IN THE UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF TEXAS

FORT WORTH DIVISION

TARRANT DIALYSIS CENTERS, INC., §

§

Plaintiff, §

§

VS. § NO. 4:04-CV-618-A

§

CORESOURCE, INC., ET AL., §

§

Defendants. §

MEMORANDUM OPINION

and

ORDER

Came on for consideration the motion of defendant

Coresource, Inc. ("Coresource") for summary judgment. Plaintiff,

Tarrant Dialysis Centers, Inc., has failed to respond to the

motion, which is ripe for ruling. The court, having considered

the motion, the record, the summary judgment evidence, and

applicable authorities, finds that the motion should be granted

in part.

I.

Plaintiff's Claims

On July 22, 2004, plaintiff filed its original petition in

the 342nd Judicial District Court of Tarrant County, Texas. The

action was brought before this court by notice of removal filed

August 26, 2004. On February 14, 2005, having first obtained

leave of court, plaintiff filed its complaint, adding claims

against defendant Teleplan Holdings USA, Inc. ("Teleplan").

Plaintiff alleges that it provided kidney dialysis treatment

for a patient participant in a welfare benefit plan sponsored by

Teleplan and administered by Coresource. Coresource promised

 

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that plaintiff would be paid if it continued to provide treatment

to the patient. Eventually, Coresource entered into a written

contract to pay outstanding charges at a negotiated discount. 

Nevertheless, plaintiff has not been paid for the services it

provided.

Plaintiff asserts claims against Coresource under the Texas

Insurance Code, Arts. 21.55, 21.21, and 20A.18, for breach of

contract and quantum meruit, for fraud and misrepresentation, and

for unjust enrichment.

II.

Grounds of the Motion

Coresource urges four grounds in support of its motion for

summary judgment. First, plaintiff's state law claims of breach

of contract and violations of Arts. 21.55 and 21.21 of the Texas

Insurance Code relate to an ERISA plan and are preempted by

ERISA. Second, under ERISA, Coresource did not abuse its

discretion in denying payment of the medical benefits claims. 

Third, Coresource is not a proper party to an action to recover

benefits under ERISA. And, fourth, the remaining state law

causes of action fail because (a) Art. 20A.18 does not apply to

PPO plans, such as the one at issue; (b) the quantum meruit claim

fails inasmuch as no services were rendered to or accepted by

Coresource; (c) the unjust enrichment claim fails inasmuch as

there is no such separate cause of action, no benefits were

conferred on Coresource, and the claim is otherwise barred by

limitations; and (d) the misrepresentation and fraud claims fail

 

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inasmuch as plaintiff cannot prove the essential elements of its

claims and such claims are otherwise barred by limitations.

III.

Applicable Summary Judgment Principles

A party is entitled to summary judgment on all or any part

of a claim as to which there is no genuine issue of material fact

and as to which the moving party is entitled to judgment as a

matter of law. Fed. R. Civ. P. 56(c); Anderson v. Liberty Lobby,

Inc., 477 U.S. 242, 247 (1986). The moving party has the initial

burden of showing that there is no genuine issue of material

fact. Anderson, 477 U.S. at 256. The movant may discharge this

burden by pointing out the absence of evidence to support one or

more essential elements of the non-moving party's claim "since a

complete failure of proof concerning an essential element of the

nonmoving party's case necessarily renders all other facts

immaterial." Celotex Corp. v. Catrett, 477 U.S. 317, 323-25

(1986). Once the moving party has carried its burden under Rule

56(c), the non-moving party must do more than merely show that

there is some metaphysical doubt as to the material facts. 

Matsushita Elec. Indus. Co., Ltd. v. Zenith Radio Corp., 475 U.S.

574, 586 (1986). The party opposing the motion may not rest on

mere allegations or denials of pleading, but must set forth

specific facts showing a genuine issue for trial. Anderson, 477

U.S. at 248, 256. To meet this burden, the nonmovant must

"identify specific evidence in the record and articulate the

'precise manner' in which that evidence support[s] [its]

 

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claim[s]." Forsyth v. Barr, 19 F.3d 1527, 1537 (5th Cir. 1994). 

An issue is material only if its resolution could affect the

outcome of the action. Anderson, 477 U.S. at 248. Unsupported

allegations, conclusory in nature, are insufficient to defeat a

proper motion for summary judgment. Simmons v. Lyons, 746 F.2d

265, 269 (5th Cir. 1984).

