| Page 86
108 F.3d 86  37 Fed.R.Serv.3d 184 Alan WEINER, D.P.M.,
Plaintiff-Appellant,
v.
KLAIS AND COMPANY, INC., Defendant-Appellee.
No. 96-3135. United States Court of Appeals,
Sixth Circuit. Argued and Submitted Feb. 6, 1997.
Decided Feb. 26, 1997.
Page 87
Paul W. Flowers (briefed), Gary
B. Garson Company, Cleveland, OH, for
Plaintiff-Appellant.
John C. Weisensell (argued and
briefed), Amer, Cunningham & Brennan, Akron,
OH, for Defendant-Appellee.
Before: KENNEDY, NELSON, and VAN
GRAAFEILAND
*,
Circuit Judges.
KENNEDY, Circuit Judge.
Plaintiff appeals the District
Court's dismissal of his complaint alleging
violations of the Employee Retirement Income
Security Act (ERISA) of 1974, 29 U.S.C. §§
1001-1461. The District Court found that
defendant was not a proper party to the
lawsuit. We AFFIRM the dismissal, although
on different grounds than the District
Court.
I. Facts
Plaintiff, Dr. Alan Weiner, is a
podiatrist who rendered medical services to
six participants and/or beneficiaries of
five different group health plans sponsored
by their respective employers: Malco
Products, Inc. Health Benefit Plan, Akron
Porcelain and Plastics Company Health
Benefit Plan, Portage County Health Benefit
Plan, Fairlawn Country Club Health Benefit
Plan, and City of Barberton Health Benefit
Plan. According to the plan documents, each
of the plans is self-funded and administered
directly by a Plan Administrator, who is an
official of the respective employer.
Defendant Klais and Company, Inc. is the
Claims Administrator for all of the plans.
The plan participants assigned
their rights to benefits under their
respective plans to plaintiff. Plaintiff
submitted to defendant claims for payments
relating to the services
Page 88 rendered. Defendant denied the claims,
either partially or completely. On August
10, 1995, plaintiff filed a complaint
against defendant only. In Count I,
plaintiff asserts that defendant denied
benefits in violation of the terms of "the
Plan".
1 As
relief, plaintiff seeks both to recover
benefits pursuant to 29 U.S.C. §
1132(a)(1)(B) and to have a permanent
injunction issued against defendant pursuant
to 29 U.S.C. § 1132(a)(3). In Count II,
plaintiff alleges that defendant breached
its fiduciary duties and that plaintiff is
entitled under 29 U.S.C. § 1109 to recover
the benefits due under the plan and "to such
other equitable or remedial relief deemed
appropriate." In Count III, plaintiff claims
that defendant has been unjustly enriched to
the detriment of plaintiff and seeks payment
for the rendered medical services. Finally,
in a fourth count, plaintiff seeks a
declaration that he is entitled to the
benefits claimed under the plans. Plaintiff
appears to concede that he never invoked the
appeals procedures provided under any of the
applicable plans, but he claims that such
action would have been futile. Plaintiff
asserts that the unpaid benefits amount to
approximately $97,000.00.
After filing its Answer,
defendant filed in a single document a
Motion to Dismiss, a Motion for Judgment on
the Pleadings, and a Motion for Summary
Judgment. Attached as exhibits to
defendant's motion were copies of the
relevant plan documents and summary plan
descriptions (SPDs), as well as the services
agreements between defendant and each
employer/plan sponsor. In a November 20,
1995 order, the District Court decided that
it would not consider the motion for summary
judgment before discovery had been completed
and, accordingly, it denied that motion
without prejudice. On November 21, 1995,
plaintiff submitted a Motion for Leave to
File First Amended Complaint, seeking to add
each of the plans and their respective plan
sponsors as defendants.
On December 22, 1995, defendant's
Motion to Dismiss/Motion for Judgment on the
Pleadings was granted. The court found that
defendant was not a fiduciary, and it
concluded that defendant was not a proper
party to the lawsuit. The court dismissed
the case without prejudice to its being
refiled against the proper parties. The
court also denied plaintiff's motion for
leave to amend, stating that an amendment
would add ten entirely new parties who had
not been part of the proceedings thus far
and, consequently, would be a "disaster"
from a case management standpoint. This
timely appeal followed.
II. Discussion
A. Standard of Review
We review de novo a district
court's dismissal of a complaint under
FED.R.CIV.P. 12(b)(6).
