Judge Grants Leave to Amend Duplicative Allegations Against Aetna

On Monday, Judge Kenneth Marra issued an order in a putative class action against Aetna Life Insurance Company et al. The opinion, issued in the Southern District of Florida, granted a motion to dismiss in part, but left leave to amend, so the plaintiff could pursue alternative theories of the defendant’s fiduciary duty toward the members of the Employee Retirement Income Security Act (ERISA) plan regarding medical treatment.

The opinion explained that ERISA has two main statutory causes of action under which most lawsuits proceed. 29 U.S.C. § 1132(a)(1)(B) permits a beneficiary “to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan” and represents the vast majority of claims. 29 U.S.C. § 1132(a)(3), on the other hand, allows an ERISA-plan beneficiary to bring a civil action to “(A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan” and is treated as a catch-all provision for claims that cannot be pursued under 29 U.S.C. § 1132(a)(1)(B).

The plaintiff filed four claims, using both ERISA provisions in the causes of action. The defendant sought dismissal of the claims, stating that the action cannot be brought under both sections as this would be duplicative, even if this means that the plaintiff lost on the merits of the 29 U.S.C. § 1132(a)(1)(B) action under the holdings of the Eleventh Circuit in Katz v. Comprehensive Plan of Grp. Ins.

The court acknowledged § 1132(a)(3) as a catch all provision and that a cause cannot proceed under both provisions, but also affirmed that cases can proceed under alternative theories where the denial of benefits is pursued under 29 U.S.C. § 1132(a)(1)(B) and the fiduciary duty is pursued as an alternative theory under a separate cause of action, leading the court to permit the plaintiff to amend her case to clarify the cause of action.

The plaintiff is represented by the firms of Kozyak Tropin & Throckmorton and Colson Hicks Eidson. Aetna is represented by DLA Piper and Groom Law Group.