Giusti v. Alliant Insurance Services, Inc et al

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF LOUISIANA
ERNEST J GIUSTI, III 	CIVIL ACTION
VERSUS 	No. 25-1347
ALLIANT INSURANCE
SERVICES, INC., ET AL. 	SECTION I
ORDER AND REASONS
Plaintiff Ernest J. Giusti, III (“plaintiff”) brings this action, individually and
on behalf of all others similarly situated (“the proposed class” or “the putative class”),
for damages arising from the alleged mismanagement of an employee benefits
healthcare plan, which resulted in delayed payment of approved claims, inability to
obtain medical care, and other losses to plan beneficiaries.1
Before the Court are two motions to dismiss. The first was filed by defendant
Alliant Insurance Services, Inc. (“Alliant”),2 and the second was filed by defendants
United Health Group, Inc. (“United Health Group”), United Healthcare, Inc. (“United
Healthcare”), and Assured Benefits Administrator, Inc. (“ABA”) (together with
Alliant, 	“moving 	defendants”).3 	Plaintiff 	opposed 	both 	motions.4 	The 	moving
defendants filed respective replies.5
1 See R. Doc. No. 33.
2 R. Doc. No. 35.
3 R. Doc. No. 39.
4 See R. Doc. Nos. 41–42.
5 R. Doc. Nos. 45–46.
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Moving defendants also filed a motion6 to stay discovery pending resolution of
their motions to dismiss.7 Plaintiff filed a response8 in opposition and moving
defendants filed a reply.9
Shortly thereafter, the Court held a telephone status conference, with counsel
for all parties participating,10 to discuss the pending motions.11 At this conference,
the Court ordered each defendant to “inform the Court what role, if any, their client(s)
played in making sure that plaintiff actually received benefits approved by the plan”
and “advise whether their client(s) in any way participated in any decision to adjust,
cease, or delay the actual payment of benefits previously approved pursuant to the
terms of the plan.”12
Defendants each filed a response to the Court’s order,13 in which each disclaims
any involvement with the untimely payment of claims and largely disagrees with the
other defendants’ characterization of their respective roles. After considering the
6 R. Doc. No. 51.
7 The motion alternatively sought to stay discovery until the case was consolidated
with a separate case brought by plaintiff against defendant HPS Advisory Services,
LLC (“HPS”). See R. Doc. No. 51-1, at 2. The Court has since consolidated the cases.
See R. Doc. No. 56.
8 R. Doc. No. 54.
9 R. Doc. No. 55.
10 This included counsel for non-moving defendant HPS—a defendant that was
originally in this case but was dismissed without prejudice by this Court on December
16, 2025, for plaintiff’s failure to serve. See R. Doc. No. 49. Plaintiff filed a separate
lawsuit against HPS, see Giusti v. Alliant Insurance Services, Inc., et al., E.D. La.
Case No. 25-1347, which was consolidated with this original case on January 30,
2026. See R. Doc. No. 56. Reference to “defendants” herein shall be understood to refer
to moving defendants and HPS collectively.
11 See R. Doc. No. 57.
12 Id. at 1–2.
13 R. Doc. No. 59–61.
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motions, responsive briefing, and supplemental responses, the Court declines to
dismiss plaintiff’s amended complaint at this time and, instead, will allow plaintiff
one last opportunity to amend his complaint.
I. 	BACKGROUND
Plaintiff 	and members 	of 	his 	proposed class 	are 	“franchise 	owners 	and
employees” of Goosehead Insurance (“Goosehead”).14 In 2023, plaintiff and other
members of the proposed class, along with their spouses, domestic partners, and/or
dependents, were able to join a medical insurance plan through Goosehead (the
“Plan”).15 	Plaintiff 	and 	the 	putative 	class 	members 	paid 	premiums 	for 	their
participation in the Plan.16
Plaintiff 	explains 	that 	he, 	and 	members 	of 	his 	family 	that 	were 	also
participants of the Plan, underwent medical treatment during the lifetime of the Plan
for which defendants “failed to pay and/or timely pay in accordance with the Plan.”17
Importantly, defendants had already notified plaintiff that these medical services
were “covered under the Plan.”18 This delay in payment and/or non-payment of
approved claims caused medical providers to withdraw care and engage collections
agencies, 	and 	also 	necessitated 	that 	plaintiff 	make 	out-of-pocket 	payments 	to
providers to ensure that he and his family “could continue receiving healthcare.”19
14 R. Doc. No. 33 ¶ 8.
15 Id. ¶ 10.
16 Id. ¶ 27.
17 Id. ¶¶ 33, 40–41, 46–47, 50–51.
18 Id. ¶ 16; see also R. Doc. No. 41, at 7 (“[T]here was no denial of the claim[s].
Defendants simply indicated they would pay, then did not.”).
