United States District Court, S.D. Indiana, Indianapolis Division
ENTRY ON MOTION TO DISMISS
William T. Lawrence, Judge
cause is before the Court on the motion to dismiss filed by
Defendant Anthem Insurance Companies, Inc.
(“AICI”) (Dkt. No. 29). The motion is fully
briefed and the Court, being duly advised,
DENIES the motion for the reasons set forth
following allegations are set forth in Plaintiff Teresa
Kersey's Amended Complaint. Kersey obtained a health
insurance plan with AICI through her employer, the
Archdiocese of Cincinnati. The plan was “through a
‘Blue Access Health Benefit Plan' health insurance
policy, Group Name ‘Archdiocese of Cincinnati',
[sic] Group Number 00070374, Plan Number 0032, Subscriber ID
Number YRP133M5672.” Dkt. No. 27 at 6. While the plan
was in effect, Kersey suffered a severe stroke in Tanzania,
which rendered her paralyzed on the right side of her body
and without the ability to speak. Kersey was taken to a
nearby medical facility in a remote area for medical
attention, but the facility lacked the necessary medical
resources to treat her condition. As a result, Kersey
required an immediate emergency air ambulance transport from
the medical facility to a hospital in the United States
capable of treating her condition.
family found an emergency air ambulance medical transport
company, Aerocare Medical Transport System, Inc.
(“Aerocare”), which could provide her with
medical transportation to the United States. Kersey's
family contacted AICI's representatives to confirm that
this transport would be covered by Kersey's insurance.
AICI, however, “knowing the urgent nature of this
request, instead delayed and insisted that the request
undergo a tedious, time consuming preauthorization process
prior to confirming her coverage for this transport, ”
id. at 2, and unreasonably delayed its approval for
the preauthorization of the emergency flight, which resulted
in Kersey's transportation to the United States being
delayed for four days after she made the initial request with
Kersey was transported to the Cincinnati Stroke Center in
Ohio, Aerocare submitted the air ambulance claim to AICI for
payment on behalf of Kersey. In response, AICI paid only
eight percent of the $2, 139, 000.00 air ambulance claim. As
a result, Kersey is responsible to Aerocare for the remaining
$1, 959, 000.00.
STANDARD OF REVIEW
moves to dismiss Kersey's Complaint pursuant to Federal
Rule of Civil Procedure 12(b)(6) for failure to state a claim
for which relief can be granted. In reviewing a Rule 12(b)(6)
motion, the Court “must accept all well pled facts as
true and draw all permissible inferences in favor of the
plaintiff.” Agnew v. Nat'l Collegiate Athletic
Ass'n, 683 F.3d 328, 334 (7th Cir. 2012). For a
claim to survive a motion to dismiss for failure to state a
claim, it must provide the defendant with “fair notice
of what the . . . claim is and the grounds upon which it
rests.” Brooks v. Ross, 578 F.3d 574, 581 (7th
Cir. 2009) (quoting Erickson v. Pardus, 551 U.S. 89,
93 (2007)) (omission in original). A complaint must
“contain sufficient factual matter, accepted as true,
to state a claim to relief that is plausible on its
face.” Agnew, 683 F.3d at 334 (citations
omitted). A complaint's factual allegations are plausible
if they “raise the right to relief above the
speculative level.” Bell Atlantic Corp. v.
Twombly, 550 U.S. 544, 556 (2007). Detailed factual
allegations are not required, but a plaintiff's complaint
may not simply state “an unadorned, the
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009).
only the allegations in the Amended Complaint, there is no
question that Kersey adequately states a claim against AICI.
She alleges that AICI is contractually obligated under her
insurance policy to pay her claim for air ambulance services
and that it breached that obligation and did so in bad faith.
AICI argues that the Court may, and should, look beyond the
allegations of the Amended Complaint and examine the contract
at issue which, it argues, establishes that it is not a party
to the contract and therefore has no obligation to Kersey.
“It is well settled that in deciding a Rule 12(b)(6)
motion, a court may consider documents attached to a motion
to dismiss . . . if they are referred to in the plaintiffs
complaint and are central to his claim.” Brownmark
Films, LLC v. Comedy Partners, 682 F.3d 687, 690 (7th
Cir. 2012) (internal quotations and citation omitted). The
document that AICI has provided, however, appears to be only
part of the relevant contract.
document submitted by AICI is entitled “Your Health
Benefit Booklet.” Dkt. No. 30-1 at 3 (hereinafter
referred to as “the Booklet”). The Booklet
contains the following definitions:
• Administrative Services Agreement-The agreement
between the Administrator and the Employer regarding the
administration of certain elements of the health care
benefits of the Employer's group health plan.
• Administrator-An organization or entity that the
Employer contracts with to provide administrative and claims
payment services under the Plan. The Administrator is
Community Insurance Company. The Administrator provides
administrative claims payment services only and does not