United States District Court, W.D. Washington, Seattle
ORDER ON MOTION TO DISMISS AND FOR SUMMARY
Honorable Marsha J. Pechman United States Senior District
Court has received and reviewed:
Defendant's Motion to Dismiss and for Summary Judgment
(Dkt. No. 7), 2. Plaintiff's Opposition to Motion to
Dismiss (Dkt. No. 12), 3. Premera's Reply in Further
Support of Its Motion to Dismiss and for Summary Judgment
(Dkt. No. 15), all attached declarations and exhibits, and
relevant portions of the record, and rules as follows:
ORDERED that the motion for summary judgment is GRANTED and
this matter is DISMISSED with prejudice.
Premera Blue Cross (“Premera”) administers an
“employee welfare benefit plan” (“the
Plan”) under ERISA, 29 U.S.C. § 1001, et
seq. Among its provisions, the Plan contains a
limitations period of one year from the final determination
of an appealed decision to commence any legal action.
(See Dkt. No. 8-1, Ex. 1 at 84.)
filed a claim for payment under the Plan which Premera only
partially granted. Plaintiff appealed the denial; Premera
denied the appeal on November 11, 2014. On November 15, 2017,
Plaintiff filed this complaint in King County Superior Court.
Defendant timely removed the matter to federal court. In the
motion at issue here, Defendant moved for dismissal of
Plaintiff's Insurance Fair Conduct Act
(“IFCA”) claim pursuant to FRCP 12(b)(6), and
summary judgment dismissal of the entire lawsuit on the
grounds that it is time-barred.
grounds for granting the summary judgment dismissal, the
Court will not address the “lesser included”
12(b)(6) motion addressing a single claim.
for summary judgment
Plan contains a provision which sets the statute of
limitations for bringing a lawsuit based on denial of a claim
at one year from the final adjudication of the denial (which,
in this case, was November 11, 2014). ERISA itself does not
specify a limitation period for plan participants to bring
suit following an adverse benefits determination, and the
Supreme Court has upheld the right of ERISA benefit plan
providers to prescribe a statute of limitations which is
shorter than comparable state statutes of limitations.
Heimeshoff v. Hartford Life & Accident Ins. Co.,
134 S.Ct. 604, 610 (2013).
first argues that the Washington statutory breach of contract
limitations period (six years; RCW 4.16.040) should apply.
But the Supreme Court has clearly stated that
in the absence of a controlling statute to the contrary, a
provision in a contract may validly limit, between the
parties, the time for bringing an action on such contract to
a period less than that prescribed in the general statute of
limitations, provided that the shorter period itself shall be
a reasonable period.
Order of United Commercial Travelers of America v.
Wolfe, 331 U.S. 586, 608 (1947)(cited with
approval in Heimeshoff, ...