WEST PALM BEACH (Florida Record) – A Port St. Lucie substance abuse and mental health treatment center is being allowed to file an amended lawsuit after a federal judge in the U.S. District Court for the Southern District of Florida, West Palm Beach Division, recently dismissed the case filed earlier this year against a Connecticut insurer.
U.S. District Judge Robin L. Rosenberg granted a motion by defendant Connecticut General Life Insurance Company, which does business as Cigna, to dismiss the case filed against the company by RMP Enterprises, which does business as Ambrosia Treatment Centers (Ambrosia), in February. "To 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 face," Rosenberg said in her 15-page order issued June 13. "Although this pleading standard does not require detailed factual allegations, it demands more than an unadorned, the-defendant-unlawfully-harmed-me accusation."
Rosenberg dismissed without prejudice counts against Cigna that included failure to comply with plan terms, breach of fiduciary duty and co-fiduciary liability, promissory estoppel and damages.
Rosenberg also granted Ambrosia Treatment Centers, a time extension to file an amended complaint.
Ambrosia filed its initial complaint against Cigna on Feb. 14, according to the background portion of Rosenberg's order. Ambrosia's allegations stemmed in part from a letter Ambrosia received from the insurer in September 2016 seeking more than $5.2 million in alleged overpayments. Ambrosia previously accepted direct payments from Cigna and other insurers as reimbursement for the services Ambrosia provided to plan members under the Employee Retirement Income Security Act of 1974 (ERISA).
"Plaintiffs allege that Cigna failed to pay them for some claims, paid some claims late and underpaid some claims," the order said.
Cigna argued for dismissal based in part on Ambrosia's failure to exhaust its administrative options. "Defendants state that plaintiffs allege they have submitted appeals for some unidentified claims," the order said.
"Plaintiffs vaguely refer to 'Level 1 appeals' and 'Level 2 appeals,' but they fail to allege which claims were allegedly appealed, when they were allegedly appealed, and how they were allegedly appealed. Plaintiffs' generalized references to 'appeals,' without identifying specific claims, are inadequate," the order said.