The standard for granting a summary judgment is the same as

the standard for rendering judgment as a matter of law. Celotex

Corp., 477 U.S. at 323. If the record taken as a whole could not

lead a rational trier of fact to find for the non-moving party,

there is no genuine issue for trial. Matsushita, 475 U.S. at

597. See also Boeing Co. v. Shipman, 411 F.2d 365, 374-75 (5th

Cir. 1969) (en banc) (explaining the standard to be applied in

determining whether the court should enter judgment on motions

for directed verdict or for judgment notwithstanding the

verdict). 

IV.

Undisputed Evidence

The following is an overview of evidence pertinent to the

motion for summary judgment that is undisputed in the summary

judgment record:

The patient to whom services were rendered was a covered

spouse under a group health plan sponsored and maintained by

Teleplan. Teleplan established and maintained the plan and

contributed to the payment of premiums for its eligible

employees. The plan was self-funded by Teleplan. From

 

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September 1, 2000, to October 31, 2004, Coresource performed

claims administration services on behalf of Teleplan under the

plan and adjudicated claims in accordance with the terms of the

plan, including the claims of the patient at issue in this case. 

Coresource did not insure the plan, but rather performed thirdparty claims administration services on behalf of Teleplan. 

Coresource was not the insurer, plan administrator, or plan

sponsor. Coresource is not an insurance company or the source of

payment of any benefits under the plan.

The plan, a "comprehensive PPO plan," offered several

options to eligible employees. The patient's spouse elected the

"network plan option" under the plan that offered high-level

coverage for most covered services if a network provider rendered

the treatment, but provided no benefits if the provider was not a

network provider. Plaintiff was not a network provider under the

plan for the time between August 1, 2001, and March 20, 2003,

when treatment was rendered to the patient. No benefits were

payable under the plan to plaintiff for the services rendered.

V.

Discussion

The summary judgment evidence establishes that the plan at

issue is an employee welfare benefit plan, as defined by 29

U.S.C. § 1002(1). Meredith v. Time Ins. Co., 980 F.2d 352, 355

(5th Cir. 1993). Moreover, the plan falls outside the safe

harbor provisions. Gahn v. Allstate Life Ins. Co., 926 F.2d

1449, 1452 (5th Cir. 1991). Accordingly, ERISA preempts any

 

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state law claims brought by a plan beneficiary or by a thirdparty health care provider bringing a derivative action based on

assignment of the beneficiary's claims. See Shaw v. Delta

Airlines, Inc., 463 U.S. 85, 98 (1983); Dowden v. Blue Cross &

Blue Shield of Tex., Inc., 126 F.3d 641, 643 (5th Cir. 1997);

Saint Luke's Episcopal Hospital Corp. v. Stevens Transport, Inc.,

172 F. Supp. 2d 837, 841 (S.D. Tex. 2000). However, ERISA does

not preempt claims that are not dependent on or derivative of a

beneficiary's right to recover under an ERISA plan. Transitional

Hospitals Corp. v. Blue Cross & Blue Shield of Tex., Inc., 164

F.3d 952, 955 (5th Cir. 1999); Saint Luke's 172 F. Supp. 2d at

841.

In this case, plaintiff's common law claims are not

preempted by ERISA inasmuch as plaintiff does not purport to

bring them as assignee of the patient's claims. Nevertheless,

Coresource is entitled to judgment on each of the claims, except

that for breach of contract, since a ground of its motion for

summary judgment is that plaintiff cannot prove each of the

elements of the non-contract common law claims. Plaintiff has

not come forward with any evidence to establish a fact issue as

to each element of its claims for quantum meruit, fraud, and

misrepresentation. (As Coresource notes, quantum meruit and

unjust enrichment are not separate causes of action. See Barnett

v. Coppell N. Tex. Ct. Ltd., 123 S.W.3d 804, 816-17 (Tex. App.--

Dallas 2003, pet. denied)).

 

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As for the claims made under the Texas Insurance Code,

Coresource has shown that it is entitled to judgment as a matter

of law that plaintiff take nothing. First, article 21.55 is

applicable only against insurers and does not apply to

Coresource. Tex. Ins. Code Ann. Art. 21.55, § 6 (Vernon Supp.

2005). Likewise, article 20A.18 applies only to health

maintenance organizations and is not applicable here. And,

plaintiff's claims under article 21.21 are necessarily dependent

on the claims of the patient and are preempted by ERISA. Saint

Luke's 172 F. Supp. 2d at 843-44.

VI.

Order

For the reasons discussed herein,

The court ORDERS that Coresource's motion for summary

judgment be, and is hereby, granted in part; that plaintiff take

nothing on its claims against Coresource except for the claim for

breach of contract; and that such claims, excluding the claim for

breach of contract, be, and are hereby, dismissed with prejudice.

SIGNED May 17, 2005.

 /s/ John McBryde 

JOHN McBRYDE

United States District Judge

 

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