The opinion of the court was delivered by: DONALD J. LEE
Pending before this Court is Defendant 84 LUMBER COMPANY MEDICAL BENEFITS PLAN'S ("Medical Plan") Motion to Dismiss (Document No. 2), as well as Motions for Summary Judgment filed by Plaintiff Children's Hospital of Pittsburgh ("Children's Hospital") (Document No. 13) and by the Medical Plan (Document No. 11).
Medical Plan is an employee welfare benefit plan within the meaning of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), 29 U.S.C. § 1002(1). Medical Plan provides medical, surgical and hospital benefits to eligible employees and dependents. (Complaint P 3, Memorandum in Support of Motion to Dismiss, p.1).
John Hood was an employee of 84 Lumber Company, and was a participant, within the meaning of 29 U.S.C. § 1002(7), of the Medical Plan and eligible for benefits provided under the Plan. On March 15, 1990, Julianna Hood, wife of John Hood, gave birth to their biological daughter, Jennifer Hood. As a result of a life-threatening medical condition, Jennifer Hood was transferred from Erie, Pennsylvania, to Children's Hospital on March 17, 1990. Children's Hospital alleges that from March 17, 1990, until Jennifer Hood's death on March 24, 1990, it rendered medical services to Jennifer Hood totalling $ 35,173.23. (Complaint, P 10).
Children's Hospital alleges in its complaint
that Medical Plan has arbitrarily and capriciously denied Children's Hospital's claim for payment for the medical services it provided to Jennifer Hood.
Medical Plan avers that, as a matter of law, the conduct of the Plan's trustee in denying coverage was neither arbitrary nor capricious. (Motion to Dismiss, P 10).
Medical Plan asserts two separate legal arguments in support of its Motion to Dismiss: (i) Medical Plan first alleges that, as a matter of law, the conduct of Medical Plan's trustee was neither arbitrary nor capricious, thus Medical Plan asserts that the complaint must be dismissed for failure to state a claim upon which relief may be granted (Memorandum in Support of Motion to Dismiss, pp. 3-8); and, (ii) Secondly, Medical Plan asserts that Children's Hospital has no standing to bring the instant ERISA action (Memorandum in Support of Motion to Dismiss, pp. 8-10).
In deciding a motion to dismiss pursuant to Fed. R. Civ. P. 12(b)(6), the court must accept the well-pleaded factual allegations as true. A claim should not be dismissed for failure to state a claim unless it appears beyond a doubt that the non-moving party can prove no set of facts in support of its allegations which would entitle it to relief. Conley v. Gibson, 355 U.S. 41, 2 L. Ed. 2d 80, 78 S. Ct. 99 (1957); Marshall-Silver Constr. Co. v. Mendel, 894 F.2d 593, 595 (3d Cir. 1990). In making this determination, the court must construe the pleading in the light most favorable to the non-moving party. Budinsky v. Pennsylvania Dep't of Envtl. Resources, 819 F.2d 418, 421 (3d Cir. 1987). For the reasons set forth below, Medical Plan's Motion to Dismiss as to standing is denied with prejudice, and the balance of the Motion to Dismiss is denied without prejudice.
i) Arbitrary and Capricious
Medical Plan's Motion to Dismiss for failure to state a claim upon which relief may be granted shall be treated as a motion for summary judgment and disposed of as provided in Rule 56 because matters outside the pleading were presented to and not excluded by the court. See Fed. R. Civ. P. 12 (b).
Therefore, the issues raised in Medical Plan's Motion to Dismiss for failure to state a claim upon which relief may be granted will be discussed and considered in conjunction with this Court's disposition of Medical Plan's pending Motion for Summary Judgment.
Medical Plan contends that Section 502 of ERISA provides that a civil action may only be brought under ERISA by a plan "participant," "beneficiary," "fiduciary," or by the Secretary of Labor. Therefore, Medical Plan claims that because Children's Hospital is an "assignee" of the benefits under the Plan, it has no standing in the instant action. (Motion to Dismiss, p.4, citing Health Scan, Ltd. v. Travelers Ins. Co., 725 F. Supp. ...