Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_09-cv-02288/USCOURTS-caed-2_09-cv-02288-2/pdf.json

Parties Involved:
Tall Tree Administrators
Defendant
Laura Turnbow
Plaintiff

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 Because oral argument will not be of material assistance, 1

the Court orders this matter submitted on the briefs. E.D. Cal.

Local Rule 230(g). 

1

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

LAURA TURNBOW,

No. 2:09-cv-02288-MCE-EFB

Plaintiff,

v. MEMORANDUM AND ORDER

TALL TREE ADMINISTRATORS LLC;

and DOES 1-100, inclusive,

Defendants.

----oo0oo----

Through this action Plaintiff Laura Turnbow (“Plaintiff”)

seeks damages for the denial of medical benefits under an

Employee Benefit Plan administered by Defendant Tall Tree

Administrators, LLC (“Defendant”). Presently before the Court is

a Motion by Defendant to Dismiss Plaintiff’s First Amended

Complaint for failure to state a claim upon which relief may be

granted pursuant to Federal Rule of Civil Procedure 12(b)(6).1

For the reasons set forth below, Defendant’s motion is granted.

Case 2:09-cv-02288-MCE -EFB Document 22 Filed 02/23/10 Page 1 of 5
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 The factual assertions in this section are based on the 2

allegations in Plaintiff’s Complaint unless otherwise specified.

2

BACKGROUND2

This dispute arises from an automobile accident in which

Plaintiff sustained personal injuries. At the time of the

accident, Plaintiff believed she was insured for health benefits

as a “significant other” through her partner’s employer-funded

benefits plan administered by Defendant. Such plan is subject to

the Federal Employee Retirement Income Security Act (“ERISA”),

29 U.S.C. § 1003(a)(3). 

Following Plaintiff’s injuries, Defendant authorized her

treatment of insurance but subsequently refused to cover her

costs based upon a belief that Plaintiff was not an eligible plan

participant. Plaintiff alleges that she was at all times a

dependant of a covered plan member, paid premiums on the plan,

and, as such, was wrongfully denied coverage of her medical

expenses. 

STANDARD

On a motion to dismiss for failure to state a claim under

Rule 12(b)(6), all allegations of material fact must be accepted

as true and construed in the light most favorable to the

nonmoving party. Cahill v. Liberty Mut. Ins. Co., 80 F.3d 336,

337-38 (9th Cir. 1996). 

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3

Rule 8(a)(2) requires only “a short and plain statement of the

claim showing that the pleader is entitled to relief” in order to

“give the defendant fair notice of what the...claim is and the

grounds upon which it rests.” Bell Atl. Corp. v. Twombly, 127 S.

Ct. 1955, 1964 (2007) (quoting Conley v. Gibson, 355 U.S. 41, 47

(1957)). 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 “entitlement to

relief” requires more than labels and conclusions, and a

formulaic recitation of the elements of a cause of action will

not do. Id. at 1964-65 (internal citations and quotations

omitted). Factual allegations must be enough to raise a right to

relief above the speculative level. Id. at 1965 (citing 5 C.

Wright & A. Miller, Federal Practice and Procedure § 1216, pp.

235-36 (3d ed. 2004) (“The pleading must contain something

more...than...a statement of facts that merely creates a

suspicion [of] a legally cognizable right of action”)). 

“Rule 8(a)(2)...requires a ‘showing,’ rather than a blanket

assertion of entitlement to relief. Without some factual

allegation in the complaint, it is hard to see how a claimant

could satisfy the requirements of providing not only ‘fair

notice’ of the nature of the claim, but also ‘grounds’ on which

the claim rests.” Twombly, 550 U.S. 556 n.3. A pleading must

contain “only enough facts to state a claim to relief that is

plausible on its face.” Id. at 570. If the “plaintiffs...have

not nudged their claims across the line from conceivable to

plausible, their complaint must be dismissed.” Id. 

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4

Nevertheless, “[a] well-pleaded complaint may proceed even if it

strikes a savvy judge that actual proof of those facts is

improbable, and ‘that a recovery is very remote and unlikely.’”

Id. at 556.

A court granting a motion to dismiss a complaint must then

decide whether to grant leave to amend. A court should “freely

give” leave to amend when there is no “undue delay, bad faith[,]

dilatory motive on the part of the movant,...undue prejudice to

the opposing party by virtue of...the amendment, [or] futility of

the amendment....” Fed. R. Civ. P. 15(a); Foman v. Davis,

371 U.S. 178, 182 (1962). Generally, leave to amend is denied

only when it is clear the deficiencies of the complaint cannot be

cured by amendment. DeSoto v. Yellow Freight Sys., Inc.,

957 F.2d 655, 658 (9th Cir. 1992).

ANALYSIS

Defendant moves to dismiss Plaintiff’s claims arguing that

Plaintiff has failed to allege exhaustion of administrative

remedies as required by ERISA. See 29 C.F.R.

§ 2560.503-1(h)(3)(I). An ERISA plaintiff claiming a denial of

benefits must avail herself of a plan’s own internal review

procedures before bringing suit in federal court. Vaught v.

Scottsdale Healthcare Corp. Health Plan, 546 F.3d 620, 626 (9th

Cir. 2008). By Plaintiff’s own admission, such internal review

has yet to be fully exhausted.

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5

The Ninth Circuit has recognized that exceptions to the

exhaustion requirement exist when a “resort to the administrative

route is futile or the remedy inadequate.” Vaught, 546 F.3d at

626-27 (citing Amato v. Bernard, 618 F.2d 559, 568 (9th Cir.

1980)). Although Plaintiff objects to the application of the

exhaustion doctrine, she fails to demonstrate how efforts to

comply with administrative requirements would now be futile or

the remedy inadequate. Plaintiff alleges that she has not yet

been provided written notice of her denial. However, rather than

being evidence of the futility of a subsequent administrative

appeal, this indicates that parties might still resolve their

dispute pursuant to internal procedures. Regardless of how they

choose to do so, Plaintiff is required to allege exhaustion of

such remedies before she may bring suit before this Court. See

Diaz v. United Agric. Employee Welfare Benefit Plan & Trust, 50

F.3d 1478, 1483 (9th Cir. 1995).

CONCLUSION

Accordingly, Defendant’s Motion to Dismiss (Docket No. 14)

is hereby GRANTED with leave to amend. The parties shall file a

joint status report not later than forty five (45) days after

this Order is electronically filed.

IT IS SO ORDERED.

Dated: February 22, 2010

_____________________________

MORRISON C. ENGLAND, JR.

UNITED STATES DISTRICT JUDGE

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