Pellicier-Mercucci et al v Puerto Rico Telephone Company, No. 3:2013cv01733 - Document 16 (D.P.R. 2014)

Court Description: OPINION & ORDER granting 9 Motion to Dismiss for Failure to State a Claim. Signed by Judge Jay A. Garcia-Gregory on 2/26/2014. (RJC)

Download PDF
IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO PELLICIER-MERCUCCI, et al., Plaintiffs v. CIVIL NO. 13-1733 (JAG) PUERTO D/B/A, RICO TELEPHONE COMPANY, Defendant. OPINION & ORDER GARCIA-GREGORY, D.J. The complaint at bar alleges that Defendant Puerto Rico Telephone Company terminated the Ricardo (d/b/a medical Perez-Rodriguez. Claro benefits The Puerto plan employee s Rico) belonging unlawfully wife and to employee daughters, which were covered under the family plan, brought this action claiming wrongful termination of medical insurance from June 1 through September 19, 2012, as well as consequential pain and suffering. Defendant moved to dismiss alleging that the plan in question was covered by the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001 et seq., and that Plaintiffs failed to exhaust administrative remedies. Defendant also argued that Plaintiffs request for damages under Article 1802 of the 13-1733 (JAG)   2 Puerto Rico Civil Code should be dismissed because it is preempted by ERISA. Plaintiffs timely opposed. BACKGROUND Pursuant to a collective bargaining agreement, Defendant provides active employee[s] with a medical benefits plan that covers employees and their families. (Docket No. 9-1 ¶¶ 1-3, 4). According to the terminate complaint, coverage if the the plan employee, allows for Defendant to reason, is any dismissed, laid off, resigns, passes away or is suspended for more than 30 days. (Id. ¶ 4). The plan in question covered employee Ricardo Perez- Rodriguez as well as his wife and minor daughters. On June 1, 2012, Defendant consequently terminated leaving him Mr. and Perez-Rodriguez s his family without plan, medical insurance. (Id. ¶ 6). Plaintiffs claim that this termination was unjustified because Mr. Perez-Rodriguez was still an active employee of Defendant, and had not been dismissed, laid off, or suspended. In an effort to resolve this problem, Mr. PerezRodriguez initiated a series of claims as well as a labor complaint against his employer, all to no avail. (Id. ¶¶ 1314). As a consequence of having no medical insurance, Mrs. Pellicier-Mercucci could not obtain treatment for her cancer and 13-1733 (JAG)   3 the minor daughters were left without the vaccinations required for school. ANALYSIS Defendant argues that the complaint at bar is, at bottom, a claim for the enforcement of rights under a medical insurance plan subject dismissed to the because provisions Plaintiffs of have ERISA, failed and to should exhaust be their administrative remedies prior to bringing this suit. Plaintiffs appear to covered should by be express concede ERISA. allowed exhaustion that the medical benefits plan is argue, however, that this Plaintiffs to proceed requirement, since and ERISA in does the not indeed case have alternative, an that they made good-faith efforts to seek relief before resorting to this forum. Neither argument presented by Plaintiffs is convincing. Plaintiffs first argument fails immediately; it is well settled that ERISA requires putative plaintiffs to exhaust their administrative remedies prior to filing suit. Madera v. Marsh USA, Inc., 426 F.3d 56, 61 (1st Cir. 2005)(citing Terry v. Bayer Corp., 145 F.3d 28, 40 (1st Cir. 1998). As Defendant correctly argues, whether the exhaustion requirement is of statutory or judicial creation is entirely immaterial. The requirement is there, and it is the Plaintiffs burden to meet it. Moreover, 13-1733 (JAG)   4 Plaintiffs suggestion that the labor complaint filed by Mr. Perez-Rodriguez should be construed as a good-faith attempt to satisfy the exhaustion requirement is not enough. The complaint does not contain a single allegation supporting an inference that the complaint filed by Mr. Perez-Rodriguez was filed in accordance with the plan s claims procedure for the purpose of obtaining reinstatement of coverage. (Docket No. 12, p. 3). As such, the Court cannot conclude that the procedure followed by Mr. Perez-Rodriguez exhausted the plan s administrative remedies for his termination. Still, courts have recognized several exceptions to this requirement. For instance, an employee is not required to exhaust his administrative remedies [ ¦] where it would be futile for him to do so, or where the remedy is inadequate. Madera, 426 F.3d at 62 (citing Drinkwater v. Metro. Life Ins. Co., 846 F.2d 821, 826 (1st Cir. 1988)). On this point, Plaintiffs rely on the adverse outcome of the labor complaint filed by Mr. Perez-Rodriguez to support the notion that the administrative procedure however, would those be in futile. pursuit For must this show exception that the to apply, administrative route is futile or the remedy inadequate. Drinkwater, 846 F.2d at 826. A blanket assertion, unsupported by any facts, is insufficient to call this exception into play. Id. Apart from 13-1733 (JAG)   5 failing to show they exhausted the plan s remedy, Plaintiffs failure to explain what the labor complaint was or what it entailed leaves the Court unable to conclude that the plan s remedies were futile or inadequate. CONCLUSION The Court finds that Plaintiffs did not meet their burden of showing that they exhausted administrative remedies prior to bringing this suit, or that they qualify for any exception to this rule. As such, Defendant s motion to dismiss is granted. As this ground is sufficient to dismiss this case, the Court declines to enter into the merits of Defendant s pre-emption argument regarding Plaintiffs damages claim. Judgment shall be issued accordingly. IT IS SO ORDERED. In San Juan, Puerto Rico, this 26th day of February, 2014. S/ Jay A. García-Gregory JAY A. GARCà A-GREGORY United States District Judge

Some case metadata and case summaries were written with the help of AI, which can produce inaccuracies. You should read the full case before relying on it for legal research purposes.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.