Analytical Surveys, Inc. v. Intercare Health Plans, Inc.

101 F. Supp. 2d 727, 2000 U.S. Dist. LEXIS 7664, 2000 WL 796998
CourtDistrict Court, S.D. Indiana
DecidedApril 25, 2000
DocketIP 99-1422 C B/S
StatusPublished

This text of 101 F. Supp. 2d 727 (Analytical Surveys, Inc. v. Intercare Health Plans, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Indiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Analytical Surveys, Inc. v. Intercare Health Plans, Inc., 101 F. Supp. 2d 727, 2000 U.S. Dist. LEXIS 7664, 2000 WL 796998 (S.D. Ind. 2000).

Opinion

ORDER GRANTING PLAINTIFF’S MOTION FOR REMAND

BARKER, Chief Judge.

Plaintiff, Analytical Surveys, Inc. (“ASI”), originally filed this action against Intercare Health Plans, Inc. and John Alden Life Insurance Company (collectively the “defendants”) in Marion County Superior Court. ASI, an employer and plan sponsor for a self-funded health insurance plan for its employees, contends that the contract administrator, Intercare Health Plans (“Intercare”), breached its contract with ASI and was grossly negligent in processing employee health insurance claims. ASI alleges that Intercare’s handling of these claims resulted in inordinate delays in presenting the claims to ASI’s stop-loss insurer, John Alden Life Insurance Company (“Alden”), who in turn denied the claims as untimely. ASI further claims that Alden wrongfully refused to process and pay the claims pursuant to the terms of the insurance policy (the “Policy”). Defendants removed the state action to this court, invoking federal-question jurisdiction pursuant to sections 502 and 514 of the Employee Retirement Income Security Act (“ERISA”). See 29 U.S.C. §§ 1132(a), 1144(a).

Defendants contend that ASI’s claims relate to, and arise out of, the administration and funding of an ERISA plan, and therefore that those claims are completely preempted by ERISA. ASI asserts that there is no complete preemption and accordingly, moves to remand this action to state court. For the reasons discussed below, we GRANT ASI’s motion for remand.

Background

Prior to August 1997, ASPs employees were insured directly through a health insurance company. ASI then determined that it would be more efficient and cost-effective to initiate a self-funded health insurance plan (the “Plan”). See Compl. ¶ 7. Various ASI employees met with Jim Beardall, the President of Intercare, to discuss the use of Intercare as contract administrator for ASPs Plan. ASI personnel advised Beardall during these meetings that one of ASI’s primary concerns was the “turn-around” time of the health claims. Id. ¶ 9. Beardall represented to ASI that Intercare was one of the largest third-party administrators in Colorado, that its average turn-around time for health claims (measured from claim submission to the completion of processing) was nine (9) days, and that Intercare’s clients would attest to this efficiency. Id. ¶10.

On January 20, 1998, based on these representations, ASI entered into an Administrative Services Agreement (“ASA”) with Intercare. Id. ¶ 11. The ASA contained an amendment which in relevant part stated:

Claims are guaranteed to be processed in ten days or less.
Claims are guaranteed to be processed at a 98 percent accuracy level.
* * * * * *
In the event that the accuracy and turnaround time of this guarantee are not satisfied, the fee for the service will be reduced by 20 percent.

Id. 112. In paragraph 12, the ASA further provided:

Indemnification. The Contract Administrator [Intercare] agrees to indemnify and hold the Plan Sponsor harmless against any and all loss, damage and *730 expense with respect to any acts or omissions resulting from the Contract Administrator’s willful action or gross negligence or bad faith.

Id. ¶ 13. ASI asserts that Intercare did not meet or honor its guarantees and that Intercare was grossly negligent in administering the claims. Id. ¶ 14. ASI alleges .that Intercare’s turn-around time for claims ranged from six (6) to twenty-one (21) months. Id. ¶ 15. In October 1998, ASI terminated the ASA with Intercare and contracted with another administrator, J.F. Molloy & Associates, Incorporated (“Molloy”), to process its employees’ health care claims.. Id. ¶ 16.

In addition to the ASA between Inter-care and ASI, ASI also purchased “stop-loss,” or excess, insurance from Alden to cover any employee health care claims exceeding a certain deductible. Id. ¶ 17. In October and November 1998, Molloy contacted Intercare concerning the claims that Intercare allegedly had processed negligently and asked Intercare to submit these claims to Alden for payment. Id. ¶ 18.

Relying on a provision in the Alden Policy requiring claims to be submitted within thirty (30) days after the deductible amount had been met, Alden refused to reimburse ASI for the submitted claims, which ASI had paid directly. Id. ¶ 19. However, the Policy also provided that Alden would not refuse to reimburse ASI if ASI was late in submitting a claim, provided that claims were submitted “as soon as reasonably possible and within one year of the date notice was required by [Alden].” Id. Additionally, ASI’s Plan, which the Policy referenced, provided:

First Notice of claim [submitted by plan participant on his or her health care provider] must be filed within ninety (90) days of occumnce. All claims should be submitted within a reasonable time frame for prompt processing. Claims fifteen (15) months or older may be denied.

Id. ¶ 20 (emphasis supplied in complaint). Thus, ASI asserts that Alden knew, from the plain language of the Plan which Alden had approved, that up to fifteen-month-old claims would be paid under the Plan. Id. ¶ 21. Many of the claims tendered to Alden, which Alden has refused to pay, were submitted within the twelve (12) month provision of the Policy and within the fifteen (15) month provision of ASI’s Plan. Id.

ASI alleges that it has paid more than $317,000 in employee health claims, which amount was incurred due to Intercare’s gross negligence and breach of the ASA and/or Alden’s refusal to abide by the terms of the Policy and the Plan. Id. ¶ 22. ASI asserts both a breach of contract and gross negligence claim against Intercare and a breach of contract claim against Alden. Id. ¶¶ 23-33.

Discussion

Before discussing whether ASI’s state law claims are completely preempted by ERISA, we must begin with a brief discussion of the principles governing removal jurisdiction in federal courts under 28 U.S.C. § 1441. That statute allows “any civil action brought in a State court of which the district courts of the United States have original jurisdiction, [to] be removed by the defendant or the defendants, to the district court of the United States....” 28 U.S.C. § 1441(a). The propriety of removal in this case depends upon whether we have federal question jurisdiction, under 28 U.S.C. § 1331

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Bluebook (online)
101 F. Supp. 2d 727, 2000 U.S. Dist. LEXIS 7664, 2000 WL 796998, Counsel Stack Legal Research, https://law.counselstack.com/opinion/analytical-surveys-inc-v-intercare-health-plans-inc-insd-2000.