ERIC L. PATTERSON, Plaintiff-Appellant, v. UNITED HEALTHCARE INSURANCE COMPANY; UNITEDHEALTH GROUP, INC.; UNITED HEALTHCARE SERVICES, INC.; OPTUM, INC.; SWAGELOK COMPANY; KREINER & PETERS CO., L.P.A.; SHAUN D. BYROADS; DARAN PAUL KIEFER, Defendants-Appellees.
No. 22-3167
UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT
August 1, 2023
RECOMMENDED FOR PUBLICATION Pursuant to Sixth Circuit I.O.P. 32.1(b) File Name: 23a0164p.06
Before: SILER, NALBANDIAN, and READLER, Circuit Judges.
Argued: October 27, 2022
Decided and Filed: August 1, 2023
COUNSEL
ARGUED: Patrick J. Perotti, DWORKEN & BERNSTEIN CO., L.P.A., Painesville, Ohio, for Appellant. Wesley E. Stockard, LITTLER MENDELSON, P.C., Atlanta, Georgia, for Appellees. ON BRIEF: Patrick J. Perotti, DWORKEN & BERNSTEIN CO., L.P.A., Painesville, Ohio, Benjamin P. Pfouts, KISLING, NESTICO & REDICK, Fairlawn, Ohio, for Appellant. Wesley E. Stockard, LITTLER MENDELSON, P.C., Atlanta, Georgia, Noah G. Lipschultz, LITTLER MENDELSON, P.C., Minneapolis, Minnesota, James P. Smith, LITTLER MENDELSON, P.C., Cleveland, Ohio, Daran Kiefer, KREINER & PETERS CO., LPA, Cleveland, Ohio, for Appellees.
OPINION
CHAD A. READLER, Circuit Judge. Eric Patterson was injured in an auto accident. Patterson‘s medical expenses were paid by his insurer, United. He also recovered for his injuries from the other driver. United claimed that Patterson‘s insurance plan obliged him to pay those monies to United. Eventually, the parties settled the matter, with Patterson agreeing to pay the plan $25,000. Patterson later obtained a copy of the plan document, which contained no provision for reimbursement rights. So he filed suit against United and related entities under the
I.
The following facts are taken from Patterson‘s complaint. United, an umbrella term for several affiliated companies, provided medical insurance to Patterson and his wife through Patterson‘s employer, Swagelok Company. The plan in which the Pattersons enrolled was subject to ERISA. See
The summary plan description said that if a beneficiary recovered from a third party for an insured incident, the plan had a right to reimbursement. That language became noteworthy when Patterson was injured in a traffic accident with a tractor trailer. United covered his accident-related medical expenses, as it was obligated to do under the plan. United‘s agent and subsidiary, Optum, notified Patterson it would invоke the plan‘s reimbursement right if he recovered from the other driver. Patterson
Ordinarily, that would have been the end of the story. But when misfortune struck again only months later, a new chapter was added. Patterson‘s wife suffered injuries in a second traffic accident. The process repeated: United paid for her medical care, Optum notified the Pattersons it would seek some or all of any recovery from the other driver, and Patterson‘s wife sued the driver and sought a declaratory judgment in state court that United had no reimbursement right. But history did not repeat itself in all respects. After initially denying the existence of a plan documеnt, as they did in the first state court case, the plan‘s attorneys produced one. The tendered plan document stated that it took precedence over the summary plan document in the event of a discrepancy between the two. And while the summary plan document included a reimbursement right, the plan document did not. On that basis, the state court entered summary judgment in Patterson‘s wife‘s favor on her declaratory judgment claim against the plan.
Patterson sued United, Optum, Swagelok, and the plan‘s attorneys—but not the plan itself. The complaint alleged that defendants violated various ERISA duties owed to Patterson, entitling Patterson to the return of his $25,000. Extrapolating from his and his wife‘s experiences, Patterson also asserted the existence of a larger scheme to swindle beneficiaries out of their third-party recoveries. To end that practice and remedy its effects, Patterson asked for injunctive and monetary relief on the plan‘s and other beneficiaries’ behalf.