Taxpayers United for Assessment Cuts v.
Austin, 994 F.2d 291, 296 (6th Cir.1993).
We must read all well-pleaded allegations of
the complaint as true.
Bower v. Federal Express Corp., 96 F.3d 200,
203 (6th Cir.1996). "Our review is
essentially the same as the district
court's; we 'take the plaintiff's factual
allegations as true and if it appears beyond
doubt that the plaintiff can prove no set of
facts in support of its claims that would
entitle it to relief, then ... dismissal is
proper.' "
Forest v. United States Postal Serv., 97
F.3d 137, 139 (6th Cir.1996) (quoting
American Eagle Credit Corp. v. Gaskins, 920
F.2d 352, 353 (6th Cir.1990)). A
complaint must contain either direct or
inferential allegations with respect to all
material elements necessary to sustain a
recovery under some viable legal theory.
Allard v. Weitzman (In re DeLorean Motor
Co.), 991 F.2d 1236, 1240 (6th Cir.1993).
B. Defendant's Exhibits
We first address plaintiff's
argument that the District Court
inappropriately considered affidavits and
exhibits submitted by defendant, because we
must determine what materials we may
properly consider in our de novo review.
Matters outside of the pleadings are not to
be considered by a court in ruling on a
12(b)(6) motion to dismiss.
Hammond v. Baldwin, 866 F.2d 172, 175
Page 89 (6th Cir.1989). Defendant attached to its
motion to dismiss the plan documents, SPDs,
and Benefit Management Services Agreements.
2 In denying
defendant's motion for summary judgment, the
court held that, in considering defendant's
motion for dismissal or for judgment on the
pleadings, it would consider "only those
exhibits submitted by the defendant which
can properly be considered incorporated by
reference into the complaint and, thus, a
part of the pleadings."
FED.R.CIV.P. 10(c) provides that
"[a] copy of any written instrument which is
an exhibit to a pleading is a part thereof
for all purposes." Rule 10(c) is permissive,
and a plaintiff is under no obligation to
attach to his complaint documents upon which
his action is based. See 5 CHARLES A. WRIGHT
& ARTHUR R. MILLER, FEDERAL PRACTICE AND
PROCEDURE § 1327, at 762 (2d ed.1990).
However, a defendant may introduce certain
pertinent documents if the plaintiff fails
to do so.
Pension Benefit Guaranty Corp. v. White
Consol. Indus., Inc., 998 F.2d 1192, 1196
(3d Cir.1993); Cortec Indus., Inc. v.
Sum Holding, L.P., 949 F.2d 42, 48 (2d
Cir.1991);
Romani v. Shearson Lehman Hutton, 929 F.2d
875, 879 n. 3 (1st Cir.1991); see also 5
WRIGHT & MILLER, supra, § 1327, at 762-63.
Otherwise, a plaintiff with a legally
deficient claim could survive a motion to
dismiss simply by failing to attach a
dispositive document upon which it relied.
See White Consol. Indus., 998 F.2d at 1196.
Hence, the Seventh Circuit has held that
"[d]ocuments that a defendant attaches to a
motion to dismiss are considered part of the
pleadings if they are referred to in the
plaintiff's complaint and are central to her
claim."
Venture Assocs. Corp. v. Zenith Data Sys.
Corp., 987 F.2d 429, 431 (7th Cir.1993).
We believe that this approach is
appropriate.
Plaintiff references the "plan"
numerous times in his complaint. Although
plaintiff maintains that the complaint
referred only to the "plan" as an entity and
not to the "plan documents," his claims are
based on rights under the plans which are
controlled by the plans' provisions as
described in the plan documents. Thus, we
will consider the plan documents along with
the complaint, because they were
incorporated through reference to the
plaintiff's rights under the plans, and they
are central to plaintiff's claims. We need
not decide whether the SPDs should be viewed
as part of the complaint since they do not
differ from the plans. The services
agreements, however, were not mentioned
directly or indirectly in the complaint.
Even if the District Court relied improperly
upon the services agreements, we may affirm
on any valid ground, see Russ'
Kwik Car Wash, Inc. v. Marathon Petroleum
Co., 772 F.2d 214, 216 (6th Cir.1985),
and we will consider only the plan documents
in making our determination.
