OPINION AND ORDER
This lawsuit arises from insurance claims made on behalf of seven covered individuals in connection with high school athletic injuries that they sustained while they were covered by both Central States, Southeast and Southwest Areas Health and Welfare Fund (collectively “Central States” or the “Fund”) and Gerber Life Insurance Company (“Gerber”). Complaint, ¶¶ 8-11, and at Ex. B.
Defendants move to dismiss Plaintiffs’ Complaint pursuant to Fed.R.Civ.P. 12(b)(6) for failure to state a claim upon which relief may be granted. For the reasons set forth below, Defendants’ motion to dismiss is GRANTED.
Background
For purposes of this motion, this Court accepts as true the facts as stated in Plaintiffs’ Complaint. Central States is an employee welfare benefit plan regulated under the Employee Retirement Income Security Act of 1974 (“ERISA”), as amended 29 U.S.C. § 1001 et seq. that provides health benefits, including medical and hospital benefits, to participants in the Teamster Industry and their dependents. Complaint ¶ 4. Gerber is a private insurance company that has sold student accident medical insurance to the same seven covered individuals through various high schools and colleges. Complaint ¶6. Administrative Concepts, Inc. is -a third party administrator that processed all of the claims at issue for Gerber. Complaint ¶ 7.
At the time of their injuries, the covered individuals were covered as dependents (immediate family members) of the Central States’ participants. Complaint ¶4 and Exhibit B. The covered individuals were also covered directly by Gerber through their participation in the organizations to which Gerber sold insurance.
When Central States receives claims for individuals who have overlapping insurance coverage, Central States’ Plan establishes rules for determining coordination of benefit (“COB”) rights. Complaint ¶21. Central States’ Plan COB provisions provide, in pertinent part, that overlapping insurance carriers are considered the primary insurers if they have no coordination of benefits provision in their plans, or if they provide specific risk coverage, including but not limited to, premises liability or medical benefits coverage. Id. Additionally, Central States’ COB provisions state that when another plan provides benefits to a person directly, as opposed to as a dependent, the other insurer has primary responsibility. Id.
Central States’ Plan also sets forth Central States’ right to reimbursement for any payments in excess of benefits payable under the terms of the Plan, from any responsible persons or entities. Complaint ¶ 20. The Plan authorizes Central States’ Trustees to file suit on behalf of Central States against other plans to recover any such payments. Complaint ¶ 24. In addition, the Plan authorizes Central States’ Trustees to seek a judicial declaration regarding the responsibility of other plans that are primarily responsible for the payment of benefits. Complaint ¶ 24.
Under Central States’ COB rules, Central States maintains that the Defendants are primarily responsible for paying the covered individuals’ medical expenses. Complaint ¶ 21. In an effort to avoid hardship to the covered individuals, Central States paid their medical expenses and sought reimbursement from the defendants. Complaint ¶¶ 29-35. However, defendants denied Central States’ demands for reimbursement and claimed that the insurance policies that they issued were accidental injury excess policies that were meant to only provide excess coverage or coverage that is secondary to that provided by Central States. Complaint, Exhibit B. Plaintiffs then filed this lawsuit to enforce the terms of Central States’ plan pursuant to Section 502(a)(3) of ERISA.
Defendants have moved to dismiss on the theory that Plaintiffs have failed to state a cause of action. Specifically, Defendants assert that Plaintiffs’ claims are for monetary relief, which is not available under Section 502(a)(3) of ERISA.
Discussion
A. Legal Standard
a. Motion to Dismiss Under Rule 12(b)(6)
On a motion to dismiss for “failure to state a claim upon which relief can be granted,” Fed.R.Civ.P. 12(b)(6), this Court accepts all factual allegations in the complaint as true and draws all reasonable inferences in the plaintiffs favor. Ruotolo v. City of N.Y.,
When there are well-pleaded factual allegations in the complaint, “a court should assume their veracity and then determine whether they plausibly give rise to an entitlement to relief.” Id. A claim is facially plausible when the factual content pleaded allows a court “to draw a reasonable inference that the defendant is liable for the misconduct alleged.” Id. The factual allegations of a complaint need not be detailed, but they must be sufficient to “nud[ge] ... claims across the line from conceivable to plausible,” Twombly,
b. Materials Considered on Motion to Dismiss
On a motion to dismiss, the court may consider the documents that are “asserted within the four corners of the complaint, the documents attached to the complaint as exhibits, and any documents incorporated in the complaint by reference.” McCarthy v. Dun & Bradstreet Corp.,
B. As to Whether Plaintiffs Claims for Reimbursement of Paid Benefits are a Form of Equitable Relief under ERISA