Defendants moved to dismiss Patterson‘s complaint. While the motion to dismiss was under advisement, Patterson moved for leave to amend his complaint. The proposed amended complaint would have sought class status, narrowed the factual allegations and group of named defendants, and dropped several claims.
The district court dismissed the complaint. To its mind, Patterson had standing to sue only for his $25,000 payment to Optum, not for the injuries purportedly inflicted upon other insureds or for other forms of relief. And as to his claim seeking $25,000, the district court concluded, Patterson did not state a viable claim under any of ERISA‘s causes of action. The court also denied on futility grounds Patterson‘s motion for leave to amend. This appeal followed.
II.
We review de novo the complaint‘s dismissal. Operating Eng‘rs’ Loc. 324 Fringe Benefit Funds v. Rieth-Riley Constr. Co., 43 F.4th 617, 621 (6th Cir. 2022). For jurisdictional and merits purposes alike, Patterson‘s well-pleaded factual allegations (and reasonable inferences from those allegations) are taken as true, and we ask whether those allegations move his claims across the line from possible to plausible to survive dismissal. Forman v. TriHealth, Inc., 40 F.4th 443, 448 (6th Cir. 2022) (citing Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)); Ass‘n of Am. Physicians & Surgeons v. U.S. Food & Drug Admin., 13 F.4th 531, 543–44 (6th Cir. 2021). We start with two jurisdictional issues raised by defendants: standing and
A.1. First up is the threshold standing question. Like every other plaintiff in federal court, Patterson must establish standing to bring his claims. Glennborough Homeowners Ass‘n v. USPS, 21 F.4th 410, 413–14 (6th Cir. 2021). That means Patterson must make out an injury-in-fact traceable to defendants’ conduct that will likely be redressed by the requested relief. Id. at 414; Thole v. U.S. Bank N.A., 140 S. Ct. 1615, 1618 (2020). An injury-in-fact must be “concrete and particularized” and “actual or imminent, not conjectural or hypothetical.” Lujan v. Defs. of Wildlife, 504 U.S. 555, 560 (1992) (cleaned up). Because standing is “not dispensed in gross,” Patterson must establish his standing as to each claim and each type of relief sought. Universal Life Church Monastery Storehouse v. Nabors, 35 F.4th 1021, 1031 (6th Cir. 2022) (quoting Lewis v. Casey, 518 U.S. 343, 358 n.6 (1996)).
Our standing analysis centers on Patterson‘s purported loss of $25,000. Monetary loss is a concrete injury. TransUnion LLC v. Ramirez, 141 S. Ct. 2190, 2204 (2021). Defendants’ behavior allegedly cаused Patterson to lose those funds. And an award of $25,000 would redress his injury. The district court thus correctly found that Patterson has standing to sue for return of his $25,000 settlement payment. But his personal interest in this suit ends with that sum. Patterson has not alleged a plausible future injury entitling him to prospective injunctive relief. See Werner v. Primax Recoveries, Inc., 365 F. App‘x 664, 668 (6th Cir. 2010). For starters, the complaint does not clearly state whether Patterson remains a beneficiary of the plan. See id. Even if he is, he has not plausibly alleged that his experience—an accident, a recovery from the other driver, and a request by United for reimbursement—is certainly impending. See Clapper v. Amnesty Int‘l USA, 568 U.S. 398, 409 (2013).
Likewise deficient are the other injuries adverted to in the complaint, allegedly consisting of third-party awards or settlements wrongfully taken from other plan beneficiaries and wasted or mismanaged plan assets. Two apparent problems arise with respect to those injuries. First, it is not entirely clear that Patterson would have standing to raise them on behalf of the plan or other beneficiaries. See Hollingsworth v. Perry, 570 U.S. 693, 708 (2013) (“[I]n the ordinary course, a litigant must assert his or her own legal rights and interests, and cannot rest a claim tо relief on the legal rights or interests of third parties.” (quoting Powers v. Ohio, 499 U.S. 400, 410 (1991))); Duncan v. Muzyn, 885 F.3d 422, 428 (6th Cir. 2018); Soehnlen v. Fleet Owners Ins. Fund, 844 F.3d 576, 583 (6th Cir. 2016) (“[T]he mere fact that a plaintiff pays funds into a non-compliant plan, if an injury at all, is ‘neither concrete nor particularized.‘” (quoting Loren v. Blue Cross & Blue Shield of Mich., 505 F.3d 598, 608 (6th Cir. 2007))).