19 R. Doc. No. 33 ¶¶ 36, 42, 48, 52, 57.
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Sometime thereafter, “without warning,” the Plan was cancelled “while unpaid
claims remained outstanding.”20 Plaintiff alleges that he and the proposed class
received notification of the cancellation, but only after the cancellation had occurred
and “with no mechanism for an administrative appeal or remedy.”21 This cancellation
“led to the denial of medical care to Plaintiff and [his family], inability to obtain care
as intended, and/or the delay of such care, in addition to out-of-pocket expenses that
have not been recovered.”22
Plaintiff filed his lawsuit against moving defendants and HPS (collectively,
“defendants”) on June 30, 2025.23 He brought claims on behalf of himself and all
others similarly situated for violations of the Employee Retirement Income Security
Act (“ERISA”), pursuant to 29 U.S.C. §§ 1132(a)(1)(B) and 1132(a)(3), as well as
various state law claims: breach of contract,24 breach of the implied covenant of good
faith and fair dealing,25 violation of Louisiana Revised Statute 22:978, which
prescribes the notice requirements for cancellation of health insurance,26 and unjust
enrichment.27 On October 28, 2025, after moving defendants had filed their first
20 Id. ¶ 21.
21 Id. ¶ 22.
22 Id. ¶ 67.
23 R. Doc. No. 1.
24 See R. Doc. No. 33 ¶¶ 91–102.
25 Id. ¶¶ 103–108.
26 Id. ¶¶ 109–113.
27 Id. ¶¶ 114–121.
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motions to dismiss,28 plaintiff moved to file an amended complaint,29 which this Court
granted.30
Plaintiff filed his amended complaint on October 29, 2025,31 and shortly
thereafter moving defendants filed two motions to dismiss.32 The first was filed by
Alliant and the second was filed by United Health Group, United Healthcare, and
ABA.33 Both motions argue that plaintiff’s amended complaint should be dismissed
because it impermissibly “group” or “shotgun” pleads.34 Both motions also argue that
plaintiff cannot state a claim under ERISA, either pursuant to §§ 1132(a)(1)(B) or
1132(a)(3),35 and that ERISA preempts plaintiff’s state law claims.36 Defendants
United Health Group, United Healthcare, and ABA additionally argue that plaintiff’s
class allegations should be stricken from the amended complaint because the
proposed class is not ascertainable and plaintiff cannot establish predominance as a
matter of law.37
Plaintiff filed a response in opposition to each motion,38 maintaining that his
group pleading is sufficient and appropriate in this case as his amended complaint
28 See R. Doc. Nos. 16–17.
29 R. Doc. No. 28.
30 See R. Doc. No. 31 (minute entry granting plaintiff’s motion for leave to file his first
amended complaint).
31 R. Doc. No. 33.
32 See R. Doc. Nos. 35, 39.
33 See generally R. Doc. Nos. 35, 39.
34 R. Doc. No. 39-1, at 9, 12, 14–16; R. Doc. No. 35-1, at 4, 7.
35 R. Doc. No. 35-1, at 9–17; R. Doc. No. 39, at 7–14.
36 R. Doc. No. 35-1, at 17–21; R. Doc. No. 39-1, at 16–17.
37 R. Doc. No. 39-1, at 18–24.
38 See R. Doc. Nos. 41–42.
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provides fair notice as to the nature of his claims and discovery will serve to narrow
the claims and defendants at a later stage.39 He also contends that ERISA authorizes
suit against moving defendants, pursuant to either §§ 1132(a)(1)(B) or 1132(a)(3).40
In response to the motion to strike class allegations, plaintiff disputes that the
proposed class is not ascertainable and asserts that the arguments raised regarding
the sufficiency of his class allegations are “more appropriate for a certification
hearing.”41 Moving defendants filed separate replies to plaintiff’s responses,42 in
which they largely re-urge the arguments articulated in their motions to dismiss.
For the reasons that follow, the Court determines that it is appropriate to deny
moving defendants’ motions to dismiss and permit plaintiff a further opportunity to
amend his complaint.
II. 	LEGAL STANDARDS
Federal 	Rule 	of 	Civil 	Procedure 12(b)(6) 	allows 	defendants 	to 	move 	for
dismissal of a complaint for “failure to state a claim upon which relief can be granted.”
To survive a motion to dismiss pursuant to Rule 12(b)(6), a plaintiff’s complaint must
meet the requirement in Rule 8(a)(2) that the complaint contain “a short and plain
statement of the claim showing that the pleader is entitled to relief.” Wampler v. Sw.
Bell Tel. Co., 597 F.3d 741, 744 (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555
(2007)). While this short and plain statement does not require detailed factual
39 R. Doc. No. 42, at 7–9; R. Doc. No. 41, at 8–11.
40 R. Doc. No. 42, at 9; R. Doc. No. 41, at 11–12.
41 R. Doc. No. 41, at 14–15.
42 R. Doc. Nos. 45–46.
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allegations, it “must contain sufficient factual matter, accepted as true, to state a
claim to relief that is plausible on its face.” Waller v. Hanlon, 922 F.3d 590, 599 (5th
Cir. 2019) (quoting Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009)).
A claim is facially plausible when the plaintiff “pleads factual content that
allows the court to draw the reasonable inference that the defendant is liable for the
misconduct alleged.” Gonzalez v. Kay, 577 F.3d 600, 603 (5th Cir. 2009) (citation
modified). “The plausibility standard is not akin to a probability requirement, but it
asks 	for 	more 	than 	a 	sheer 	possibility 	that 	a 	defendant 	has 	acted
unlawfully.” Culbertson 	v. 	Lykos, 	790 	F.3d 	608, 	616 	(5th 	Cir. 	2015) 	(citation
modified).
The face of the complaint must contain enough factual matter to raise a
reasonable expectation that discovery will reveal evidence of each element of the
plaintiff’s claim. Lormand v. US Unwired, Inc., 565 F.3d 228, 255–57 (5th Cir. 2009).
