United States District Court, E.D. Missouri, Eastern Division
MEMORANDUM AND ORDER
A. ROSS, UNITED STATES DISTRICT JUDGE.
matter is before the Court on Defendant Benefit
Administrative Systems' (“BAS”) Motion to Set
Aside Default. (Doc. 13.) The motion is fully briefed and
ready for disposition. (Docs. 14, 15.) For the following
reasons, the motion will be granted.
case concerns the denial of medical benefit coverage for an
emergency surgery to remove Plaintiff Irene Malan's
gallbladder. Plaintiff alleges the following in her complaint
(Doc. 1): On May 18, 2016, she was admitted to the hospital
for acute gallbladder inflammation. Two days later, her
gallbladder was removed. On June 22, 2016, a little more than
a month after the surgery, Plaintiff went to the emergency
room for severe abdominal pain. She was diagnosed with sepsis
related to the gallbladder surgery, treated with antibiotics,
and sent home. On July 11, 2016, Plaintiff returned to the
emergency room with severe abdominal pain. A CT scan showed a
peritoneal abscess and sepsis. Doctors performed emergency
surgery to drain the abscess and remove infected tissue.
During the procedure, doctors also removed a previously
installed lap band system, which had become infected
following the gallbladder surgery. Plaintiff's benefits
claim for the second surgery was denied under plan language
that excluded coverage for charges related to the
“care, treatment, surgery, any drugs or supplies that
are primarily for obesity, weight reduction or dietary
control.” (Doc. 1 at ¶ 19.) Plaintiff's
surgeon wrote a letter to BAS, representing that the lap band
removal was a medical necessity after it became infected
following the unrelated gallbladder removal. On this basis,
Plaintiff argues that the surgery was a result of the
gallbladder surgery, not the lap band system, and that
therefore Defendants improperly denied her claim.
October 9, 2017, Plaintiff filed suit against her employer
Solon Gershman, Inc., and BAS, which acted as a third-party
administrator of the Solon Gershman employee health insurance
plan. (Doc. 1.) On October 13, 2017, a request for waiver of
service summons was delivered by certified mail to BAS. (Doc.
14 at 1.) When BAS did not timely respond, Plaintiff sent an
alias summons, which was delivered to BAS on November 30,
2017. (Id.) On January 3, 2018, the Clerk entered a
default against BAS. (Doc. 11.) It was not until March 29,
2018- more than five months after Plaintiff filed her
complaint and nearly three months after the entry of
default-that BAS's counsel entered his appearance and
filed this motion to set aside default. (Docs. 12, 13.)
asks the Court to set aside the default, representing that
its delay in responding was the result of an internal
administrative oversight and that allowing the case to
proceed would not prejudice Plaintiff. (Doc. 13.) Likewise,
BAS asserts that it has a meritorious defense-it lacks
sufficient authority to be liable for the denial of
Plaintiff's medical claim. (Id.) Plaintiff
responds that BAS failed to respond not once but twice-to the
request for waiver of service and to the alias summons. (Doc.
14.) That said, Plaintiff has not sought a formal order of
default. Instead, Plaintiff responds that, if the Court
grants BAS's motion to set aside the default, it should
also accept BAS's claim that it lacked sufficient
authority as a judicial admission that triggers a lower de
novo standard of review applied to the denial of her claims.
(Doc. 14.) In its reply, BAS notes that it must prove its
affirmative defense before the Court adopts a de novo
standard and that the judicial admission Plaintiff proposes
would actually relieve BAS of any liability. (Doc. 15.)
Court is mindful of the strong policy underlying the Federal
Rules of Civil Procedure favoring decisions on the merits
rather than resolution of cases through default judgment.
See United States on behalf of Time Equip. Rental &
Sales, Inc. v. Harre, 983 F.2d 128, 130 (8th Cir.1993).
A court may set aside a default that was the result of
“mistake, inadvertence, surprise, or excusable
neglect.” Fed.R.Civ.P. 55(c), 60(b). When determining
whether neglect is excusable, courts consider “the
danger of prejudice to the [movant], the length of the delay
and its potential impact on judicial proceedings, the reason
for the delay, including whether it was within the reasonable
control of the movant, and whether the movant acted in good
faith.” Pioneer Inv. Servs. Co. v. Brunswick
Assocs. Ltd. P'ship, 507 U.S. 380, 395 (1993).
asserts that Plaintiff's waiver request and alias summons
were both received by lower-level personnel who failed to
promptly forward the documents to upper-level management.
(Doc. 13 at 2.) The Court finds the significant passage of
time between the filing of Plaintiff's complaint and
BAS's response concerning but accepts BAS's
representation and concludes that the oversight is excusable.
Plaintiff fails to allege any concrete prejudice and the
Court notes that the only filing in this case-other than
Plaintiff's complaint-relates to BAS's default.
Likewise, there has been no procedural or judicial action
which might be upset by setting aside the default. Both
Plaintiff and B AS appear to the Court to be acting in good
Court further concludes that it would be premature to grant
Plaintiffs request that the Court treat BAS's proposed
defense as a judicial admission. Plaintiff may assert the
argument at a later time if the issue is presented.
IT IS HEREBY ORDERED that Defendant Benefit
Administrative Systems' (“BAS”) Motion to ...