United States District Court, D. New Jersey
MEMORANDUM AND ORDER
G. SHERIDAN, U.S.D.J.
before the Court are Defendants' Horizon Blue Cross Blue
Shield of New Jersey, CareFirst of Maryland, Inc., Regence
BlueShield of Idaho, Inc., Blue Cross and Blue Shield of
Massachusetts, Inc., Blue Cross Blue Shield of North
Carolina, Premera Blue Cross, and Excellus Health Plan, Inc.
d/b/a Excellus Blue Cross Blue Shield Motion to Dismiss (ECF
No. 142) and Defendants' Health Care Service Corporation
(named as Blue Cross Blue Shield of Illinois and Blue Cross
Blue Shield of Texas), Highmark Inc. (named as Highmark Blue
Cross Blue Shield), and Blue Cross Blue Shield Delaware Inc.
(named as Highmark Blue Cross Blue Shield Delaware) Second
Motion to Dismiss (ECF No. 146). For the purposes of clarity,
the Court will refer to the above-named defendants as the
the Court noted several deficiencies in Plaintiffs first
amended complaint, and granted Defendants' motion to
dismiss for failure to state a claim upon which relief could
be granted. (ECF No. 117). The Court thereafter allowed
Plaintiff to file a second amended complaint. In the second
amended complaint, Plaintiff, a medical billing agent,
alleges that healthcare providers outside of the United
States provided services to patients with healthcare coverage
either supplied by or administered by the Blue Defendants,
and Plaintiff processed those claims on behalf of citizens of
the United States who received medical care while traveling
abroad. (Second Amended Compl. ("SAC"), ECF No.
134, at ¶ 22). Plaintiff alleges that in January 2017,
the Blue Defendants implemented a new procedure for
processing claims, where GeoBlue (a corporation that serves
as the administrative service provider for the Blue Cross and
Blue Shield Association) would "handle" the
international claims for the Blue Defendants. (Id.
at ¶ 25). Plaintiff further alleges that this decision
made "business incredibly difficult on Med-X so as to
augment Blue's corporate profit by way of delaying
claims, denying/underpaying claims, and defending
claims," and that it required additional documentation
before processing claims that were submitted by Med-X.
(Id. at ¶ 26).
alleges that on June 28 and 29, 2017, it sent letters to
GeoBlue which concerned claims that GeoBlue had allegedly
"denied, underpaid, or not yet decided."
(Id. at 28). The letters, in part, requested the
"entire administrative record" for every single
patient and the patient's claims that had been denied,
underpaid, or had been delayed by non-decision. (Id.
at ¶¶ 28, 36). In response to the letters, GeoBlue
informed Plaintiff that it would "pass those requests on
to the applicable Home Licensees [the Blue Defendants] for
handling." (Id. at ¶ 30). Plaintiff claims
that it has not received any administrative record in
response to its request. (Id. at ¶ 31).
Second Amended Complaint raises two claims: (1) Petition to
Compel Production of Administrative Records and Recovery of
Administrative Penalty under ERISA, 29 U.S.C. § 1024(b),
29 U.S.C. § 1132(c)(1) and 29 C.F.R. § 2575.502c-l
(Against all Defendants); and (2) Tortious Interference with
Prospective Economic Advantage (Against GeoBlue). Prior to
the return date of the present motion, Plaintiff and GeoBlue
reached a settlement agreement; accordingly Count I is the
only issue remaining before the Court. (ECF No. 169).
motion to dismiss for failure to state a claim pursuant to
Fed.R.Civ.P. 12(b)(6), the Court is required to accept as
true all allegations in the Complaint and all reasonable
inferences that can be drawn therefrom, and to view them in
the light most favorable to the non-moving party. See
Oshiver v. Levin, Fishbein, Sedran & Berman, 38 F.3d
1380, 1384 (3d Cir. 1994). "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 BellAtl. Corp. v.
Twombly, 550 U.S. 544, 570 (2007)). The Third Circuit
set forth a three-part analysis for determining whether a
complaint may survive a motion to dismiss for failure to
state a claim:
First, the court must "tak[e] note of the elements a
plaintiff must plead to state a claim." Second, the
court should identify allegations that, "because they
are no more than conclusions, are not entitled to the
assumption of truth." Finally, "where there are
well-pleaded factual allegations, a court should assume their
veracity and then determine whether they plausibly give rise
to an entitlement for relief."
Santiago v. Warminster Twp., 629 F.3d 121, 130 (3d
means that [the] inquiry is normally broken into three parts:
(1) identifying the elements of the claim, (2) reviewing the
complaint to strike conclusory allegations, and then (3)
looking at the well-pleaded components of the complaint and
evaluating whether all of the elements identified in part one
of the inquiry are sufficiently alleged." Malleus v.
George, 641 F.3d 560, 563 (3d Cir. 2011). While a court
will accept well-pleaded allegations as true for the purposes
of the motion, it will not accept bald assertions,
unsupported conclusions, unwarranted inferences, or sweeping
legal conclusions cast in the form of factual allegations.
Iqbal, 556 U.S. at 678-79; see also
Morse v. Lower Merion School District, 132 F.3d 902, 906
(3d Cir. 1997). A complaint should be dismissed only if the
well-pleaded alleged facts, taken as true, fail to state a
claim. See In re Warfarin Sodium, 214 F.3d 395,
397-98 (3d Cir. 2000).
29 U.S.C. § 1024(b)(4), the "administrator shall,
upon written request of any participant or beneficiary,
furnish a copy of the latest updated summary, plan
description, and the latest annual report, any terminal
report, the bargaining agreement, trust agreement, contract,
or other instruments under which the plan is established or
operated." Section 502(c)(1) of ERISA imposes a
statutory penalty of up to $110 per day for any administrator
who fails to or refuses to comply with a request for any
information that the administrator is required to furnish to
a participant or beneficiary, within thirty days after such a
request. See 29 U.S.C. § 1132(c)(1); 29 C.F.R.
state a claim under Section 502(c)(1), "a plaintiff must
allege that 1) it made a request to a plan administrator, 2)
who was required to provide the requested material, but 3)
failed to do so within 30 days of the request."
Spine Surgery Assocs. & Discovery Imaging, P.C v. IN
DECS Corp., 50 F.Supp.3d 647, 656 (D.N.J. 2014) (citing
Narducci v. Aegon USA, Inc., No. 10-955, 2010 U.S.
Dist. LEXIS 134514, at *3 (D.N.J. Dec. 15, 2010)). "As a
penal statute, the terms of § 502(c)(1) must be
'construed strictly,' and thus, a plaintiff seeking
relief under § 502(c)(1) must demonstrate compliance
with each of these statutory requirements." Plastic
Surgery Ctr., P. A. v. Cigna Health & Life Ins. Co.,
No. 17-2055, 2018 U.S. Dist. LEXIS 90422, at *24 (D.N.J. May
31, 2018) (quoting Haberern v. Kaupp Vascular Surgeons
Ltd. Defined Ben. Pension Plan, 24 F.3d 1491, 1505 (3d
"[f]or the purposes of assessing statutory penalties
under Section 502(c)(1), claims are proper only as against
the plan administrator." Mazzarino v. Prudential
Ins. Co. of Am., No. 13-4702, 2015 U.S. Dist. LEXIS
38351, at *27 ...