A complaint is insufficient if it contains “only labels and conclusions, or a formulaic
recitation of the elements of a cause of action.” Whitley v. Hanna, 726 F.3d 631, 638
(5th Cir. 2013) (citation modified). The complaint must “provide the defendant with
fair notice of what the plaintiff’s claim is and the grounds upon which it rests.” Pub.
Emps. Ret. Sys. of Miss. v. Amedisys, Inc., 769 F.3d 313, 320 (5th Cir. 2014).
When considering a motion to dismiss, a court views the complaint “in the light
most favorable to plaintiff, accepting as true all well-pleaded factual allegations and
drawing all reasonable inferences in plaintiff’s favor.” Lovick v. Ritemoney Ltd., 378
F.3d 433, 437 (5th Cir. 2004). A court must limit its review to “the complaint, any
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documents attached to the complaint, and any documents attached to the motion to
dismiss that are central to the claim and referenced by the complaint.” Lone Star
Fund V (U.S.), L.P. v. Barclays Bank PLC, 594 F.3d 383, 387 (5th Cir. 2010) (citing
Collins v. Morgan Stanley Dean Witter, 224 F.3d 496, 498–99 (5th Cir. 2000)).
III. 	ANALYSIS
a. 	Group or shotgun pleading
As a threshold matter, the Court addresses the argument made in both
motions 	to 	dismiss 	that 	plaintiff’s 	amended 	complaint 	is 	deficient 	because 	it
impermissibly “group” or “shotgun” pleads.43
Shotgun pleadings are those which “fail[] to give the defendants adequate
notice of the claims against them and the grounds upon which each claim rests.”
Alexander v. Dresser, L.L.C., No. 21-161, 2022 WL 509366, at *5 (W.D. La. Feb. 18,
2022) (internal quotations and alterations omitted). One such type of shotgun
43 R. Doc. No. 39-1, at 9, 12, 14–16 (“Here, Plaintiff’s shotgun pleading scrambles
allegations against each of the Defendants and makes no reference to individual
Defendants’ conduct. Plaintiff’s Amended Complaint continues to improperly blur the
actions of the Defendants.”); R. Doc. No. 35-1, at 4, 7 (“Almost every allegation
mentioning Alliant is ‘group pleaded’ along with every other Defendant.”), 11
(“Plaintiff does not in any way distinguish the alleged actions of Alliant from the other
defendants.”). Although both motions seem to argue, to some extent, that group
pleading amounts to a failure to state a claim pursuant Federal Rule of Civil
Procedure 12(b)(6), Bell Atlantic Corp. v. Twombly, 550 U.S. 544 (2007) and Ashcroft
v. Iqbal, 556 U.S. 662 (2009), the argument really pertains to whether plaintiff’s form
of pleading complies with Federal Rule 8(a)(2). See Weiland v. Palm Beach Cnty.
Sheriff’s Off., 792 F.3d 1313, 1320 (11th Cir. 2015) (“Complaints that violate either
Rule 8(a)(2) or Rule 10(b), or both, are often disparagingly referred to as ‘shotgun
pleadings.’”). Of course, “pleading deficiencies may impact application of the well-
established standards for stating a claim set out in” Twombly and Iqbal. Valadez v.
City of San Antonio, No. 21-02, 2022 WL 1608016, at *4 (W.D. Tex. May 20, 2022).
But the Court will separately address the Rule 12(b)(6) analysis infra, Section III(b).
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pleading, as is relevant to moving defendants’ argument, is one which “fail[s] to
distinguish between the actions of named defendants.” Hicks v. Andrews, No. 23-81,
2024 WL 1202922, at *7 (E.D. Tex. Feb. 28, 2024), report and recommendation
adopted, No. 23-81, 2024 WL 1198859 (E.D. Tex. Mar. 20, 2024); O’Neal v. Universal
Prot. Serv., LLC, No. 21-737, 2022 WL 1631970, at *5 (M.D. La. May 23, 2022)
(finding the plaintiff’s complaint was an impermissible “shotgun pleading” where the
complaint “indiscriminately allege[d] nine claims against two separate Defendants
without any indication whether (or how) each Defendant [wa]s liable.”); Hinojosa v.
Livingston, 807 F.3d 657, 684 (5th Cir. 2015) (Jones, J., dissenting) (describing this
form of shotgun pleading as when a plaintiff’s complaint “uses blanket terms covering
all the defendants, by lumping them together or [referring to] them collectively”).
Plaintiff 	concedes 	that 	he 	does 	not 	specifically 	allege 	the 	actions 	each
defendant took that caused or contributed to the untimely payments and non-
payments of his approved benefits. However, he maintains that he “cannot know the
exact 	explanation 	for 	the 	plan’s 	mismanagement” 	or 	“which 	of 	[the 	moving
defendants] (or all) are responsible for this administrative failure,” because the
alleged “mismanagement” of the Plan is “hidden from the view” of plaintiff, and any
potential class members.44 He, therefore, does not and cannot know “which [of moving
defendants’] role[s] led predominantly to the failure of the Plan to make proper
payments, or whether all share equal responsibility.”45 He avers that his amended
44 R. Doc. No. 41, at 2.
45 Id. at 7.
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complaint provides fair notice to moving defendants of his claims,46 and that moving
defendants’ group and shotgun pleading arguments are merely an “attempt to
capitalize on these unknowns . . . to avoid discovery.”47
Not every instance in which a plaintiff’s pleadings lumps defendants together
amounts to impermissible group or shotgun pleading. Body by Cook, Inc. v. State
Farm Mut. Auto. Ins., No. 15-2177, 2016 WL 4479507, at *3 (E.D. La. Aug. 25, 2016)
(Morgan, J.), aff’d in part, rev’d in part and remanded on other grounds, 869 F.3d 381
(5th Cir. 2017) (“A complaint that contains ‘group allegations’ and ‘lumps together’
defendants is not ipso facto in violation of Rule 8.”); Valadez, 2022 WL 1608016, at *6
(acknowledging 	that 	lumping 	defendants 	together may 	be 	improper 	in 	some
circumstances, but concluding that it “does not mean that lumping defendants
together is insufficient to state a claim in all circumstances”). The controlling aspect
in each case is whether “the complaint, with its ‘group allegations,’ gives each
defendant adequate notice” of the plaintiff’s claims and grounds upon which they rest.
