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Barriero v. N.J. Bac Health Fund

United States District Court, Third Circuit

December 27, 2013



ROBERT B. KUGLER, District Judge.

In this case, Plaintiff Debra L. Barriero ("Barriero") seeks benefits under section 502(a)(1)(B) of the Employee Retirement Income Security Act of 1974 ("ERISA" or the "Act") from Defendant New Jersey BAC Health Fund (the "Fund"). Currently before the Court is the Fund's motion for summary judgment on statute of limitations grounds. (Doc. No. 9.) For the reasons stated herein, the Court will GRANT the Fund's motion.


The Fund is an employee welfare benefit plan within the meaning of section 3(1)[1] of ERISA, and is administered by a board of trustees. (Def.'s SOMF ¶ 1-2.[2]) The sole purpose of the Fund is "to provide medical, health and welfare, death and disability benefits and other benefits for employees of participating employers, and for their beneficiaries." ( Id. ¶ 5.) The Fund operates according to a plan of benefits adopted by the board of Trustees. (Id.) This plan of benefits was set forth in the "Summary of Plan Description for New Jersey B.A.C. Health Fund Effective January 1, 2008" (the "SPD"), (id. ¶ 6), and mailed to all of the Fund's participants in 2008, (id. ¶ 7). The SPD provides, inter alia, that a participant's "eligible dependents" include the participant's spouse. ( Id. ¶ 10.) The SPD also contains a section entitled "Limitation on When a Lawsuit May be Started, " which provides that "[n]o lawsuit may be started more than 3 years after the end of the year in which medical or dental services were provided...." ( Id. ¶ 18.) According to the SPD, each year begins January 1 and ends December 31. ( Id. ¶ 19.)

Throughout 2008 and 2009, Anthony Barriero, Jr. was a participant in the Fund. ( Id. ¶ 8.) Plaintiff Barriero, Anthony Barriero's wife, received benefits from the fund as an eligible dependent. ( Id. ¶ 9.) On March 26, 2009, and April 20, 2009, Barriero underwent surgery. ( Id. ¶ 11.) Barriero's surgeons submitted invoices to Horizon Blue Cross Blue Shield of New Jersey ("Horizon"), which performed claims processing services for the Fund. ( Id. ¶¶ 13-14.)

From May through July 2009, the Fund, through Horizon, paid a total of $38, 003.50 to Barriero's surgeons. ( Id. ¶ 15.) On February 22, 2011, Barriero's counsel filed an appeal with Horizon disputing the amounts of these payments. ( Id. ¶ 16.) Horizon responded to Barriero's appeal by letter dated April 1, 2011, stating that the payment amounts were correct and no further payments were due. ( Id. ¶ 17.)

On January 28, 2013, Barriero filed suit in the Superior Court of New Jersey, Burlington County alleging that pursuant to section 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B), she is entitled to recover additional benefits for the surgical services performed in March and April 2009. ( Id. ¶¶ 20-21.)

On March 12, 2013, the Fund removed this action pursuant to 28 U.S.C. §§ 1441 and 1446, invoking this Court's jurisdiction under 29 U.S.C. § 1132(e). (Doc. No. 1.) After answering Barriero's Complaint on March 12, 2013, (Doc. No. 2), and engaging in discovery, the Fund filed its motion for summary judgment on May 29, 2013, (Doc. No. 9). As this motion has been fully briefed, the Court now turns to the parties' arguments.


Summary judgment is appropriate where the Court is satisfied that "there is no genuine dispute as to any material fact and that the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a); see Celotex Corp. v. Catrett , 477 U.S. 317, 330 (1986). A genuine dispute of material fact exists only if the evidence is such that a reasonable jury could find for the nonmoving party. Anderson v. Liberty Lobby, Inc. , 477 U.S. 242, 248 (1986). When the Court weighs the evidence presented by the parties, "[t]he evidence of the non-movant is to be believed, and all justifiable inferences are to be drawn in his favor." Id. at 255. The burden of establishing the nonexistence of a "genuine issue" is on the party moving for summary judgment. Aman v. Cort Furniture Rental Corp. , 85 F.3d 1074, 1080 (3d Cir. 1996). The moving party may satisfy its burden either by "produc[ing] evidence showing the absence of a genuine issue of material fact" or by showing' - that is, pointing out to the district court - that there is an absence of evidence to support the nonmoving party's case." Celotex , 477 U.S. at 325.

If the party seeking summary judgment makes this showing, it is left to the nonmoving party to "do more than simply show that there is some metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co. v. Zenith Radio Corp. , 475 U.S. 574, 586 (1986). Rather, to survive summary judgment, the nonmoving party must "make a showing sufficient to establish the existence of [every] element essential to that party's case, and on which that party will bear the burden of proof at trial." Celotex , 477 U.S. at 322. Furthermore, "[w]hen opposing summary judgment, the nonmovant may not rest upon mere allegations, but rather must identify those facts of record which would contradict the facts identified by the movant.'" Corliss v. Varner , 247 F.Appx. 353, 354 (3d Cir. 2007) (quoting Port Auth. of N.Y. and N.J. v. Affiliated FM Ins. Co. , 311 F.3d 226, 233 (3d Cir. 2002)).

In deciding the merits of a party's motion for summary judgment, the Court's role is not to evaluate the evidence and decide the truth of the matter, but to determine whether there is a genuine issue for trial. Anderson , 477 U.S. at 249. Credibility determinations are the province of the fact finder, not the district court. BMW, Inc. v. BMW of N. Am., Inc. , 974 F.2d 1358, 1363 (3d Cir. 1992).


A. Statute of ...

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