Second, even if Patterson were the proper party to vindicate these other harms, they are sketched so faintly in the complaint that he fails to establish an injury for standing purposes at all. Start with the ostensible losses suffered by Patterson‘s fellow plan beneficiaries. Extrapolating from only his experiences, Patterson asserts that “numerous” other еnrollees fell victim to a large-scale “scheme,” losing
Nor сan we accept as plausible Patterson‘s claim that defendants’ actions caused harm to the plan itself, an injury he seeks to remedy under
Equally hypothetical are Patterson‘s claims of harm to the plan in the form of inadеquate funding. By way of background, ERISA mandates certain “minimum funding standards” to ensure the financial wellbeing of employee benefit plans. See
2. The second arrow in defendants’ jurisdictional quiver is the Rooker-Feldman doctrine. Honoring principles of state/federal comity, the doctrine bars a state-court loser from circumventing
Defendants cite a number of cases concerning the res judicata effects of a settlement like the one Patterson concluded with the plan. Res judicata, however, is not jurisdictional. Exxon Mobil Corp. v. Saudi Basic Indus. Corp., 544 U.S. 280, 293 (2005) (explaining that Rooker-Feldman, a jurisdictional bar, is not a substitute for preclusion law). Similarly distinguishable are defendants’ cases invoking Rooker-Feldman. In each, the plaintiff attempted to undo a state court settlement by arguing his attorney committed malpractice (that is, he is entitled to a sweeter deal than he got). See, e.g., Delfrate v. Shanner, 229 F.3d 1151 (6th Cir. 2000) (unpublished table decision); Anderson v. Chesley, Nos. 2:10-116-DCR, 2:10-117-DCR, 2011 WL 3319890, at *3–5 (E.D. Ky. Aug. 1, 2011). Patterson, on the other hand, does not attack the settlement itself. He instead argues that defendants, through various misrepresentations and actions in the underlying litigation, breached their ERISA duties owed to him, claims that could not have been pursued in state court.
B. That takes us to the merits. The complaint invoked two of ERISA‘s “six carefully integrated civil enforcement provisions.” Mass. Mut. Life Ins. Co. v. Russell, 473 U.S. 134, 146 (1985). The complaint also listed a third cause of аction, which we do not consider because Patterson has waived reliance on it on appeal. See Appellant Br. at 17 (disavowing
1. Begin with ERISA‘s cause of action for equitable relief. See
For that to be the case, (1) the basis for Patterson‘s claim and (2) the nature of the underlying remedy sought must each be equitable in nature. Sereboff v. Mid Atl. Med. Servs., 547 U.S. 356, 363 (2006). The era of the “divided bench,” a point in time before the courts of law and equity merged into one, supplies the frame of reference for conducting each inquiry. Montanile v. Bd. of Trs. of Nat‘l Elevator Indus. Health Benefit Plan, 577 U.S. 136, 142 (2016). We ask whether a plaintiff “typically” would have been able to obtain in a pre-merger equity action the remedy he seeks under ERISA, recognizing that equity courts often granted relief outside the bounds of “equitable” relief as defined by the statute. Id. (quoting Mertens v. Hewitt Assocs., 508 U.S. 248, 256 (1993)).