Id.; Valadez, 2022 WL 1608016, at *6 (“Ultimately, it boils down to whether the
pleading provides fair notice of what the claims are and the grounds supporting
them.”).
For example, courts have found that a complaint is sufficient, notwithstanding
“group” pleading or lumping of defendants, where the complaint otherwise explains
46 See id. at 9–11; R. Doc. No. 42, at 7–8.
47 R. Doc. No. 41, at 2; see also id. at 10 (“It is unclear which of these functions led to
the untimely payments and non-payments. Thus, suit is proper against each for the
losses sustained by the class.”).
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the roles and interconnectedness of the defendants. See, e.g., Hicks, 2024 WL
1202922, at *8 (holding that the pleading was “sufficient to notify [the] [d]efendants
of the claims against them – thereby allowing them to prepare responsive pleadings
– and [did] not constitute an improper ‘shotgun’ pleading” in part because the notice
of removal provided “detailed allegations regarding the interrelatedness of the
various” defendants).
In fact, district courts evaluating the sufficiency of group pleading against
ERISA 	defendants 	have 	found 	such 	pleading 	permissible 	given 	their
interconnectedness and collective responsibilities with respect to the subject plan. See
Surgery Ctr. of Viera, LLC v. Meritain Health, Inc., No. 19-1694, 2020 WL 7389987,
at *9 (M.D. Fla. June 1, 2020), report and recommendation adopted, No. 19-1694,
2020 	WL 	7389447 	(M.D. 	Fla. 	June 	16, 	2020) 	(finding 	the 	provider-plaintiff’s
complaint, which alleged harm from partial reimbursement by plan-defendants for
medical services provided to a plan beneficiary, was not an impermissible shotgun
pleading because the “[d]efendants [were] inextricably intertwined – [one] is the plan
sponsor and plan administrator, [another] is the third-party administrator . . . and
the Plan is the vehicle under which the subject claim was submitted”); Igo v. Sun Life
Assurance Co. of Canada, 652 F. Supp. 3d 929, 935 (S.D. Ohio 2023) (finding that the
plaintiff’s claim for denied life insurance benefits brought collectively against the
plan’s 	life 	insurance 	company, 	plan 	sponsor, 	and 	plan 	administrator 	was 	not
impermissible group pleading because “[a]s alleged in the complaint, all defendants
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collectively have responsibilities over administ[ration] of the Plan and paying or
denying benefits under the Plan”).
Moreover, the Fifth Circuit has stated, albeit in a different context, that ERISA
plaintiffs “generally lack the inside information necessary to make out their claims
in detail” and, therefore, plaintiffs should not be held to “overly burdensome pleading
requirements in ERISA contexts.” Innova Hosp. San Antonio, Ltd. P’ship v. Blue
Cross & Blue Shield of Georgia, Inc., 892 F.3d 719, 728–29 (5th Cir. 2018) (quoting
Braden v. Wal-Mart Stores, Inc., 588 F.3d 585, 598 (8th Cir. 2009)); see also id. at 728
(quoting Allen v. GreatBanc Tr. Co., 835 F.3d 670, 678 (7th Cir. 2016) (“[A]n ERISA
plaintiff alleging breach of fiduciary duty does not need to plead details to which she
has no access, as long as the facts alleged tell a plausible story.”)).
After reviewing plaintiff’s amended complaint and the Plan document,48 the
Court finds that the use of “defendants” to describe the “common factual allegations”
against moving defendants does not amount to impermissible group or shotgun
pleading.49 	The 	allegations 	in 	the 	amended 	complaint 	are 	sufficient 	to 	give
defendants notice of the nature of plaintiff’s claims and the grounds upon which they
rest, such that defendants can adequately respond and defend against the claims. It
is clear that plaintiff’s claims arise from the “nonpayment and/or failure to timely pay
claims” which he was entitled to under the Plan.50 Plaintiff’s individual factual
48 Attached to the motion to dismiss filed by United Health Group, United Healthcare,
and ABA. See R. Doc. No. 39-2.
