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Campo v. Oxford Health Plans

June 26, 2007

FANCIS M. CAMPO, JR., ET AL. PLAINTIFFS,
v.
OXFORD HEALTH PLANS, INC. ET AL. DEFENDANTS.



The opinion of the court was delivered by: Honorable Jerome B. Simandle

OPINION

SIMANDLE, District Judge

This matter arises out of the cancellation of Plaintiffs' employer-sponsored health insurance policy and Plaintiffs having incurred over $300,000 in medical bills as a result of their lack of health insurance. Specifically, Plaintiffs bring this action against Oxford Heath Plans, Inc. and Green Giant Nursery & Landscaping, Inc. alleging that these defendants violated the Employment Retirement Security Act, 29 U.S.C. § 1001 et seq. ("ERISA") and New Jersey law when they cancelled Plaintiffs' health insurance policy and failed to provide Plaintiffs with certain information regarding Plaintiffs' right to elect to continue their health insurance coverage after one of the Plaintiffs (Francis Campo) was terminated by his employer, Green Giant.*fn1 This matter is before the Court upon Defendant Oxford Heath Plans, Inc.'s motion to dismiss Counts Two, Four, Five and Seven of the Second Amended Complaint.

The Court will grant Oxford's motion and dismiss Counts Two, Four, Five and Seven of the Second Amended Complaint with respect to Oxford. Count Five of the Second Amended Complaint will be dismissed because Plaintiffs concede that the inclusion of Oxford as a defendant in Count Five was a typographical error. The Court will also grant Oxford's motion and dismiss Counts Two, Four and Seven because these claims fail to state a claim against Oxford.

I. BACKGROUND

A. The Facts

Plaintiffs are Francis M. Campo, Jr. and Tina E. Campo (and their children Domencia Campo, and Lorenzo Campo) who reside in Washington Township, New Jersey. (Second Am. Compl. ("SAC") ¶ 5.) Beginning in May of 2005, Francis Campo began working for Defendant Green Giant Nursery and Landscaping, Inc. ("Green Giant") as a laborer.*fn2 (Id. ¶ 11.) As a benefit of his employment with Green Giant, Plaintiff and his family were provided with group health insurance coverage through Oxford Health Plans, Inc. ("Oxford"). (Id.)

On September 29, 2005, Green Giant terminated Francis Campo. (Id. ¶ 12.) In Campo's termination letter, Green Giant stated that his health insurance coverage would continue for ninety days and that Oxford would contact him regarding the exact termination date of coverage. (Id.; Ex. D.) Also in the termination letter, Green Giant indicated that Plaintiff was eligible for health insurance coverage under COBRA and enclosed certain information about COBRA coverage. (Id.) On December 27, 2005, Green Giant sent Oxford completed COBRA application forms, requesting that Oxford provide COBRA insurance coverage to Plaintiffs. (Id. ¶ 14.) Oxford returned this application to Green Giant three days later requesting that Francis sign the continuation of coverage forms. (Id. ¶ 15.) Plaintiffs signed this form and promptly returned it to Oxford. (Id.) On January 23, 2006, Green Giant faxed an addition/termination/change form to Oxford, notifying Oxford of the birth of Francis and Tina Campo's second child, Domencia, on December 23, 2005 and requesting that Domencia be added as a dependant to Plaintiffs' health care coverage. According to Plaintiffs, despite completing all of the necessary paperwork required by Oxford and Green Giant, on February 22, 2006, Oxford informed Plaintiffs that their medical coverage had been cancelled effective December 27, 2005. (Id. at ¶ 18.)

The cancellation of Plaintiffs' insurance came at a particularly inopportune time for Plaintiffs. (Id. ¶ 13.) Due to complications caused by a premature birth, Domencia Campo spent over six weeks in the Neonatalogy Intensive Care Unit at Kennedy Memorial Hospital in Stratford, New Jersey. (Id.) According to a letter from Plaintiffs' counsel to Green Giant, Plaintiffs' lack of heath insurance resulted in Plaintiffs incurring over $300,000 in medical bills due to Domencia's extended hospital stay. (Id. at ¶ 19; Ex. F.)