(a). Patterson asserts claims under ERISA‘s equitable cause of action, both for breach of fiduciary duty and for engagement in prohibited transactions. That means our interrogation of the “basis” for his claim is a two-headed one. The breach of fiduciary duty claim, to begin, has an equitable basis. Before the law/equity merger, “the courts of equity had exclusive jurisdiction over virtually all” breach of trust actions, Mertens, 508 U.S. at 256, the forefather of the ERISA breach of fiduciary duty claim. See Chaffeurs, Teamsters & Helpers, Loc. No. 391 v. Terry, 494 U.S. 558, 567 (1990) (citing Joseph Story, 2 Commentaries on Equity Jurisprudence § 960 (13th ed. 1886)); see also Stiso v. Int‘l Steel Grp., 604 F. App‘x 494, 498 (6th Cir. 2015) (describing a
What about Patterson‘s claim that United and Optum engaged in prohibited transactions? See
We think so. The facts underlying both the breach of fiduciary duty and prohibited transactions claims are identical. In this type of scenario, where a fiduciary uses plan funds “for its own purposes,” it violates both of these ERISA duties. Pipefitters Loc. 636 Ins. Fund v. Blue Cross & Blue Shield of Mich., 722 F.3d 861, 868–69 (6th Cir. 2013); see also Hi-Lex Controls, Inc. v. Blue Cross & Blue Shield of Mich., 751 F.3d 740, 750–52 (6th Cir. 2014). The fiduciary duties ERISA imposes—which we have already concluded give rise to an equitable claim here—are “undeniably broader than the prohibition against self-dealing.” Pipefitters Loc. 636 Ins. Fund, 722 F.3d at 869. Patterson‘s claim of a prohibited transaction for impermissibly collecting his $25,000, then, also rests on an equitable basis. For the same reason we deemed his requested relief for breach of fiduciary duty equitable in nature, so too for the prohibited transactions claim.
Defendants see things differently. To their eyes, Pаtterson‘s claims are different in kind than those in a trio of Supreme Court decisions. Montanile, 577 U.S. at 144; Sereboff, 547 U.S. at 364–68; Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204, 218 (2002). Those cases involved equitable lien by agreement claims brought by plan fiduciaries against beneficiaries. Yet here, they
Defendants likewise believe that no breach could have occurred because Optum was not acting in a fiduciary capacity when it entered into the settlement agreement with Patterson. See McLemore v. Regions Bank, 682 F.3d 414, 422 (6th Cir. 2012). True or not, the district court did not decide the issue because it did not have to, leaving us with an insufficiently developed record to address it now. So we leave it to the district court to conduct in the first instance the “granular” inquiry of whether Optum was acting as a fiduciary at the relevant time. See Chelf v. Prudential Ins. Co. of Am., 31 F.4th 459, 464–65 (6th Cir. 2022).
(b). As for step two, the relief Patterson requests is also equitable. To recover the $25,000 Patterson paid, his complaint seeks disgorgement of the $25,000. On appeal, the parties debate whether equitable restitution might be another manner of available relief. In the abstract, both disgorgement and equitable restitution may be pursued through
Relief in the universe of transferred assets is generally limited, however, by an important caveat—the tracing requirement. That is certainly true for equitable restitution, where an award must trace back to “particular funds or property in the defendant‘s possession.” Zirbel v. Ford Motor Co., 980 F.3d 520, 524 (6th Cir. 2020) (quoting Knudson, 534 U.S. at 214); see also Cent. States, S.E. & S.W. Areas Health & Welfare Fund v. First Agency, Inc., 756 F.3d 954, 960 (6th Cir. 2014). Although we have not so held, there is reason to believe the tracing requirement also aрplies to disgorgement in ERISA cases between two private parties. See Teets v. Great-West Life & Annuity Ins. Co., 921 F.3d 1200, 1225 (10th Cir. 2019) (“The tracing requirement . . . for equitable restitution also applies to . . . disgorgement of profits but may be modified in certain limited circumstances.” (citing Knudson, 534 U.S. at 214 n.2)). But see Liu, 140 S. Ct. at 1953–54 (Thomas, J., dissenting) (“Disgorgement reaches further [than equitable restitution] because it has no tracing requirement.“); FTC v. Bronson Partners, LLC, 654 F.3d 359, 373 (2d Cir. 2011) (declining to apply the tracing requirement in a government enforcement action for disgorgement but noting its applicability in a private-party action for a constructive trust). We leave more robust analysis of the issuе to a future case because, as explained next, Patterson adequately pleaded any tracing
