United States District Court, D. New Jersey
Evans Wohlforth, Jr., Esq. Debra A. Clifford, Esq. Lauren B.
Cooper, Esq. Gibbons, P.C. Counsel for Defendant.
Nowak, Esq. Callagy Law, P.C. Counsel for Plaintiff.
Parties Leda D. Wettre, U.S.M.J.
LETTER OPINION FILED WITH THE CLERK OF THE
D. WIGENTON, U.S.D.J.
this Court is Defendant Cigna Health and Life Insurance
Company's (“Defendant”) Motion to Dismiss
Plaintiff Complete Foot and Ankle's
(“Plaintiff”) Complaint pursuant to Federal Rule
of Civil Procedure 12(b)(6). This Court having considered the
parties' submissions, and having reached its decision without
oral argument pursuant to Federal Rule of Civil Procedure 78,
for the reasons discussed below, GRANTS
& PROCEDURAL HISTORY
a health care provider located in Bergen County, New Jersey,
alleges that “[o]n various dates of service in 2013
through 2017” it provided medical services to nine
separate patients covered by a health benefit plan or plans
(the “Plans”) subject to the Employee Retirement
Income Security Act of 1974 (“ERISA”), 29 U.S.C.
§ 1002, et seq. (Compl. ¶¶ 5-6.)
Plaintiff alleges it obtained an assignment of benefits from
each of those patients. (Id.) Plaintiff then
demanded reimbursement from Defendant, the Claims
Administrator for the Plans, in the amount of $1, 591,
450.80, of which Defendant paid $48, 490.84. (Id.
¶¶ 8-9, 12.) Plaintiff alleges that it
“exhausted the applicable administrative appeals
maintained by Defendant” but Defendant denied those
appeals and refused to make additional payment. (Id.
¶¶ 10-11.) On December 28, 2017, Plaintiff filed a
two-count Complaint in this Court alleging 1) failure to make
payments pursuant to the Plans, and 2) breach of fiduciary
duty. (Dkt. No. 1.) Defendant filed the instant motion to
dismiss on March 14, 2018, alleging Plaintiff has failed to
state claims upon which relief can be granted. (Dkt. No. 10.)
Plaintiff filed its opposition on May 7, 2018 and Defendant
replied on May 14, 2018. (Dkt. Nos. 19, 20.)
survive a motion to dismiss under Federal Rule of Civil
Procedure 12(b)(6), a complaint must include “a short
and plain statement of the claim showing that the pleader is
entitled to relief.” Fed.R.Civ.P. 8(a)(2). This Rule
“requires more than labels and conclusions, and a
formulaic recitation of the elements of a cause of action
will not do. Factual allegations must be enough to raise a
right to relief above the speculative level[.]”
Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007)
(internal citations omitted); see also Phillips v. Cty.
of Allegheny, 515 F.3d 224, 231 (3d Cir. 2008) (stating
that Rule 8 “requires a ‘showing, ' rather
than a blanket assertion, of an entitlement to
relief”). In considering a Motion to Dismiss under Rule
12(b)(6), the Court must “accept all factual
allegations as true, construe the complaint in the light most
favorable to the plaintiff, and determine whether, under any
reasonable reading of the complaint, the plaintiff may be
entitled to relief.” Phillips, 515 F.3d at 231
(external citation omitted). However, “the tenet that a
court must accept as true all of the allegations contained in
a complaint is inapplicable to legal conclusions. Threadbare
recitals of the elements of a cause of action, supported by
mere conclusory statements, do not suffice.”
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009); see
also Fowler v. UPMC Shadyside, 578 F.3d 203 (3d Cir.
2009) (discussing the Iqbal standard).
Complaint fails to satisfy the requirements of Rule 8. As to
the factual basis for its claims, Plaintiff's pleading
does not identify the dates upon which services were
rendered,  the nature of the services provided, which
patient received which services, the amounts charged for each
patient, the terms of the assignments of benefits executed by
the patients, or the terms of the Plans under which Plaintiff
seeks payment. Without this information, the Complaint
contains little more than an assertion that Plaintiff is owed
more than it was paid for the services it provided. This is
insufficient under Rule 8. See e.g., Atl.
Plastic & Hand Surgery, PA v. Anthem Blue Cross Life
& Health Ins. Co., Civ. No. 17-4600, 2018 WL
1420496, at *10-11 (D.N.J. Mar. 22, 2018) (dismissing claim
where plaintiff's “threadbare allegations”
did not point “to any provision of a . . . benefit plan
suggesting” an entitlement to payment); Lemoine v.
Empire Blue Cross Blue Shield, Civ. No. 16-6786, 2018 WL
1773498, at *6 (D.N.J. Apr. 12, 2018) (granting motion to
dismiss, finding plaintiff “fails to plausibly plead
which portions of [benefit plans] have been violated”).
Therefore, Defendant's motion to dismiss will be
Motion to Dismiss is GRANTED. An ...