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Hoagland v. Amerihealth Administrators

March 2, 2006

DONNA HOAGLAND, PLAINTIFF
v.
AMERIHEALTH ADMINISTRATORS, ET AL., DEFENDANTS



The opinion of the court was delivered by: Judge Jones

MEMORANDUM AND ORDER

THE BACKGROUND OF THIS ORDER IS AS FOLLOWS:

Pending before the Court is a Motion to Amend the Judgment to Include the Award of Attorneys' Fees in its favor pursuant to 29 U.S.C. § 1132(g)(1) ("the Motion") (doc. 44) filed by Defendant Ono Transport Services, Inc., Health and Medical Benefits Plan ("Defendant" or "Plan") on January 16, 2006.

For the reasons that follow, Defendant's Motion will be denied.

FACTUAL BACKGROUND/PROCEDURAL HISTORY:

On January 13, 2005, Plaintiff Donna Hoagland ("Plaintiff" or "Hoagland") filed a complaint arising under the provisions of the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 etseq. in the United States District

Court for the Middle District of Pennsylvania with Erin Group Administrators, Inc. ("Erin"), AmeriHealth Administrators ("AmeriHealth"), and J.P. Donmoyer, Inc. ("Donmoyer") as named Defendants. (See Rec. Doc. 1).

On March 21, 2005, all named Defendants in the complaint, Erin, AmeriHealth, and Donmoyer filed a Motion to Dismiss the complaint. (See Rec. Doc. 8). The Court's April 4, 2005 Order denied the Motion to Dismiss as moot as Plaintiff filed an Amended Complaint on March 30, 2005 naming Erin, AmeriHealth, and Ono Transport Services, Inc. Health and Medical Benefits Plan as Defendants. Plaintiff therefore dropped Donmoyer as a Defendant and named Ono Transport Services, Inc. Health and Medical Benefits Plan in its place. (See Rec. Docs. 13-14).

Thereafter, on June 28, 2005, we granted in part and denied in part Defendants' Motion to Dismiss the Amended Complaint. (Rec. Doc. 21). In that Order, we granted Defendants' Motion to the extent that Count I of the Amended Complaint was dismissed and Defendant Erin was dismissed from this action. We denied Defendants' Motion with respect to Defendant AmeriHealth but noted that either party reserves the right to raise this issue at a subsequent point in the litigation if it becomes evident that Plaintiff is not pursuing equitable relief under ERISA as against Defendant AmeriHealth.

The parties subsequently filed cross-motions for summary judgment on the claims pending against AmeriHealth and the Plan. On January 6, 2006, we granted Defendants' Motion for Summary Judgment and denied Plaintiff's Motion for Summary Judgment. (Rec. Doc. 43). We determined that Defendants' decision to deny Plaintiff's claim for benefits pursuant to the Plan's Pre-Existing Condition Exclusion was not arbitrary and capricious as she had been advised prior to the effective date of coverage to have a colonoscopy performed to determine if she was suffering from an inflammatory bowel disease ("IBD") such as Crohn's disease, which was the eventual diagnosis of her medical condition.

On January 16, 2006, Defendant filed the instant Motion seeking attorneys' fees from Plaintiff. The Motion has been fully briefed and is ripe for disposition.

DISCUSSION:

In the Motion brought pursuant to 29 U.S.C. § 1132(g)(1), Defendant argues that the Third Circuit Court of Appeal's five factor test to guide district courts in determining whether to award attorneys' fees to the prevailing party reveals that attorneys' fees should be awarded in the case sub judice. Defendant contends that Plaintiff and Plaintiff's counsel acted unreasonably in pursuing this claim based upon their unsupported allegation that Dr. Wright misdiagnosed Plaintiff's condition. "As this Court made clear in its Memorandum of January 6, 2006, there was no misdiagnosis of Plaintiff's condition. Dr. Wright was very concerned with Plaintiff's condition, and strongly recommended that she have a colonoscopy performed to determine if she was suffering from an inflammatory bowel disease." (Def.'s Mot. Attn. Fees at 5).

In response, Plaintiff asserts that an analysis of the above-referenced factors indicates that attorneys' fees should not be awarded in this case. Plaintiff's counsel argues that he was making a good faith argument to extend the rationale of the McLeod v. Hartford Life and Accident Ins., 372 F.3d 618 (3d Cir. 2004), case to his client's factual scenario. In addition, Plaintiff's counsel maintains that he filed the instant action believing it might cause Defendants to settle the case and that a ...


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