Opinion ID: 791097
Heading Depth: 1
Heading Rank: 1

Heading: facts

Text: 4 Daley is an employee of Marriott Corporation, Inc., a subsidiary of Marriott. Daley is a participant in the Plan, which is self-funded and sponsored by Marriott and governed by ERISA. 4 Marriott is the administrator of the Plan, and as such, under the Plan it has the sole and absolute final discretion to determine eligibility for plan benefits, to construe the terms of the plan, and to resolve any factual issues relevant to benefit eligibility or benefit enrollment. Pursuant to an agreement with Marriott, Empire performs third-party administrative and claims-processing services for the Plan. 5 Under the terms of the Plan, in-network outpatient mental-health visits are fully covered, subject to a co-payment. Such coverage, however, is subject to a plan-year maximum of thirty visits and a lifetime maximum of 200 visits. 6 In 2000, Daley began receiving outpatient treatment for an unspecified mental-health condition. In 2000 and 2001, she incurred claims exceeding the plan-year maximum of thirty visits. Empire denied those claims and Daley's appeals of those claims on the basis that Daley's visits exceeded the plan-year maximum. Daley argued that Nebraska's mental-health parity law, Neb.Rev.Stat. §§ 44-791 to 795 (2000), prohibited the Plan from imposing any limits on mental-health coverage. 5 The Plan, through Empire, took the position that the Nebraska mental-health parity law does not apply to the Plan because the law is preempted by ERISA. 7 Daley decided not to pursue an optional appeal of her denied claims to Marriott. Instead, on January 20, 2003, Daley filed a complaint against the Plan and Empire for breach of contract under state law and breach of fiduciary duty under ERISA § 409, 29 U.S.C. § 1109, based on the Plan's failure to provide mental-health coverage in accordance with the Nebraska mental-health parity law. 8 Daley made three attempts to amend her complaint to add Marriott as a defendant. First, on August 29, 2003, Daley filed a motion to add Marriott as a defendant. The magistrate judge 6 denied the motion, citing Daley's failure to comply with Rule 15.1 of the Local Rules of the United States District Court for the District of Nebraska, which requires the moving party to attach a proposed amended pleading to the motion. 7 Then, on December 26, 2003, Daley filed another motion to amend her complaint seeking to add Marriott as a defendant, to expand the time-frame of denied claims to 2003, and to add an allegation of untimely notices of those additional claim denials. The magistrate judge denied this motion because the proposed amended complaint attached to the motion failed to reference Marriott, the party Daley intended to add as a defendant. 8 Finally, on January 23, 2004, Daley filed a motion to reconsider the denial of her motion to amend and attached a corrected proposed amended complaint which substituted Marriott as a defendant in place of the Plan, expanded the time-frame of denied claims, and added an allegation of untimely claim denials. The magistrate judge construed the motion as a renewed motion for leave to amend and denied it. 9 9 The Plan and Empire moved for summary judgment, arguing that ERISA preempts the Nebraska mental-health parity law. On June 1, 2004, the district court granted the motion, concluding that Daley's claims were based on a state law that, as applied to self-funded ERISA plans, is preempted by ERISA. See Daley v. Marriott Health Plan, No. 8:03CV26 (D. Neb. June 1, 2004) ( Daley I ). 10 Meanwhile, on February 19, 2004, Daley filed a lawsuit against Marriott in its capacity as Plan administrator ( Daley II ). The complaint in Daley II is the same as the complaint filed in Daley I, except in the following respects: (1) Marriott, as opposed to the Plan and Empire, is the named defendant in Daley II; (2) the Daley II complaint contains an allegation of additional claim denials based on the plan-year limit since the filing of Daley I; and (3) the Daley II complaint contains an allegation of untimely notices of those additional claim denials. Marriott moved to dismiss Daley II based on the doctrine of res judicata. On June 18, 2004, the district court granted the motion on res judicata grounds and alternatively held, like the district court in Daley I, that Daley failed to state a claim because her claim relied on a state law that, as applied to self-funded ERISA plans, is preempted by ERISA. 11 Daley now appeals the district court's adverse grant of summary judgment in Daley I. She also appeals the district court's dismissal of Daley II.