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Ford v. Premera Blue Cross

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

April 4, 2018

TRISTAN FORD, Plaintiff,
v.
PREMERA BLUE CROSS, Defendant.

          ORDER ON MOTION TO DISMISS AND FOR SUMMARY JUDGMENT

          Honorable Marsha J. Pechman United States Senior District Court Judge.

         The Court has received and reviewed:

         1. 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:

         IT IS ORDERED that the motion for summary judgment is GRANTED and this matter is DISMISSED with prejudice.

         Background

         Defendant 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.)

         Plaintiff 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.

         Finding grounds for granting the summary judgment dismissal, the Court will not address the “lesser included” 12(b)(6) motion addressing a single claim.

         Discussion

         Motion for summary judgment

         The 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).

         Plaintiff 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, ...


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