Defendants contend that Patterson cannot trace the funds he professedly paid. The district court agreed, finding that the plan, “not the named Defendants . . . possess[ed]” the $25,000 and any profit derived from those funds. But the complaint specifically alleges that Optum retained the payment for its own benefit, and did not deposit those monies into the plan. So Optum‘s legal obligation to pay the funds into the plan notwithstanding, we are required to accept at the pleading stage Patterson‘s plausible allegation that it did not do so. Hobart-Mayfield, Inc. v. Nat‘l Operating Comm. on Standards for Athletic Equip., 48 F.4th 656, 663 (6th Cir. 2022). As for United, Patterson‘s allegations that the company “controlled” its “subsidiary,” Optum, and that Optum sought reimbursement on United‘s behalf, are sufficient to retain United as a viable defendant past the motion to dismiss stage. See Midwest Terminals of Toledo Int‘l v. Int‘l Longshoremen‘s Ass‘n, No. 22-1330, 2023 WL 4586172, at *5 (6th Cir. July 18, 2023) (requiring “sufficient facts to render it facially plausible that an agency relationship was present” to survive a motion to dismiss).
Even so, say dеfendants, the complaint fails to identify a “specifically identified fund” in their possession, a component of the tracing requirement. See Montanile, 577 U.S. at 144–45. Not so. The complaint explicitly requests the return of the $25,000 it says Patterson paid to Optum and Optum retained. In this way, it resembles a recent suit in which we found a specifically identified fund for tracing purposes. See Zirbel, 980 F.3d at 523–25. In Zirbel, an insurance plan claimed equitable restitution from a beneficiary under
2. As an ERISA plan beneficiary, Patterson also asserts his right to sue for “appropriate relief under section 1109” of ERISA.
Patterson urges that his claims under
3. As an alternative basis for dismissing both of Patterson‘s claims, defendants renew the argument they made below—that the complaint‘s facts do not state a claim for breach of fiduciary duty or prohibited transactions. The district court did not address the issue because it was not necessary to do so. By and large, then, we leave it to the district court to take up the argument in the first instance, including examining whether Patterson‘s claims are subject to a heightened pleading standard. See
In the interest of judicial economy, however, we address the merits insofar as they relate to defendants Swagelok and the plan attorneys. See Fisher v. Perron, 30 F.4th 289, 296 (6th Cir. 2022) (confirming our discretion to affirm a complaint‘s dismissal on “any ground supported by the law and the record” (citation and quotation omitted)). Patterson‘s viable claims under
This is true even though ERISA allows for co-fiduciary liability. See
III.
That leaves one loose thread to tie up. We see no error in the district court‘s denial of leave to amend the complaint on behalf of a putative class. See Skatemore, Inc. v. Whitmer, 40 F.4th 727, 737 (6th Cir. 2022) (applying de novo review). The proposed amendment was futile as it eliminated (not added) facts. As we have stated, the flaw at the heart of Patterson‘s theory that other insureds were injured was the absеnce of facts to suggest those injuries actually occurred. Without those facts, the new class action complaint on behalf of a putative class would not survive a motion to dismiss. See Doe v. Mich. State Univ., 989 F.3d 418, 424–25 (6th Cir. 2021).
* * * * *
At day‘s end, Patterson is left with cognizable claims for breach of fiduciary duty and engagement in prohibited transactions against United and Optum. Section 1132(a)(3) offers the only viable route for recovery against defendants. And Patterson‘s relief is limited to obtaining return of his $25,000 settlement payment. Consistent with these conclusions, the district court‘s dismissal of Patterson‘s breach of fiduciary duty and prohibited transactions claims is reversed and remanded. The remainder of its decision is affirmed.
