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Pushkin v. Nussbaum

United States District Court, Third Circuit

April 24, 2013

DR. DAVID B. PUSHKIN, Plaintiff,


DENNIS M. CAVANAUGH, District Judge.

This matter comes before the Court upon the filing of six motions to dismiss the First Amended Complaint of Dr. David M. Pushkin ("Plaintiff') filed by Defendants Meritain Health. Inc. and Timothy J. Quinlivan (hereinafter "Meritain Health" and "Quinlivan" respectively) (Aug. 30, 2012, ECF No. 208); Premier Prizm Solutions, LLC (hereinafter-PPS") (Aug. 30, 2012, ECF No. 209); RHI Entertainment, Inc. (hereinafter "RHI") (Aug. 31, 2012, ECF No. 210); Beth Nussbaum (hereinafter "Nussbaum") (Aug. 31, 2012, ECF No. 211); Defendants GEICO, Lisa Ardron, Gina Fuge, Dominic Spaventa, and Paul Feldmann (hereinafter "GEICO Defendants") (Sept. 4, 2012, ECF No. 212); Aronsohn Weiner & Salerno, P.C. and Kevin L. Bremer, Esq. (hereinafter "AWS" and "Bremer") (Sept. 5, 2012, ECF No. 213) (hereinafter collectively referred to as "Moving Defendants"). Pursuant to FED. R. Civ. P. 78, no oral argument was heard. The Court has reviewed and considered the submissions of the parties. Because this Court finds that Plaintiff failed to plead the Amended Complaint with the requisite specificity, the Moving Defendants motions to dismiss (ECF Nos. 208, 209, 210, 211, 212, 213) are granted. The Amended Complaint is dismissed without prejudice, and Plaintiff is granted leave to file a second amended complaint within thirty days.


On or about November 30, 2010, Plaintiff filed an initial action against Defendants Nussbaum, RHI, Quinlivan, Meritain Health, Bremer, and AWS seeking to recover for damages alleged to have stemmed from a denial of medical coverage and benefits Plaintiff believes he was entitled to. On February 17, 2011, Plaintiff filed an Amended Complaint naming additional Defendants, including the GEICO Defendants and PPS.

Plaintiff married Nussbaum on December 28, 2008. Nussbaum was an employee of RHI and was covered under the RHI employee benefit health plan ("RHI Plan"). Plaintiff received benefits under the RHI Plan, as Nussbaum's spouse from January 1, 2004 to November 22, 2006. Meritain Health was the Third Party Administrator ("TPA") of the RHI Plan. Quinlivan was an attorney employed by Meritain Health during the relevant time period.

Plaintiff carried group insurance coverage through his own employer from January 1, 2004 to November 22, 2006, using it as secondary coverage. Plaintiff resigned from his employment as a chemistry and physics educator on November 22, 2006 and filed for disability status. On November 22, 2006, Plaintiff declined secondary COBRA from his employer, as he asserts the RHI plan was of superior quality. Plaintiff had spinal surgery in March 2007. Several months later, on or around January 28, 2008, Plaintiff alleges he was in a car accident, from which he suffered a spinal injury.

In November 2008, Nussbaum's employment with RI II was terminated. Plaintiff asserts that Nussbaum continued the couple's health insurance coverage by paying for the COBRA premiums from November 22, 2008 through September 21, 2009. During the aforementioned time period, Plaintiff and Nussbaum had access to health care coverage under the RHI Plan. Plaintiff asserts, on September 21, 2009, Nussbaum "unilaterally declined all COBRA benefits at employee expense." Meritain Health, as the TPA, processed claims through and including September 21, 2009.

