document 36 Filed 10/11/05 Page 2 of 2