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Whitley v. Dr. Pepper Snapple Group, Inc.

United States District Court, E.D. Texas, Sherman Division

September 19, 2017

AMY WHITLEY, INDIVIDUALLY AND AS NEXT FRIEND TO L.K.W. and L.Q.W.
v.
DR PEPPER SNAPPLE GROUP, INC., DR PEPPER SNAPPLE GROUP HEALTH PLAN, and ADMINISTRATIVE COMMITTEE

          MEMORANDUM OPINION AND ORDER

          AMOS L. MAZZANT UNITED STATES DISTRICT JUDGE

         Pending before the Court is Defendant Dr Pepper Snapple Group, Inc. (“Dr Pepper”), Dr Pepper Snapple Group Health Plan, and the Dr Pepper Snapple Group, Inc. Administrative Committee's (collectively, “Defendants”) Motion to Dismiss Plaintiff's First Amended Complaint. (Dkt. #10). After considering the relevant pleadings, the Court grants in part and denies in part Defendants' motion.

         BACKGROUND

         This lawsuit concerns Defendants' alleged erroneous denial of coverage for treatment of Plaintiff Amy Whitley's (“Whitley”) sons', L.K.W. and L.Q.W., autism spectrum disorder. From August 2015 through January 2016, Whitley inquired into whether her healthcare plan (“the Plan”) covered treatments for autism. During this time, Defendants gave Whitley conflicting information as to whether the Plan covered L.K.W.'s Applied Behavior Analysis (“ABA”) treatment, including different variations of the Summary Plan Description. For example, Whitley received a 2013 Summary Plan Description that did not contain an ABA treatment exclusion provision, but received a 2016 Summary Plan Description that did.

         In January 2016, L.K.W.'s ABA treatment provider requested a pre-service claim determination (“L.K.W.'s First Claim”) to determine whether the Plan covered L.K.W.'s ABA therapy. Defendants denied coverage, and Plaintiff appealed Defendants' decision. On July 26, 2016, Defendants issued a final administrative denial.

         On September 21, 2016, Plaintiff filed a second pre-service claim for L.K.W.'s ABA therapy (“L.K.W.'s Second Claim”). Defendants again denied coverage issuing a final administrative denial on May 9, 2017.

         Additionally, on February 16, 2017, Plaintiff filed a pre-service claim for L.Q.W.'s ABA therapy (“L.Q.W.'s Initial Claim”). Like Plaintiff's previous claims, Defendants denied coverage and issued a final administrative denial on May 24, 2017.

         On April 28, 2016, Whitley filed suit in state court alleging Dr Pepper violated, among other things, the Americans with Disabilities Act by denying coverage for L.K.W.'s autism treatment. On May 31, 2016, Dr Pepper removed Whitley's state court action to federal court. Whitley v. Dr Pepper Snapple Group, Inc., 4:16-CV-362-ALM, Dkt. #1 (E.D. Tex. May 31, 2016) (“Whitley I”). Subsequently, on January 19, 2017, Whitley filed this lawsuit (“Whitley II”) alleging Defendants wrongfully denied both of her sons coverage for ABA therapy in violation of the Employee Retirement Income Security Act of 1974 (“ERISA”) and the Pete Domenici Mental Health Parity and Addiction Equity Act (“MHPAEA”). On July 20, 2017, the Court consolidated Whitley I and Whitley II for purposes of discovery and trial. (Whitley I, Dkt. #74).

         On April 26, 2017, Defendants filed their motion to dismiss Plaintiff's First Amended Complaint pursuant to Federal Rule of Civil Procedure 12(b)(6). (Dkt. #10). Specifically, Defendants allege Plaintiff's claims are untimely and Plaintiff failed to exhaust administrative remedies prior to filing suit. Plaintiff filed her response on May 17, 2017. (Dkt. #12). Defendants filed their reply (Dkt. #22) on June 7, 2017, and Plaintiff filed her sur-reply (Dkt. #23) on June 23, 2017.

         LEGAL STANDARD

         The Federal Rules of Civil Procedure require that each claim in a complaint include a “short and plain statement . . . showing that the pleader is entitled to relief.” Fed.R.Civ.P. 8(a)(2). Each claim must include enough factual allegations “to raise a right to relief above the speculative level.” Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007).

         A Rule 12(b)(6) motion allows a party to move for dismissal of an action when the complaint fails to state a claim upon which relief can be granted. Fed.R.Civ.P. 12(b)(6). When considering a motion to dismiss under Rule 12(b)(6), the Court must accept as true all well-pleaded facts in plaintiff's complaint and view those facts in the light most favorable to the plaintiff. Bowlby v. City of Aberdeen, 681 F.3d 215, 219 (5th Cir. 2012). The Court may consider “the complaint, any documents attached to the complaint, and any documents attached to the motion to dismiss that are central to the claim and referenced by the complaint.” Lone Star Fund V (U.S.), L.P. v. Barclays Bank PLC, 594 F.3d 383, 387 (5th Cir. 2010). The Court must then determine whether the complaint states a claim for relief that is plausible on its face. ‘“A claim has facial plausibility when the plaintiff pleads factual content that allows the [C]ourt to draw the reasonable inference that the defendant is liable for the misconduct alleged.'” Gonzalez v. Kay, 577 F.3d 600, 603 (5th Cir. 2009) (quoting Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009)). “But where the well-pleaded facts do not permit the [C]ourt to infer more than the mere possibility of misconduct, the complaint has alleged-but it has not ‘show[n]'-‘that the pleader is entitled to relief.'” Iqbal, 556 U.S. at 679 (quoting Fed.R.Civ.P. 8(a)(2)).

         In Iqbal, the Supreme Court established a two-step approach for assessing the sufficiency of a complaint in the context of a Rule 12(b)(6) motion. First, the Court should identify and disregard conclusory allegations, for they are “not entitled to the assumption of truth.” Iqbal, 556 U.S. at 664. Second, the Court “consider[s] the factual allegations in [the complaint] to determine if they plausibly suggest an entitlement to relief.” Id. “This standard ‘simply calls for enough facts to raise a reasonable expectation that discovery will reveal evidence of the necessary claims or elements.'” Morgan v. Hubert, 335 F. App'x 466, 470 (5th Cir. 2009) (citation omitted). This evaluation will “be a context-specific task that requires the reviewing [C]ourt to draw on its judicial experience and common sense.” Iqbal, 556 U.S. at 679.

         Thus, “[t]o survive a motion to dismiss, a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its ...


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