49 See R. Doc. No. 33 ¶¶ 7–25.
50 Id. ¶ 17.
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allegations serve to further demonstrate the nature of his claims and the harm he
has suffered as a result of not receiving, timely or at all, the benefits to which he was
entitled.51 While plaintiff “must ultimately prove [his] case separately against” each
defendant, Igo, 652 F. Supp. 3d at 935, determining which defendant is responsible
for this non- or delayed-payment failure is more appropriately reserved for later, after
plaintiff has had an opportunity to pursue discovery on the issue.52 Cf. Innova Hosp.,
892 F.3d at 730–31 (“While a plaintiff must offer sufficient factual allegations to show
that he or she is not merely engaged in a fishing expedition or strike suit, we must
also take account of his or her limited access to crucial information.” (quoting Braden,
588 F.3d at 598) (internal alterations omitted)).
b. 	Plaintiff’s ERISA claims pursuant to §§ 1132(a)(1) and 1132(a)(3)
In finding that plaintiff’s pleadings were adequate in form, the Court must now
determine whether plaintiff has substantively stated a claim sufficient to survive a
Rule 12(b)(6) dismissal. See Bank of Abbeville & Tr. Co. v. Commonwealth Land Title
51 See id. ¶¶ 26–60.
52 Having determined that the amended complaint would not be dismissed for its
group pleading, the Court attempted to avoid wasting the resources of both the
parties and the Court by ordering counsel for each defendant to ‘inform the Court
what role, if any, their client(s) played in making sure that plaintiff actually received
benefits approved by the plan” and “advise whether their client(s) in any way
participated in any decision to adjust, cease, or delay the actual payment of benefits
previously approved pursuant to the terms of the plan.” See R. Doc. No. 57, at 1–2.
Such 	responses 	were 	intended 	to 	avoid 	lengthy 	discovery 	for 	the 	purpose 	of
determining which defendant exercised control over the portion of the claims process
of which plaintiff complains. Yet, perhaps unsurprisingly, defendants’ responses were
unhelpful in this regard as each defendant disclaimed any involvement with the
untimely payment of claims and largely disagrees with the other defendants’
characterization of their respective roles in regards to the Plan. See generally R. Doc.
Nos. 59–61; see generally infra Section III(b)(1).
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Ins. Co., 201 F. App’x 988, 990 (5th Cir. 2006) (“[M]ere compliance with Rule 8 does
not itself immunize the complaint against a motion to dismiss. The [plaintiff] confuses
form with substance. Rule 8(a)(2) specifies the conditions of the formal adequacy of a
pleading. It does not specify the conditions of its substantive adequacy, that is, its
legal merit.” (internal quotations and citations omitted)).
Plaintiff’s amended complaint seeks redress pursuant to 29 U.S.C. § 1132(a)(1)
or, in the alternative, § 1132(a)(3).53 Section 1132(a) sets forth the types of civil
enforcement actions that may be brought, and who may bring them, under ERISA.
Hager v. DBG Partners, Inc., 903 F.3d 460, 469 (5th Cir. 2018) (describing § 1132(a)
as encompassing ERISA’s “potential avenues for [civil] enforcement”). As is relevant
to plaintiff’s first-sought avenue for relief, § 1132(a)(1) states that a civil action may
be brought by a “participant or beneficiary . . . to recover benefits due to him under
the terms of his plan, to enforce his rights under the terms of the plan, or to clarify
his rights to future benefits under the terms of the plan.” § 1132(a)(1)(B).
Claims brought pursuant to § 1132(a)(1)(B) “are generally limited to actions
respecting the interpretation of plan documents and the payment of claims.” Manuel
v. Turner Indus. Grp., L.L.C., 905 F.3d 859, 864 (5th Cir. 2018) (internal alterations
omitted). Section 1132(a)(1)(B) does not “permit the recovery of extracontractual
53 See R. Doc. No. 33 ¶¶ 84–85. Plaintiff’s amended complaint also states that
“defendants breached ERISA” §§ 1109 and 1133. See id. ¶ 86–87. Moving defendants
interpreted this to mean separate causes of action. See R. Doc. No. 39-1, at 13; R. Doc.
No. 35-1, at 12, 16. The Court, however, understands these sections as being cited in
reference to the § 1132(a)(3) claim. See § 1132(a)(3) (allowing suit to be brought for
“violat[ions] [of] any provision of this subchapter or the terms of the plan”).
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damages or damages based on undue delay in administration of a disputed claim.”
Hamann v. Indep. Blue Cross, 543 F. App’x 355, 357 (5th Cir. 2013). “Instead, a plain
reading of this provision provides that when a participant or beneficiary believes that
benefits promised to him under the terms of the plan are not provided, he can bring
suit seeking provision of those benefits.” Id. (internal quotations omitted).
The “proper party defendant in an action concerning ERISA benefits is the
party that controls administration of the plan.” LifeCare Mgmt. Servs. LLC v. Ins.
Mgmt. Adm’rs Inc., 703 F.3d 835, 845 (5th Cir. 2013) (internal quotations and
citations 	omitted). 	While 	this 	often 	includes 	named 	plan 	administrators 	or
fiduciaries, 	§ 1132(a)(1)(B) 	does 	not 	limit 	lawsuits 	for 	benefits 	to 	only 	such
defendants. See id. at 843–45 (holding that a third-party administrator may be held
liable for benefits pursuant to § 1132(a)(1)(B)) (“The plain language of § 1132(a)(1)(B)
. . . does not limit the scope of defendants that a claimant may bring a lawsuit
against.”).
However, a “party will be exposed to liability” pursuant to § 1132(a)(1)(B) “only
if it exercises ‘actual control’ over the administration of the plan.” Id. at 844–45;
Bryant v. Express Scripts Inc., No. 20-1343, 2021 WL 1216888, at *6 (W.D. La. Mar.
15, 2021), report and recommendation adopted, No. 20-1343, 2021 WL 1207722 (W.D.
