Opinion · District Court, C.D. California

Simon v. Value Behavioral Health, Inc.

955 F. Supp. 93

Type
Opinion
Court
District Court, C.D. California
Jurisdiction
California
Date
1997-03-05
Topic
general

How later courts describe this case

  • holding that “a third party who [wa]s not a health care provider lack[ed] standing to sue on an assigned claim for ERISA benefits payment,” which was obtained “from six health care providers and over 600 individual participants or beneficiaries”

Citator

UpLaw has not yet analyzed Simon v. Value Behavioral Health, Inc.. The absence of a flag is not a finding that it is good law.

Authority status
pending
Cited by
6 opinions
SIMON v. VALUE BEHAVIORAL HEALTH INC. (C.D.Cal. 3-5-1997)
955 F. Supp. 93
Stephen SIMON, Plaintiff, v. VALUE BEHAVIORAL HEALTH INC., et al.,
Defendants.
No. SA CV 96-711 GLT [CC].
United States District Court, C.D. California.
March 5, 1997
West Page 94
Stephen Simon, Jupiter, FL, pro. per.

Audrey Lyness, Barger Wolen, Los Angeles, CA, Bruce Beckman, Jeffrey Smith, Beckman, Davis, Smith Ruddy, L.L.P., Los Angeles, CA, Geoffrey Glass, Robins, Kaplan, Miller Ciresi, Costa Mesa, CA, Guy O. Kornblum, Jeffrey J. Fowler, Bailey Kornblum, San Francisco, CA, James P. Collins, Jr., Cotkin Collins, Santa Ana, CA, Dale F. Kinsella, Jack G. Cairl, Jr., Alan R. Kossoff, Kinsella, Boesch, Fujikawa Towle, Los Angeles, CA, Gregory H. Halliday, Michael J. Khouri, Deborah L. O'Connor, Sedgwick, Detert, Moran Arnold, Irvine, CA, Erica S. Arouesty, Stephen L. Hewitt, Hewitt Prout, North Hollywood, CA, Dennett F. Kouri, Sr., Geoffrey Tong, Meserve, Mumper Hughes, Los Angeles, CA, Kirk A. Patrick, Gibson, Dunn Crutcher, Los Angeles, CA, Ellen Kamon, Rosato Samuels, North Hollywood, CA, Daniel W. Maguire, Mark Riekhof, Galton Helm, Los Angeles, CA, Gordon E. Krischer, Kenneth E. Johnson, O'Melveny Myers L.L.P., Los Angeles, CA, Kenneth L. Schmetter, Senior Supervising Attorney, City of Chicago, Department of Law, Chicago, IL, Patrick J. Mahoney, Chief Trial Attorney, Margaret W. Baumgartner, Deputy City Attorney, San Francisco, CA, Marta M. Fernandez, Rebecca L. Torrey, Lynne M. Hook, Jeffer, Mangels, Butler Marmaro, Los Angeles, CA, Jeffrey L. Sikkema, Juan C. Basombrio, Dorsey Whitney, L.L.P., Costa Mesa, CA, Ronald J. Cooke, Meghan A. White, Littler, Mendelson, Fastiff, Tichy Mathiason, Los Angeles, CA, Mark A. Wooster, Universal City, CA, J. Thomas Bowen, Davis, Cowell Bowe, San Francisco, CA, Roland C. Bainer, Clayson, Mann Yaeger, Corona, CA, Marc J. Wodin, Law Offices of Marc J. Wodin, Woodland Hills, CA, J. Mark Waxman, Jonathon E. Cohn, Foley Lardner Weissburg Aronson, Los Angeles, CA, Patrick T. Connor, DeCarlo, Connor Selvo, Los Angeles, CA, Michael R. Feinberg, Los Angeles, CA, David C. Capell, J. Matthew Patton, Gordon Rees, L.L.P., San Francisco, CA, Ronald J. Hein, Jr., Terrence T. Creamer, Chicago, IL, Sean P. Nalty, Wynne A. Ahern, Kelly Herlihy, San Francisco, CA, Keith M, Parker, Rachelle Singer, Irvine, CA, Stephen M. Harris, Diron M. Ohanian, Knapp, Petersen Clarke, Glendale, CA, Elizabeth W. Walker, Paul, Hastings, Janofsky Walker, Los Angeles, CA, Alexander B. Cvitan, Esteban Lizardo, Darren Goodman, Reich, Adell, Crost Cvitan, Los Angeles, CA, Ted L. Wilkes, New York City, Robert J. Stumpf, Jr., Lynn A. Bersch, Bronson, Bronson McKinnon, L.L.P., San Francisco, CA, Stephanie L. Chilton, Hermosa Beach, CA, Robert L. Dysart, Bess Dysart, Phoenix, AZ, W. Mark Wood, Phillip R. Kaplan, Todd A. Green, O'Melveny Myers, L.L.P., Newport Beach, CA, Margaret H. Campbell, Andrea L. Bailey, Ogletree, Deakins, Nash, Smoak Stewart, P.C., Atlanta, GA, John Provost, Beeson, Tayer Bodine, Sacramento, CA, Lesley C. Green, Los Angeles, CA, Diane C. Blasdel, Seizer, Ealy, Hemphill Blasdel, Rancho Mirage, CA, Scott A. Brooks, Daniels, Baratta Fine, Los Angeles, CA, Robert S. Schulman, Linda Margolies Salem, Crosby, Heafey, Roach May, Los Angeles, CA, Meghan K. Serwin, Paula Financial Inc., Pasadena, CA, Paul Alexander, Vanessa Wells, Palo Alto, CA, Richard J. Foster, Paone, Callahan, McHolm Winton, Irvine, CA, Peter E. Romo, Jr., Horace W. Green, Seyfarth, Shaw, Fairweather Gerald, San Francisco, CA, Philip M. Miller, Saltzman Johnson Law Corp., San Francisco, CA, Mark Lipton, Lipton, Warnlof Segal, Walnut Creek, CA, Jacob J. Stettin, Stettin Cass, Los Angeles, CA, Robert S. Hark, Lewiston, ME, Patrick M. Smith, Nugent Newnham, A.P.C., San Diego, CA, Ronald K. Alberts, Jeffrey A. Katz, Frye, Alberts Malchow, Los Angeles, CA, Neil J. Barker, Gronemeier Barker, Pasadena, CA, Marc A. Becker, Munger, Tolles Olson, L.L.P., Los Angeles, CA, David T. DiBiase, Regina R. Wong, Los Angeles, CA, Jana I. Lubert, Lewis, D'Amato, Brisbois Bisgaard, Los Angeles, CA, Marc Epstein, Gaims, Weil,West Page 95West Epstein, L.L.P., Los Angeles, CA, Judith A. Ripps, Harnett Lesnick Ripps, P.A., Boca Raton, FL, Douglas A. Kuber, Quinn Emanuel Urquhart Oliver, L.L.P., Los Angeles, CA, Scott D. Norton, Sullivan, Ward, Bone, Tyler Asher, P.C., Southfield, MI, Owen Strange, Booth, Mitchel Strange, L.L.P., Los Angeles, CA, for Defendants.
ORDER GRANTING DEFENDANTS' MOTIONS TO DISMISS
TAYLOR, District Judge.
The Court holds a third party who is not a health care provider lacks standing to sue on an assigned claim for ERISA benefits payment.