C. Subject Matter Jurisdiction
Defendant claims that we do not
have jurisdiction to hear this case with
regard to claims under the Portage County
Health Benefit Plan and the City of
Barberton Health Benefit Plan, because these
plans are "governmental plans." Federal
subject matter jurisdiction is granted to
cases arising under ERISA pursuant to 29
U.S.C. § 1132(e). Section 4(b) of ERISA
excludes application of the Act's provisions
to governmental plans. See 29 U.S.C. §
1003(b)(1). Section 3(32) defines
"governmental plan" as a plan "established
or maintained for its employees ... by the
government of any State or political
subdivision thereof, or by any agency or
instrumentality of any of the forgoing." Id.
at § 1002(32).
The plan documents disclose that
the Portage County and City of Barberton
plans are not governed by ERISA. According
to the plan documents, Portage County
established the Portage County Health
Benefit Plan for its employees, and the City
of Barberton established the City of
Barberton Health Benefit Plan for its
employees. Portage
Page 90 County and the City of Barberton are
political subdivisions of the State within
the meaning of section 3(32) of ERISA, 29
U.S.C. § 1002(32). Therefore, we do not have
jurisdiction over causes of action
pertaining to these plans.
3
D. Settled Claims
Per this Court's request after
oral argument, plaintiff informed us in
writing that after the District Court
dismissed this action, he brought separate
suits against the individual plans for
recovery of benefits. He tells us that he
has settled all claims against the Fairlawn
Country Club Health Benefit Plan and the
Akron Porcelain and Plastics Company Health
Benefit Plan. Moreover, defendant has been
released of all liability in connection with
these two settlements. We therefore dismiss
this appeal as moot in so far as it relates
to these two plans. Plaintiff is apparently
in the process of settling all claims
against the Malco Products, Inc. Health
Benefit Plan; it has not agreed to release
defendant of all liability with respect to
this plan. Therefore, plaintiff's appeal is
not entirely moot, and we shall consider his
claims as they relate to the Malco Plan.
E. Breach of ERISA Plan
In Count I of his complaint,
plaintiff claims that he is entitled to
recover benefits from defendant.
4 Section 502(a)(1) of
ERISA permits suits to recover benefits. See
29 U.S.C. § 1132(a)(1)(B).
5
However, we have explained that "[t]he
administrative scheme of ERISA requires a
participant to exhaust his or her
administrative remedies prior to commencing
suit in federal court."
Miller v. Metropolitan Life Ins. Co., 925
F.2d 979, 986 (6th Cir.1991); see also
Baxter v. C.A. Muer Corp., 941 F.2d 451, 453
(6th Cir.1991). Although ERISA does not
explicitly require exhaustion, the statute
does require benefit plans to provide
internal dispute resolution procedures. See
29 U.S.C. § 1133(2).
6
"[T]he exhaustion requirement enables plan
fiduciaries to 'efficiently manage their
funds; correct their errors; interpret plan
provisions; and assemble a factual record
which will assist a court in reviewing the
fiduciaries' actions.' " Baxter, 941 F.2d at
453 (quoting
Makar v. Health Care Corp. of Mid-Atlantic,
872 F.2d 80, 83 (4th Cir.1989)).
The Malco Plan provides for an
appeals process. According to the plan
document, a claimant must first file a claim
for benefits with the Claims Administrator,
namely defendant. If the claim is denied, a
claimant may seek review by the Plan
Administrator, namely the employer/plan
sponsor. "The Plan Administrator shall
render a full and fair review of the claim
and its denial, and shall make a final
decision."
Plaintiff appears to concede that
he has not exhausted his administrative
remedies under the plan. In his complaint,
he states that he "has not been advised
whether the Plan contains an internal appeal
procedure which, in any event, would be
futile under the circumstances." Traditional
exhaustion principles do include an
exception for instances "when resort to the
administrative route is futile or the remedy
inadequate." Costantino
Page 91 v. TRW, Inc., 13 F.3d 969, 974 (6th
Cir.1994).
Here, the District Court did not
dismiss plaintiff's complaint for failure to
exhaust remedies nor did it even consider
the issue, although defendant raised the
defense in its motion. However, our review
is de novo, and a decision of a district
court must be affirmed if correct for any
reason, including a reason not considered by
the district court. See Russ' Kwik Car Wash,
772 F.2d at 216. We conclude that plaintiff
should have exhausted the administrative
remedies provided under the plans and,
because he did not, dismissal of his action
for recovery of benefits is proper. Although
he contends that such exhaustion would be
futile, he has not alleged any factual basis
for this claim. Additionally, he has not
alleged a cause of action pursuant to 29
U.S.C. § 1132(c), which permits suits
against any plan administrator who fails or
refuses to comply with a request for
information.
