F. v. California Physicians' Service

Background

Amy F.’s First Amended Complaint asserted claims under the Employee Retirement Income Security Act (ERISA), including a first cause of action seeking recovery of benefits and a second cause of action alleging breach of fiduciary duty. California Physicians’ Service, doing business as Blue Shield of California, moved to dismiss the second cause of action. The motion challenged standing to seek certain relief, the sufficiency of the claim under 29 U.S.C. § 1132(a)(2), and the request for equitable relief under § 1132(a)(3). Blue Shield did not move to dismiss the first cause of action for recovery of benefits.

Standing for Injunctive Relief

The court held that Amy F. had not alleged facts showing a likelihood of future injury. She did not clearly allege that she remained a plan beneficiary or that she or her dependents would seek similar benefits in the future. Because an injunction is forward-looking relief, the court concluded that she had not alleged the required constitutional standing to seek one.

The court also rejected reliance on injuries to other plan beneficiaries as a substitute for Amy F.’s own standing. She had not brought a class action and had not identified statutory authority allowing her to proceed as a representative of those beneficiaries.

ERISA Remedies

The court agreed that the complaint did not allege a basis for relief under § 1132(a)(2). The court explained that the allegations concerned the handling of Amy F.’s individual claim and did not provide a basis for the type of plan-related relief required under that provision.

The court rejected Blue Shield’s argument that Amy F.’s claim for equitable relief under § 1132(a)(3) duplicated her claim for benefits under § 1132(a)(1)(B). Under Ninth Circuit precedent, those claims may proceed at the same time and in the alternative, as long as there is no double recovery.

The court further held that Amy F. had alleged enough facts at the pleading stage to support a breach-of-fiduciary-duty claim seeking appropriate equitable relief. Her requested relief included requiring fiduciaries to give up profits allegedly made through denying medically necessary claims while using inconsistent care guidelines. The court stated that the precise form and nature of any equitable relief did not need to be specified at that stage.

Disposition

The court granted in part the motion to dismiss, with leave to amend. Specifically, the motion to dismiss based on the failure to allege standing for injunctive relief was granted with leave to amend. The court also determined that the complaint lacked a stated basis for relief under § 1132(a)(2), while finding that it sufficiently alleged a basis for equitable relief under § 1132(a)(3). Amy F. was ordered to file a second amended complaint within 21 days, and the defendants were ordered to respond within 21 days after that. Judge Yvonne Gonzalez Rogers terminated Docket No. 33.