Defendants’ motion to dismiss argues that Central States failed to plead a viable ERISA claim for equitable relief. The enforcement mechanism Plaintiffs pursues is ERISA § 502(a)(3), which states, in relevant part, 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) (emphasis added). ‘We have interpreted the term ‘appropriate equitable relief in § 502(a)(3) as referring to ‘those categories of relief that, traditionally speaking (i.e., prior to the merger of law and equity) ‘were typically available in equity.’ ” CIGNA Corp. v. Amara, — U.S. -,
The core of the dispute here is “whether the remedy the Plaintiffs seek falls within such ‘other appropriate equitable relief as they may obtain” under Section 502. Gerosa v. Savasta & Co., Inc.,
In GreatAWest, Petitioner insurance company sought reimbursement for insurance proceeds it previously paid to the Respondent, pursuant to the terms of the Plan that obligated the recipient of insurance proceeds to repay such moneys if the recipient later recovered at least that amount-in a settlement or judgment. Id. at 207,
Justice Scalia, delivering the majority opinion, drew a fine distinction between remedies that a court should consider equitable rather than legal, and clarified that even where a party seeks restitution, a court must still decide “whether it is legal or equitable [which] depends on the basis for the [plaintiffs] claim and the nature of the underlying remedies sought.” Id. at 214,
The Court’s decision that Petitioners actually sought to “impose personal liability” on respondents turned on the fact that the Respondent was not in actual possession of the money Petitioners sought. Great-West,
Courts interpreting Greatr-West have likewise held that a money or property must be traceable to a particular fund or property in a defendant’s possession in order for the remedy to be considered equitable rather than legal. See, e.g., De Pace v. Matsushita Elec. Corp.,
The Court, however, is not convinced. The crux of Defendants’ argument is that ERISA § 502(a)(3) only allows ERISA Plans to recover for equitable relief, and that this case is, as Defendants argue, “a classic suit for money damages/legal relief. ...” Defendants’ Mem. of Law at 17. Specifically, Defendants maintain that the Fund’s claims for (I) declaratory judgment for unpaid and future expenses; (II) declaratory judgment for past expenses; (III) restitution; and (IV) equitable lien/constructive trust are classically monetary claims because, as they argue, there are no specifically identifiable and traceable funds or property originally belonging to the Fund that are now in Defendants’ possession.
Fiduciaries, such as trustees of ERISA-based funds, have a duty to locate and reclaim trust fund assets that have been improperly taken or disbursed. Central States v. Central Transp., Inc.,
In Sereboff v. Mid Atlantic Medical Services, Inc.,
In Thurber v. Aetna Life Ins. Co.,
Plaintiff asserts that she is not seeking contractual-based rights but, instead, is seeking “declaratory relief for guidance on how to administer its plan.” Opposition at p. 18. Plaintiff cites Board of Trustees of the CWA/ITU Negotiated Pension Plan, et al. v. Weinstein, 107 F.3d 139 (2d Cir.1997) for the holding that claims for declaratory relief are equitable and within the scope of Section 502(a)(3)(B) of ERISA, rejecting defendant’s argument that such a claim be dismissed. Here, plaintiffs prayer for “equitable” relief is properly characterized as a legal remedy unavailable under 502(a)(3), see Great-West Life & Annuity Ins. Co.,
As the Second Circuit has observed in an action by ERISA plan beneficiaries seeking recalculation and payment of benefits via an injunctive order, “[wjhile the plaintiffs seek to expand the nature of their claim by couching it in equitable terms to allow relief under Section 502(a)(3), the gravamen of this action remains a claim for monetary compensation and that, above all else, dictates the relief available [and forecloses application of Section 502(a)(3) where other relief provisions of ERISA are applicable].” Frommert v. Conkright,
The relief that Plaintiff seeks is monetary in nature and not equitable as anticipated by § 502(a)(3). See Kendall v. Employees Retirement Plan of Avon Products,
In CIGNA Corp. v. Amara, the Supreme Court was faced with a dispute regarding the failure to properly disclose information between an employer and beneficiaries of a pension plan that had been converted to a “cash balance” retirement plan. CIGNA,
Defendants rely on two recent district court cases that dismissed Central States’ complaints in those proceedings, Cent. States, Se. & Sw. Areas Health and Welfare Fund v. Health Special Risk Ins. Inc., et al., Civ. No. 3:11-2910,
Reimbursement to Central States is not the type of “equitable relief’ anticipated by the statute, and there is no “appropriate equitable relief’ alleged to be in Defendants’ possession. Varity,
Conclusion
For the foregoing reasons, the Court grants Defendants’ motion to dismiss Plaintiffs Complaint. The clerk of the court is directed to terminate the motion. (Docket No. 28).
SO ORDERED.
Notes
. Note that the second subsection of 502(a) provides an avenue for a civil suit by a plan beneficiary for "appropriate relief under section 409 [entitled ‘Liability for Breach of Fiduciary Duties’].” 29 U.S.C. § 1132(a)(2). However, recovery under section 409 accrues to the plan, and not to the individual beneficiary. 29 U.S.C. § 1109 ("Any person who is a fiduciary with respect to a plan who breaches any of the responsibilities, obligations, or duties imposed upon fiduciaries by this sub-chapter 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----”). Further, the court in Massachusetts Mut. Life Ins. Co. v. Russell,