Count I also states a claim for
an injunction and "other appropriate
equitable relief" under section 502(a)(3) of
ERISA, 29 U.S.C. § 1132(a)(3), which
provides a cause of action for statutory
violations.
7
Although not expressly alleged in the
complaint, plaintiff suggests in his brief
that this relief is sought for violations of
ERISA section 406, 29 U.S.C. § 1106, which
prohibits specific transactions between a
plan and its parties in interest. Some
circuits have held that the exhaustion
requirement does not apply to alleged
violations of the statute. See, e.g.,
Graphic Communications Union v.
GCIU-Employer Retirement Benefit Plan, 917
F.2d 1184, 1187 (9th Cir.1990). We need
not address that question here, however,
because plaintiff alleges no facts
suggesting that defendant engaged in any
prohibited transactions. Indeed, plaintiff
does not even mention section 406 in his
complaint. Thus, we affirm the dismissal of
Count I of plaintiff's complaint.
F. Breach of Fiduciary Duty
Plaintiff also alleges that
defendant has violated its fiduciary duties
in failing to act in accordance with ERISA
section 404, 29 U.S.C. § 1104, and that he
"is entitled to recover the benefits due
under the plan" under ERISA section 409, 29
U.S.C. § 1109.
8
Plaintiff also seeks "other equitable or
remedial relief" for the alleged violation.
As previously suggested, some
courts have held that the exhaustion
requirement does not apply to a claim for
breach of fiduciary duty, because such a
claim involves an alleged violation of the
statute, not the plan. See Graphic
Communications Union, 917 F.2d at 1187.
Regardless of whether exhaustion is required
for such claims, however, plaintiff here is
essentially claiming that defendant breached
its fiduciary duty by denying him payments
which he was entitled to under the plan. In
other words, the basis of this claim is the
denial of benefits, which plaintiff had an
obligation to appeal before he sued in
federal court. Plaintiff cannot get around
the exhaustion requirement by simply
disguising his claim as a breach of
fiduciary duty.
Drinkwater v. Metropolitan Life Ins., 846
F.2d 821, 826 (1st Cir.1988) ("If we
were to allow claimants to play this
characterization game, then the exhaustion
requirement would be rendered
meaningless.").
Moreover, plaintiff cannot
recover in his individual capacity under
ERISA section 409.
Massachusetts Mutual Life Insurance Co. v.
Russell,
473 U.S. 134, 140-44, 105 S.Ct.
3085, 3089-91, 87 L.Ed.2d 96 (1985), the
Supreme Court held that section 409 and its
Page 92 companion remedial provision, section
502(a)(2), 29 U.S.C. § 1132(a)(2),
9 provide relief only for
a plan and not for individual participants.
Thus, a fiduciary who breaches its duties
must reimburse the plan, not the individual
participants. See id. at 140, 105 S.Ct. at
3089. This court has repeatedly held that
although an individual may bring a section
409 claim, ERISA does not permit recovery by
an individual who claims a breach of
fiduciary duty. See, e.g.,
Tregoning v. American Community Mut. Ins.
Co., 12 F.3d 79, 83 (6th Cir.1993);
Kuper v. Iovenko, 66 F.3d 1447, 1452-53 (6th
Cir.1995).
10
G. Unjust Enrichment & Declaratory
Judgment
Finally, plaintiff argues that
even if he has not alleged viable claims
under ERISA, he has properly alleged claims
against defendant for unjust enrichment and
declaratory relief. First, he asserts that
Count III sets forth a federal common law
claim for unjust enrichment, presumably in
order to avoid ERISA's broad preemption of
state law claims. See 29 U.S.C. § 1144(a)
("[T]he provisions of [ERISA] shall
supersede any and all State laws insofar as
they may now or hereafter relate to any
employee benefit plan...."). Courts have
recognized that Congress intended for the
judiciary to develop and apply a federal
common law to actions premised on the
contractual obligations created by ERISA
plans.
Whitworth Bros. Storage Co. v. Central
States, Southeast and Southwest Areas
Pension Fund, 794 F.2d 221, 235-36 & n.