La. Mar. 30, 2021) (“[While] that party usually is the plan itself or the designated
plan administrator . . . another party may be sued if it exercises actual control over
the claims process.”); see also Kirschbaum v. Reliant Energy, Inc., 526 F.3d 243, 251
(5th Cir. 2008) (“Fiduciary duties may thus arise either from the terms of the
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governing plan or from acts and practices in carrying it out.” (emphasis added)). “The
mere exercise of physical control or the performance of mechanical administrative
tasks generally is insufficient for liability under § 1132(a)(1)(B).” LifeCare, 703 F.3d
at 845 (cleaned up).
As for plaintiff’s alternatively-sought avenue for relief, “ERISA includes
numerous requirements beyond the mere payment of benefits in accord with a plan’s
written terms,” and § 1132(a)(3) serves as the civil enforcement mechanism “for
certain injuries that result from some of these other ERISA violations.” Manuel, 905
F.3d at 864. Section 1132(a)(3) states that a civil action may be brought “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.”
In contrast with § 1132(a)(1), § 1132(a)(3) places no “limit . . . on the universe
of possible defendants.” Harris Tr. & Sav. Bank v. Salomon Smith Barney, Inc., 530
U.S. 238, 246 (2000). It does, however, limit the type of damages recoverable to
“appropriate 	equitable 	relief.” 	See 	id. 	at 	253. 	For 	this 	reason, 	although 	not
categorically 	excluded, 	money 	damages 	are 	typically 	not 	recoverable 	through
§ 1132(a)(3). See Cent. States, Se. & Sw. Areas Health & Welfare Fund ex rel. Bunte
v. Health Special Risk, Inc., 756 F.3d 356, 361 (5th Cir. 2014) (“[W]hile almost
invariably suits seeking (whether by judgment, injunction, or declaration) to compel
the defendant to pay a sum of money to the plaintiff are suits for money damages
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since they seek no more than compensation for loss resulting from the defendant’s
breach of legal duty, there are some instances in which equitable relief can result in
monetary compensation for a plaintiff.” (cleaned up)); see also Hager, 903 F.3d at 469
(implying that restitution may be a viable remedy pursuant to § 1132(a)(3) if it was
“traditionally available in equity”); Harris Tr., 530 U.S. at 253 (“[A]n action for
restitution against a transferee of tainted plan assets satisfies the ‘appropriate[ness]’
criterion in § 502(a)(3). Such relief is also ‘equitable’ in nature.”).
Moreover, 	the 	Fifth 	Circuit 	has 	made 	clear 	that 	“generally, 	an 	ERISA
§ [1132](a)(3) 	claim 	for 	equitable 	relief 	may 	not 	be 	maintained 	when 	ERISA
§ [1132](a)(1)(B) ‘affords an adequate remedy.’” Manuel, 905 F.3d at 865 (cleaned up)
(emphasis added). This is not to say that a plaintiff whose § 1132(a)(1) claim is
unsuccessful is therefore entitled to proceed on a § 1132(a)(3) claim. See Hollingshead
v. Aetna Health Inc., 589 F. App’x 732, 737 (5th Cir. 2014) (“The simple fact that [the
plaintiff] cannot prevail on his claim under section 1132(a)(1) does not make his
alternative claim under section 1132(a)(3) viable.” (internal alterations omitted)).
Rather, the Court must determine whether a plaintiff’s alleged injury creates a cause
of action pursuant to § 1132(a)(1)(B) and, if so, the plaintiff’s § 1132(a)(3) claim
cannot proceed. See Manuel, 905 F.3d at 865 (“A claimant whose injury creates a
cause of action under ERISA § 502(a)(1)(B) may not proceed with a claim under
ERISA § 502(a)(3).” (emphasis in original) (cleaned up)).
As stated by the Fifth Circuit: “when a beneficiary simply wants what was
supposed to have been distributed under the plan, the appropriate remedy is
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available under § 1132(a)(1), rather than § 1132(a)(3).” Hager, 903 F.3d at 469
(cleaned up); Mowdy v. Huntington Ingalls Inc., No. 19-570, 2021 WL 4242364, at *2
(S.D. Miss. Jan. 19, 2021). A plaintiff cannot escape this determination by “simply
framing a claim as equitable relief.” Cent. States, 756 F.3d at 361 (“Simply framing a
claim as equitable relief is insufficient to escape a determination that the relief
sought is legal.”); Hager, 903 F.3d at 469 (noting that although the plaintiff’s claim
“could arguably be characterized as seeking restitution,” it was clear that the remedy
sought “to impose liability and require the defendant to pay the plaintiff a sum of
money” which was legal rather than equitable in nature).
Moving defendants argue, first, that plaintiff’s amended complaint fails to
state a claim pursuant to § 1132(a)(1) because they are not Plan administrators or
fiduciaries.54 Next, moving defendants argue that plaintiff’s § 1132(a)(3) claim fails
because: such claims authorize only equitable relief, which they argue plaintiff does
not request; and plaintiff’s § 1132(a)(1) claim is the proper mechanism for providing
the relief that plaintiff seeks, namely, benefits he is entitled to pursuant to the Plan.
The Court will address both arguments in turn.