B. Procedural History

On July 26, 2006, Plaintiffs filed this action in Superior Court of New Jersey, Law Division, Camden County. The Complaint contains seven counts against both Oxford and Green Giant including: (1) a violation of 29 U.S.C. § 1132(a)(1)(B) (also known as "Section 502(a)(1)(B)") for failure to provide Plaintiffs with the medical benefits to which they were entitled under an ERISA Plan (Count One); (2) failure by the plan administrator to provide requested information to a participant in compliance with 29 U.S.C. § 1132(c) ("Section 502(c)")(Count Two); (3) failure to provide coverage to newly-born-children from the moment of birth in violation of N.J. Stat. Ann. 17B:27-30 (Count Three); (4) failure to provide an employee with requisite notice of the employee's continuation rights in the certificate of coverage prepared by the carrier in violation of N.J. Stat. Ann. 17B:27A-27(a) & (e) (Count Four); (5) violation of relief under 29 U.S.C. § 1332(a)(3) ("Section 502(a)(3)")(Count Five); (6) breach of Oxford's insurance policy (Count Six); and (7) breach of fiduciary duty under 29 U.S.C. § 1332(a)(3) ("Section 502(a)(3)") (Count Seven).

On September 15, 2006, Oxford removed this action to this Court. [Docket Item No. 1.] On October 17, 2006 and again on October 27, 2006, Plaintiffs amended their complaint. [Docket Item Nos. 8, 11.] On November 9, 2006, Oxford filed this motion to dismiss certain counts in the Second Amended Complaint under Fed. R. Civ. P. 12(b)(6). [Docket Item No. 12.] On December 19, 2006, upon application by Plaintiffs and with the consent of all parties, this Court stayed all proceedings for ninety (90) days so that the parties could seek to resolve this matter through mediation. [Docket Item No. 16.] Mediation being unsuccessful, Plaintiffs filed opposition to Oxford's motion of April 10, 2007 to which Oxford replied on April 24, 2007. [Docket Item Nos. 20, 22.] The Court has considered all submissions and did not hear oral argument on this motion.*fn3

II. STANDARD OF REVIEW

A Rule 12(b)(6) motion to dismiss for failure to state a claim upon which relief may be granted must be denied "unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief." Scheuer v. Rhodes, 416 U.S. 232, 236 (1974). A district court must accept any and all reasonable inferences derived from those facts and must view all allegations in the complaint in the light most favorable to the plaintiff. See Scheuer, 416 U.S. at 236; Unger v. Nat'l Residents Corp. v. Exxon Co., U.S.A., 761 F. Supp. 1100, 1107 (D.N.J. 1991); Jordan v. Fox, Rothschild, O'Brien & Frankel, 20 F.3d 1250, 1261 (3d Cir. 1994).

In the complaint, it is not necessary for the plaintiff to plead evidence, and it is not necessary to plead the facts that serve as the basis for the claim. See Bogosian v. Gulf Oil Corp., 561 F.2d 434, 446 (3d Cir. 1977). When a motion to dismiss is before the court, the question for the court is not whether plaintiff will ultimately prevail; rather, it is whether he or she can prove any set of facts in support of their claims that would entitle them to relief. See Hishon v. King & Spalding, 467 U.S. 69, 73 (1984). While the court is required to take all of the allegations of fact as true, the court is "not required to credit bald assertions or legal conclusions alleged in the complaint," Jones v. Intelli-Check, Inc., 274 F. Supp. 2d 615, 625 (D.N.J. 2003), and need not accept conclusory recitations of law. Nappier v. Pricewaterhouse Coopers LLP, 227 F. Supp. 2d 263, 272 (D.N.J. 2002).

IV. DISCUSSION

A. Preliminary ...


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