United States District Court, D. New Jersey
CALLAGY LAW, P.C. By: Michael Gottlieb, Esq. Counsel for
LLC Michael E. Holzapfel, Esq. Counsel for Defendant Horizon
Blue Cross Blue Shield of Massachusetts.
HILLMAN, United States District Judge.
one of many ERISA suits filed by Plaintiff Dr. Rahul Shah, as
purported assignee of his individual patients, against his
patients' various insurance companies. In each suit, Dr.
Shah asserts that the insurance companies wrongfully denied
requests for payment of benefits under the patients'
health insurance policies, and consequently, Dr. Shah's
bills for services were not paid, or not fully paid.
before the Court is Defendant's Motion to Dismiss the
Complaint pursuant to Fed.R.Civ.P. 12(b)(6). For the reasons
stated herein, the motion will be granted in part, denied in
part, and denied as moot in part.
October 28, 2013, Dr. Shah allegedly performed surgery on
Monica M. (Compl. ¶ 5-6; and Ex. A) He alleges all
services were medically necessary and reasonable
(Id. at ¶ 5), yet Monica M.'s health
insurance company, Defendant Horizon Blue Cross Blue Shield
of Massachusetts, allegedly denied the claim. (Compl. ¶
Shah alleges that he obtained an assignment of benefits from
Monica M. (Compl. ¶ 7 and Ex. B) The Complaint asserts
four claims: breach of contract; denial of benefits in
violation of § 1132(a)(1)(B); breach of fiduciary duty
in violation of § 1132(a)(3)(B); and failure to maintain
a reasonable claims process pursuant to 29 C.F.R. 2560.503-1.
considering a motion to dismiss a complaint for failure to
state a claim upon which relief can be granted pursuant to
Federal Rule of Civil Procedure 12(b)(6), a court must accept
all well-pleaded allegations in the complaint as true and
view them in the light most favorable to the plaintiff.
Evancho v. Fisher, 423 F.3d 347, 351 (3d Cir. 2005).
It is well settled that a pleading is sufficient if it
contains “a short and plain statement of the claim
showing that the pleader is entitled to relief.”
the liberal federal pleading rules, it is not necessary to
plead evidence, and it is not necessary to plead all the
facts that serve as a basis for the claim. Bogosian v.
Gulf Oil Corp., 562 F.2d 434, 446 (3d Cir. 1977).
However, “the Federal Rules of Civil Procedure . . . do
require that the pleadings give defendant fair notice of what
the plaintiff's claim is and the grounds upon which it
rests.” Baldwin Cnty. Welcome Ctr. v. Brown,
466 U.S. 147, 149-50 n.3 (1984) (quotation and citation
district court, in weighing a motion to dismiss, asks
“‘not whether a plaintiff will ultimately prevail
but whether the claimant is entitled to offer evidence to
support the claim.'” Bell Atlantic v.
Twombly, 550 U.S. 544, 563 n.8 (2007) (quoting
Scheuer v. Rhoades, 416 U.S. 232, 236 (1974));
see also Ashcroft v. Iqbal, 556 U.S. 662, 684
(2009)(“Our decision in Twombly expounded the
pleading standard for ‘all civil actions' . . .
.”); Fowler v. UPMC Shadyside, 578 F.3d 203,
210 (3d Cir. 2009)(“Iqbal . . . provides the
final nail in the coffin for the ‘no set of facts'
standard that applied to federal complaints before
asserts the following arguments: (1) Dr. Shah lacks standing
because the applicable ERISA plan contains an anti-assignment
clause; (2) the suit is barred by the Plan's limitations
period; (3) the breach of contract claim (Count One) is
preempted by ERISA; and (4) Count Four, violation of 29