1. 	Are moving defendants proper defendants pursuant to § 1132(a)(1)?
Moving defendants rely on the language of the Plan to support their contention
that they are not proper defendants pursuant to § 1132(a)(1).55 Specifically, United
Health Group, United Healthcare, and ABA argue that the Plan names defendant
54 R. Doc. No. 39-1, at 10; R. Doc. No. 35-1, at 13.
55 R. Doc. No. 35-1, at 4; R. Doc. No. 39-1, at 11.
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HPS as the Plan Administrator and Fiduciary and that the Plan “provides that ‘full
and final authority to adjudicate [claims] and make determination as to their
payability by and under the Plan belongs to and resides solely with the Plan
Administrator.’”56 They also point out that the Plan names ABA as the Third Party
Administrator and states that “[t]he Third Party Administrator is not a fiduciary of
the Plan and does not have discretionary authority to make claims payment decisions
or interpret the meaning of the Plan terms.”57 Alliant likewise argues that the Plan
does 	not 	identify 	it 	as 	the 	Plan’s 	sponsor, 	named 	fiduciary, 	or 	third-party
administrator and, therefore, plaintiff cannot establish that Alliant “had any role in
Plan administration.”58
However, as the Court has already noted, whether a defendant is a fiduciary
or plan administrator such that it is a proper defendant pursuant to § 1132(a)(1)(B)
does not turn only on whether the defendants are so named in the Plan, but includes
an inquiry into whether that defendant exercised “actual control” over the claims
process. LifeCare, 703 F.3d at 844–45 (“[I]f an entity or person other than the named
plan administrator takes on the responsibilities of the administrator, that entity may
also be liable for benefits [pursuant to § 1132(a)(1)(B)].”); Bannistor v. Ullman, 287
F.3d 394, 401 (5th Cir. 2002) (“[An ERISA] ‘fiduciary’ should be defined not only by
reference to particular titles . . . but also by considering the authority which a
56 R. Doc. No. 39-1, at 11 (quoting R. Doc. No. 39-2, at 47).
57 Id. (quoting R. Doc. No. 39-2, at 47).
58 R. Doc. No. 35-1, at 4, 7; see also id. at 12 (arguing that plaintiff failed to recognize
that the Plan document disclosed the Plan’s administrative roles).
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particular person has or exercises over an employee benefit plan.”). The Court finds
that this inquiry is more appropriately resolved on a motion for summary judgment
or trial, after discovery has allowed for factual development regarding each of
defendants’ respective roles and responsibilities as it relates to the payment of
approved claims. See LifeCare, 703 F.3d at 844 (explaining that “courts finding
liability under § 1132(a)(1)(B) . . . apply a restrained functional test” and arrived at
a decision based on facts demonstrating the third-party administrator’s actual
control, 	rather 	than 	the 	language 	in 	the 	contract 	alone, 	that 	the 	third-party
administrator was a proper defendant); see also Woods v. Riverbend Country Club,
Inc., 320 F. Supp. 3d 901, 908 (S.D. Tex. 2018) (deciding this issue on a motion for
summary judgment and considering both the plan language as well as facts elicited
during discovery).
Moreover, the Court is not persuaded that the Plan document language that
moving defendants reference is instructive with respect to the present issue, as it
seems 	this 	language 	pertains 	to 	the 	defendants’ 	roles 	with 	respect 	to 	the
consideration 	and 	determination 	of 	submitted 	claims 	for 	benefits, 	not 	to 	the
defendants’ roles with respect to the payment of approved claims.59 Whether moving
defendants plausibly exercised actual control over any portion of the claims process
that involves the payment of approved claims is a separate question from whether,
59 See R. Doc. No. 39-2, at 47–48. It is therefore possible, despite Alliant’s position to
the contrary, see R. Doc. No. 35-1, at 6–7, that it is not mentioned in the Plan
document but still exercises actual control over the portion of the claims process at
issue.
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and the extent to which, they exerted control over the determination of benefits
pursuant to the terms of the Plan. Cf. Kirschbaum, 526 F.3d at 250–51 (“An ERISA
fiduciary for one purpose is not necessarily a fiduciary for other purposes. Rather, a
person is a fiduciary only ‘to the extent’ he has or exercises specified authority,
discretion, or control over a plan or its assets.” (internal citations omitted)); Humana
Health Plan, Inc. v. Nguyen, 785 F.3d 1023, 1027 (5th Cir. 2015) (“[T]hird-party
service providers can serve as ERISA fiduciaries in one capacity and non-fiduciaries
in another.”).
For these reasons, the Court declines to dismiss plaintiff’s motion on this
ground.
2. 	Is the relief plaintiff seeks legal or equitable?
Moving defendants’ argument with respect to plaintiff’s § 1132(a)(3) claim is
driven by their characterization of plaintiff’s injury and requested relief. They
contend that plaintiff’s § 1132(a)(3) claim requests monetary damages, rather than
equitable relief, and that such damages “represent the claims for Plan benefits
Plaintiff believes should have been awarded” and therefore § 1132(a)(1) affords an
adequate remedy.60
The Court agrees that at some points, plaintiff’s amended complaint seems to
seek the benefits owed to him and the other members of the putative class from the
Plan that were deemed covered by the Plan but were never dispersed.61 At other
60 R. Doc. No. 35-1, at 15; R. Doc. No. 39-1, at 13.
61 See R. Doc. No. 33 ¶ 16; see also R. Doc. No. 41, at 6 (explaining that he seeks
reimbursement for the out-of-pocket expenses he has paid due to delays in processing
pending claims).