Plaintiff sues over 1,600 defendants to recover ERISA benefits allegedly due. Although not a health care provider, Plaintiff holds assigned claims from six health care providers and over 600 individual participants or beneficiaries.1

Under the Employees Retirement Income Security Act of 1974 (ERISA), plan participants or beneficiaries are permitted to bring civil enforcement actions to recover plan benefits.29 U.S.C. § 1132(a)(1)(B). A "participant" is defined as "any employee . . . who is or may become eligible to receive a benefit of any type from an employee benefit plan. . . ."29 U.S.C. § 1002(7). A "beneficiary" is defined as "a person designated by a participant, or by the terms of an employee benefit plan, who is or may become entitled to a benefit thereunder."29 U.S.C. § 1002(8).

ERISA creates "six carefully integrated civil enforcement provisions" which identify who may pursue a claim under the statute.MassachusettsMutual Life Ins. Co. v. Russell,473 U.S. 134,146,105 S.Ct. 3085,3092,87 L.Ed.2d 96(1985). The Ninth Circuit has held ERISA does not forbid a beneficiary from assigning a right of reimbursement under a medical an to his health care provider.Misic v. Building ServiceEmployees Health and Welfare Trust,789 F.2d 1374,1377(9th Cir. 1986). But, Plaintiff fails to present persuasive authority supporting standing of a third party ERISA claim assignee other an the beneficiary's health care provider.2

Other courts have permitted standing based on assignments of ERISA claims to health care providers.See Lutheran Medical Center v,Contractors, Laborers, Teamsters and Engineers Health and Welfare Plan,25 F.3d 616,620(8th Cir. 1994);Hermann Hospital v. MEBA MedicalBenefits Plan,845 F.2d 1286,1290(5th Cir. 1988);Protocare ofMetropolitan N.Y. Inc. v. Mutual Ass'n Administrators, Inc.,866 F. Supp. 757,762(S.D.N.Y. 1994);Care Unit Hospital v. TravelersCompanies,787 F. Supp. 750,753(S.D.Ohio 1991);Belmont CommunityHospital v. Local Union No. 9,737 F. Supp. 1034,1037(N.D.Ill. 1990).But see Northeast Dept. ILGWU Health and Welfare Fund v. Teamsters LocalUnion No. 229 Welfare Fund,764 F.2d 147,154n. 6 (3d Cir. 1985) (expressing "serious doubts" over whether assignment of ERISA claims was valid under29 U.S.C. § 1132(a)(1)(B)). However, apparently no court has recognized an assignment to a third party who is not a health care provider.

Without further authority from the Ninth Circuit, this Court will not "tamper with an enforcement scheme crafted with such evident care,"Massachusetts Mutual,473 U.S. at 147,105 S.Ct. at 3093, and recognize the standing of a third party not specifically authorized by Congress in section 1132(a). The Ninth Circuit and other circuits have expanded that class to health care providers, but this Court will not expand it further. Accordingly, the Court holds Plaintiff does not have standing to pursue assigned claims for payment of ERISA benefits. Defendants'West Page 96Motions to Dismiss Plaintiff's ERISA claims are GRANTED without leave to amend.
  1. Plaintiff was not assigned these claims from the individuals themselves. Apparently, he received these assignments from six health care providers who had the claims assigned to them by the individuals. Thus, Plaintiff is the assignee of an assignee. ↩
  2. InMisic, the court concluded ERISA did not forbid a health care provider assignment because "the general goal of the statute would [not] be served by prohibiting the type of assignments involved in this case."789 F.2d at 1377. Unlike like inMisic, Plaintiff here does not have the same personal interest in dealing directly with the trust fund as does a health care provider. ↩