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Nielsen v. Unum Life Insurance Co.

United States District Court, W.D. Washington, Seattle

March 26, 2015

RONALD D. NIELSEN, Plaintiff,
v.
UNUM LIFE INSURANCE COMPANY OF AMERICA, UNUM GROUP CORPORATION, CATHOLIC HEATH INITIATIVES PLAN, AND FRANCISCAN HEALTH SYSTEM, Defendants.

ORDER ON PENDING MOTIONS TO DISMISS

RICARDO S. MARTINEZ, District Judge.

I. INTRODUCTION

This matter comes before the Court on two Motions to Dismiss. First, the Court examines the Unum Defendants' (collectively "Unum") Motion to Dismiss Plaintiff's Second and Fifth Causes of Action pursuant to Federal Rule of Civil Procedure 12(b)(6). Dkt. #47. Unum argues that Plaintiff has failed to remedy the deficiencies it had with these Causes of Action in its First Amended Complaint, and otherwise fails to state viable claims. Id. Plaintiff opposes the motion, arguing that Unum has misconstrued his claims, and that he has otherwise met the appropriate pleading standard. Dkt. #51. Second, the Court examines Defendant Catholic Health Initiatives' and their affiliates' (collectively "CHI") Motion to Dismiss under Federal Rules of Civil Procedure 12(b)(6) and 41(b). Dkt. #48. CHI argues that Plaintiff violated this Court's prior Order by asserting new claims against CHI that were not allowed by this Court, and that Plaintiff has otherwise failed to assert plausible claims against them. Id. Plaintiff agrees that some of the claims may be stricken, but opposes the remainder of the motion. Dkt. #58. Having reviewed the parties' briefing, the record, and relevant case law, and for the reasons stated herein, the Court now GRANTS Unum's Motion to Dismiss, and GRANTS IN PART AND DENIES IN PART CHI's Motion to Dismiss.

II. BACKGROUND

This Court has previously set forth the background of this case in its Order on Defendants' first motions to dismiss, and incorporates it by reference herein. See Dkt. #41. The Court previously granted Defendants' motions to dismiss Plaintiff's First Amended Complaint, but allowed Plaintiff to file a Second Amended Complaint in an effort to remedy the identified deficiencies. Id. Plaintiff's Second Amended Complaint continues to assert multiple state and federal causes of action arising out of Defendants' decision to deny Plaintiff, Dr. Ronald Nielsen, short and long-term disability benefits. Unum and CHI now seek to dismiss several of the pending causes of action in the newly-amended Complaint.

III. DISCUSSION

A. Unum's Motion to Dismiss

1. Second Cause of Action - Breach of Fiduciary Duty

Unum seeks dismissal of Plaintiff's Second Cause of Action, alleging a state law claim for breach of fiduciary duty, on the basis that there is no fiduciary relationship between it and Plaintiff. Dkt. #47. The Court agrees. Plaintiff alleges that Unum owed him a fiduciary duty as the Claims Administrator under the Short Term Disability ("STD") Program. Specifically, Plaintiff asserts that the fiduciary relationship between Unum and himself "arose out of Unum's role as the arbiter of claims for STD benefits." Dkt. #51 at 3. Plaintiff then contrasts Unum's role in the program with that of a trustee, arguing that a fiduciary relationship was thereby created. Dkt. #51 at 3-5.

As Unum has noted, "Washington courts have yet to recognize a claim for breach of fiduciary duty by an insured against an insurer." Baker v. Phoenix Ins. Co., 2014 U.S. Dist. LEXIS 7918, *9 (W.D. Wash. Jan. 22, 2014) (citations omitted). Moreover, this Court has already determined that Plaintiff is not a third-party beneficiary of the STD program contract between Unum and CHI. Dkt. #41. Indeed, the Court noted that "[w]hile the contract required Unum to administer claims for CHI, it did not require Unum to adjudicate claims in Plaintiff's favor or for his direct benefit." Dkt. #41 at 11 (citing Dkt. # 20 at 8). Further, Plaintiff fails to cite a single case in which a third-party administrator was deemed to have a fiduciary duty in a situation such as the instant matter. Accordingly, the Court agrees with Defendant that Plaintiff's Second Cause of Action should be dismissed.

2. Fifth Cause of Action - Violation of Washington's Consumer Protection Act

Unum next moves to dismiss Plaintiff's Fifth Cause of Action, alleging a claim under Washington's Consumer Protection Act ("CPA"). Dkt. #47 at 5. Unum argues that Plaintiff has failed to state a claim under the CPA, and particularly has failed to establish an unfair or deceptive practice or that the public interest is affected. Dkt. #47 at 5. Plaintiff argues that Unum committed a per se violation that has the capacity to deceive the public. Dkt. #51 at 5-10. Plaintiff's argument is not persuasive.

In order to succeed on a CPA claim, Plaintiff must prove: (a) an unfair or deceptive act or practice; (b) that occurred in trade or commerce; (c) that has an impact on public interest; (d) that results in injury to plaintiff in their business or property; and (e) that satisfied the causal link between the unfair or deceptive act and the injury suffered. Klem v. Wash. Mut. Bank, 176 Wn.2d 771, 782, 295 P.3d 1179 (2013). A plaintiff may predicate the first CPA element on "a per se violation of statute, an act or practice that has the capacity to deceive substantial portions of the public, or an unfair or deceptive act or practice not regulated by statute but in violation of public interest." Klem, 176 Wn.2d 771, 787, 295 P.3d 1179 (2013) (clarifying Hangman Ridge Training Stables, Inc. v. Safeco Title Ins. Co., 105 Wn.2d 778, 785-86, 719 P.2d 531 (1986)). A defendant's act or practice is per se unfair or deceptive if the plaintiff shows it violates a statute declaring the conduct to be an unfair or deceptive act or practice in trade or commerce. See Hangman Ridge, 105 Wn.2d at 786. To state a claim for a per se CPA violation, the plaintiff must allege "the existence of a pertinent statute'" and "its violation.'" Fid. Mortg. Corp. v. Seattle Times Co., 131 Wn.App. 462, 471, 128 P.3d 621 (2005) (quoting Keyes v. Bollinger, 31 Wn.App. 286, 290, 640 P.2d 1077 (1982)); see Dempsey v. Joe Pignataro Chevrolet, Inc., 22 Wn.App. 384, 393, 589 P.2d 1265 (1979). Plaintiff has not done so here.

Plaintiff does not assert a statutory violation upon which his per se allegation is based. Rather, he alleges that the denial of his short-term disability claim itself is the violation because, as he alleges, "Unum substituted its own undisclosed definition of disabled' for the definition that was provided to participants in the STD program." Dkt. #51 at 6. Plaintiff's allegation reveals that he is really asserting a breach of contract claim specific to his denial of benefits. As such, he fails to meet the elements of a CPA claim, ...


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