23 (6th Cir.1986). However, federal common
law is developed under ERISA only in those
instances in which ERISA is silent or
ambiguous.
Muse v. International Bus. Machs. Corp., 103
F.3d 490, 495 (6th Cir.1996), petition
for cert. filed, 65 U.S.L.W. 3666 (U.S. Mar.
25, 1997). Here, creation of a federal
common law of unjust enrichment for plan
beneficiaries seeking to recover benefits
under a plan would be inconsistent with
ERISA's terms and policies.
Morales v. Pan Am. Life Ins. Co., 914 F.2d
83, 87 (5th Cir.1990). Plaintiff
essentially seeks the same relief in Count
III as he seeks in Counts I and II, namely
the benefits to which he believes he is
entitled under the plans. ERISA provides him
with a cause of action in § 1132(a)(1)(B).
With regard to Count IV, in which
plaintiff seeks declaratory relief,
plaintiff has merely asserted a form of
relief, not a cause of action. Plaintiff is
not entitled to this relief in the absence
of a viable claim.
III. Conclusion
For the foregoing reasons, we
AFFIRM.
* The Honorable Ellsworth A. Van Graafeiland, Circuit Judge of the United
States Court of Appeals for the Second
Circuit, sitting by designation.
1 Apparently, at the time the complaint
was filed, plaintiff believed that only one
plan was involved.
2 Defendant also submitted an affidavit
of its Director of Claims. Plaintiff
suggests in his reply brief that defendant
is claiming that the court could consider
this affidavit in ruling on the 12(b)(6)
motion. However, the record shows that
defendant submitted this affidavit in
support of its motion for summary judgment
only. Since the District Court denied the
summary judgment motion as premature, we
assume that the court did not consider the
affidavit in granting the motion to dismiss.
Regardless, we will not consider this
affidavit in our de novo review.
3 Plaintiff contends that we cannot find
that the Portage County and City of
Barberton plans are governmental plans,
because defendant alleged in its
counterclaim that both were "employee
benefit plan[s] as defined under ERISA."
However, a plan may be an "employee benefit
plan" and thus fall within the scope of
ERISA, but then be excluded from ERISA
coverage because it is a governmental plan.
Defendant therefore did not concede ERISA
coverage and, in any event, we find that the
plans are governmental plans.
4 We will assume, as the District Court
apparently did, that plaintiff received
valid assignments of each of his patients'
rights under their respective plans.
5 Section 502(a)(1) of ERISA provides
that
A civil action may be brought--
(1) by a participant or beneficiary--
...
(B) 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[.]
29 U.S.C. § 1132(a)(1)(B).
6 Specifically, ERISA requires that
employee benefit plans "afford a reasonable
opportunity to any participant whose claim
for benefits has been denied for a full and
fair review by the appropriate named
fiduciary of the decision denying the
claim." 29 U.S.C. § 1133(2).
7 Section 502(a)(3) of ERISA provides
that a civil action may be brought
(3) by a participant, beneficiary, or
fiduciary (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[.]
29 U.S.C. § 1132(a)(3).
8 Section 409 provides that a fiduciary
who breaches his or her responsibilities
shall be personally liable to make good
to such plan any losses to the plan
resulting from each such breach, and to
restore to such plan any profits of such
fiduciary which have been made through use
of assets of the plan by the fiduciary, and
shall be subject to such other equitable or
remedial relief as the court may deem
appropriate, including removal of such
fiduciary.
29 U.S.C. § 1109(a).
9 Section 502(a)(2) provides that a civil
action may be brought "by the Secretary, or
by a participant, beneficiary, or fiduciary
for appropriate relief under section 1109 of
this title." 29 U.S.C. § 1132(a)(2).
10
Varity Corp. v. Howe, --- U.S. ----, ----
- ----, 116 S.Ct. 1065, 1076-78, 134 L.Ed.2d
130 (1996), the Supreme Court held that
ERISA plan beneficiaries harmed by a breach
of fiduciary duty by their plan
administrator may seek equitable relief
against the administrator under 29 U.S.C. §
1132(a)(3). However, even though plaintiff
could state a claim for equitable relief
against defendant, if defendant is in fact a
fiduciary, we find that the alleged breach
in this case is essentially a denial of
benefits and should be dismissed for failure
to exhaust administrative remedies. |