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points, plaintiff’s alleged harm seems to include damages associated with defendants’
prolonged retention of benefits already approved and owed to him62 and his amended
complaint could be read to seek equitable relief of such allegedly improper, prolonged
retention.63 See CIGNA Corp. v. Amara, 563 U.S. 421, 441 (2011) (noting, in the
context of an ERISA case, that “[e]quity courts possessed the power to provide relief
in the form of monetary ‘compensation’ for a loss resulting from a trustee’s breach of
duty, or to prevent the trustee’s unjust enrichment”); see also Dunnigan v. Metro. Life
Ins. Co., 277 F.3d 223, 228-29 (2d Cir. 2002) (finding that a beneficiary may recover
interest on late payments of benefits as equitable relief under ERISA).
Determining the relief sought and injury alleged drives whether § 1132(a)(1)
affords 	plaintiff 	an 	adequate 	remedy 	and, 	consequently, 	whether 	plaintiff’s
§ 1132(a)(3) claim may proceed. See Manuel, 905 F.3d at 865. Ambiguities as to the
relief sought by plaintiff make this determination implausible at this juncture.
Moreover, 	although 	not 	raised 	by 	the 	parties, 	the 	Court 	questions 	whether
§ 1132(a)(1) provides adequate relief to plaintiff and the putative class considering
62 See, e.g., R. Doc. No. 33 ¶ 33 (“Plaintiff received notice that Defendant(s) failed to
pay, and/or failed to timely pay in accordance with the plan . . . .” (emphasis added));
id. ¶ 35 (“Due to nonpayment, Sprout Pediatrics withdrew care.”); id. ¶ 52 (describing
how defendants’ alleged failure resulted in a provider engaging a collections agency);
R. Doc. No. 41, at 6 (stating that the fact that defendants may have “finally satisfied”
some of the claims “does not resolve the harm done to [plaintiff] and the putative
class”).
63 See, e.g., R. Doc. No. 33 ¶ 80 (“Absent a class action, Defendants will likely retain
the benefits of their wrongdoing. . . . and Defendants will be allowed to continue these
violations of law and to retain the proceeds of its ill-gotten gains.”); see also id. ¶¶
114–121 (pleading, in the alternative, an unjust enrichment claim against defendants
for wrongful retention of plaintiff’s benefits); id. at 19 (seeking “any other relief
provided by law”).
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the Plan is now terminated.64 See Hager, 903 F.3d at 469 (explaining that the remedy
afforded by § 1132(a)(1)(B) is “unavailable to a plaintiff whose employer’s plan had
been discontinued, reasoning that if the plan is defunct, a plaintiff cannot recover
benefits due under the plan’s terms”).
There is both lack of clarity in the amended complaint and lack of briefing by
the parties on the issue of the relief requested and recoverable by plaintiff given the
alleged harm and cancellation of the Plan. The Court finds that it is appropriate to
deny the motion to dismiss and allow plaintiff one additional opportunity to cure this,
and other,65 potentially dispositive ambiguities in a second amended complaint.
Having 	so 	decided, 	the 	Court 	will 	not 	reach 	moving 	defendants’ 	other
arguments regarding ERISA preemption of plaintiff’s state law claims and striking
the 	class 	allegations 	from 	the 	amended 	complaint.66 Such 	arguments 	will 	be
64 Id. ¶ 21.
65 There are other notable issues with plaintiff’s amended complaint that the Court
does not discuss at length herein. For example, plaintiff’s claims are based upon
alleged violations of the terms of the Plan, § 1132(a)(1)(B), and provisions of ERISA,
§ 1132(a)(3), yet plaintiff does not point to which terms of the Plan or which provisions
of ERISA were violated, aside from, for the latter, making general reference to 	29
U.S.C. §§ 1109 (outlining ERISA liability for breach of fiduciary duty) and 1133
(outlining ERISA requirements for claims procedures) and generally stating that
“Defendants 	breached 	ERISA 	by 	failing 	to 	follow 	the 	proper 	procedure 	for
cancellation of health insurance coverage,” without citing any particular provision of
ERISA explaining the proper procedure for cancelling the Plan. The Court is unable
to identify any terms of the Plan or provisions of ERISA that establish that
defendants’ alleged actions amount to a remediable violation pursuant to either
§ 1132(a)(1)(B) 	or 	§ 	1132(a)(3). 	See 	Harris 	Tr., 	530 	U.S. 	at 	247 	(“ERISA’s
comprehensive and reticulated scheme warrants a cautious approach to inferring
remedies not expressly authorized by the text . . . .” (internal quotations omitted)). To
avoid the possibility of dismissal on this ground, plaintiff should take care to cure
these potential deficiencies in his second amended complaint.
66 See R. Doc. No. 35-1, at 17–23; R. Doc. No. 39-1, at 16–24.
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addressed if they are applicable to the second amended complaint and re-raised by
defendants. Likewise, because moving defendants’ motion67 to stay discovery was
premised on the resolution of the motions to dismiss,68 and the motions to dismiss are
now resolved, their motion to stay is denied as moot.
IV. 	CONCLUSION
IT IS ORDERED that moving defendants’ motions69 to dismiss are DENIED.
IT IS ORDERED that moving defendants’ motion70 to stay is DENIED AS
MOOT.
IT IS FURTHER ORDERED that plaintiff is granted leave to file a second
amended complaint no later than MARCH 20, 2026.
New Orleans, Louisiana, February 26, 2026.
_______________________________________
LANCE M. AFRICK
UNITED STATES DISTRICT JUDGE
67 R. Doc. No. 51.
68 See id. at 2 (“[Moving defendants] move this Court to stay discovery until it resolves
Defendants’ pending Motions to Dismiss the Amended Complaint.”).
69 R. Doc. Nos. 35, 39.
70 R. Doc. No. 51.
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