Plaintiff asserts that, in accordance with the 2009 Federal Stimulus and 2010 Recovery Act's COBRA Health Insurance Continuation Premium Subsidy, in the event of a divorce involving unemployed spouses, each spouse is entitled to their own separate COBRA policy for the remainder of the COBRA Period. Plaintiff argues Nussbaum, Meritain Health, RIII, Bremer, and AWS did not present Plaintiff with an application for his own COBRA policy after Plaintiff and Nussbaum divorced in December 2009. Since Plaintiff was already on COBRA status effective November 21, 2008, Plaintiff argues all Defendants were obligated to provide Plaintiff his own separate insurance policy with RHI and Meritain.

Plaintiff also maintained auto insurance coverage with GEICO, which included some health care coverage. PPS is a TPA of Personal Injury Protection Benefits (hereinafter "PIP") for GEICO, providing GEICO with medical cost containment services related to GEICO's PIP claims. Plaintiff alleges that PPS denied payment of various benefit claims to Plaintiffs pain management provider and other health care service providers. Plaintiff also seeks to hold four of GIECO' s employees during the relevant time period, Lisa Ardron, Gina Fuge, Dominic Spaventa, and Paul Feldman, responsible for the denial of claims. Plaintiff further asserts that because of PPS's "repeated and pre-emptive termination of benefits and denial of provider claims, " he "has gone without several medical procedures and other means of healthcare." These denials contributed to Plaintiff's "declining health and isolated and unsafe living situation."

The Amended Complaint also includes allegations concerning Nussbaum's treatment of Plaintiff during the course of his illnesses and following his injuries, as well as her conduct during the couple's divorce proceedings. Plaintiff asserts Nussbaum refused to modify the couple's residence to assist with his medical needs following Plaintiff's surgery and that Nussbaum doubted Plaintiff's eligibility for disability services. Thereafter, Plaintiff asserts Nussbaum hired AWS and Bremer to assist in divorce proceedings she initiated against Plaintiff. Plaintiff alleges, that with the assistance of AWS and Bremer, Nussbaum barred Plaintiff from his residence "without any legal order and denied access to personal property, including any items Plaintiff uses for ambulation and assistance relative to his physical condition." Plaintiff further alleges that AWS and Bremer submitted a "take it or leave it" divorce settlement to Plaintiff. According to Plaintiff, AWS and Bremer communicated with the human resource department of RHI, seeking to terminate Plaintiffs health care insurance coverage and failed to offer him a COBRA application.


A. FED. R. Ctv. P. 12(b)(6)

In deciding a motion under Rule 12(h)(6), a district court is "required to accept as true all factual allegations in the complaint and draw all inferences in the facts alleged in the light most favorable to the [Plaintiff]." Phillips v. Cnty. of Allegheny , 515 F.3d 224, 228 (3d Cir. 2008). "[A] complaint attacked by a... motion to dismiss does not need detailed factual allegations." Bell Atl. Corp. v. Twombly , 550 U.S. 544, 555 (2007). However, the Plaintiff's "obligation to provide the grounds' of his entitle[ment] to relief' requires more than labels and conclusions, and a formulaic recitation of the elements of a cause of action will not do." Id . (internal citations omitted). "[A court is] not bound to accept as true a legal conclusion couched as a factual allegation." Papasan v. Allain , 478 U.S. 265, 286 (1986). Instead, assuming that the factual allegations in the complaint are true, those "[f]actual allegations must be enough to raise a right to relief above a speculative level." Twombly , 550 U.S. at 555.

To survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to state a claim to relief that is plausible on its face.'" Ashcroft v. Iqbal , 556 U.S. 662, 678 (2009) (quoting Twombly , 550 U.S. at 570). "A claim has facial plausibility when the pleaded factual content allows the court to draw the reasonable inference that the defendant is liable for misconduct alleged." Id . "Determining whether the allegations in a complaint are plausible' is a context-specific task that requires the reviewing court to draw on its judicial experience and common sense." Young v. Speziale, Civ. No. 07-03129 , 2009 WL 3806296, at *3 (D.N.J. Nov. 10, 2009) (quoting Iqbal , 556 U.S. at 679). "[W]here the well-pleaded facts ...

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