BCBSM, Inc. v. I.B.E.W. 292 Health Care Plan

CourtDistrict Court, D. Minnesota
DecidedMarch 23, 2022
Docket0:21-cv-01885
StatusUnknown

This text of BCBSM, Inc. v. I.B.E.W. 292 Health Care Plan (BCBSM, Inc. v. I.B.E.W. 292 Health Care Plan) is published on Counsel Stack Legal Research, covering District Court, D. Minnesota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
BCBSM, Inc. v. I.B.E.W. 292 Health Care Plan, (mnd 2022).

Opinion

UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA BCBSM, INC. d/b/a Blue Cross and Blue Shield of Minnesota, Civil No. 21-1885 (JRT/TNL)

Plaintiff,

MEMORANDUM OPINION AND ORDER v. GRANTING MOTION TO REMAND,

DENYING MOTION FOR ATTORNEY FEES, I.B.E.W. 292 HEALTH CARE PLAN, AND DENYING MOTION TO DISMISS

Defendant.

Gerardo Alcazar and Jerry W. Blackwell, BLACKWELL BURKE PA, 431 South Seventh Street, Suite 2500, Minneapolis, MN 55415, for plaintiff.

Amanda R. Cefalu and Ruth S. Marcott, KUTAK ROCK LLP, 60 South Sixth Street, Suite 3400, Minneapolis, MN 55402, for defendant.

Plaintiff BCBSM, Inc. commenced this action by serving Defendant I.B.E.W. 292 Health Care Plan (the “Plan”) with a Minnesota state court complaint alleging the Plan breached a contract between the parties and seeking (1) a declaratory judgment that the Plan must defend and indemnify BCBSM in accordance with the contract and (2) monetary damages. The Plan removed the action to federal court asserting BCBSM’s claims are preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”) and therefore the Court has original federal question subject matter jurisdiction. The Plan then filed a Motion to Dismiss under Federal Rules of Civil Procedure 12(b)(1) and 12(b)(6). BCBSM filed a Motion to Remand to state court. BCBSM also seeks to recover its attorney fees and costs from responding to the removal. The Court lacks federal question subject matter jurisdiction because ERISA does not preempt the claims raised in

BCBSM’s well-pleaded Complaint. As a result, the Court will grant BCBSM’s Motion to Remand. The Court will, however, deny BCBSM’s Motion for Attorneys’ Fees. The Court will also deny the Motion to Dismiss as moot.

BACKGROUND I. FACTUAL BACKGROUND The Plan is a self-insured, self-administered multiemployer benefits plan established under the Taft-Hartley Act that provides medical benefits. (Notice of

Removal, Ex. 1 (“Compl.”) ¶ 2, Aug. 20, 2021, Docket No. 1.) It is subject to ERISA, 29 U.S.C. § 1000, et seq. (Notice of Removal ¶ 11.) BCBSM is a nonprofit health service plan corporation. (Compl. ¶ 1.) BCBSM alleges the parties entered into an Agreement concerning the payment of

medical claims for beneficiaries of the Plan. (Id. ¶ 5; see also Sealed Exs. for Aff. of Amanda R. Cefalu, Ex. 5 (“BCBSM-Plan Agreement”), Aug. 27, 2021, Docket No. 10.) Under the Agreement, BCBSM provided the Plan access to a BCBSM network of medical providers and discounts negotiated with those providers. (Compl. ¶ 9.) According to

BCBSM, the Agreement provided that BCBSM did not assume any financial risk associated with claims and the Plan retained final authority to determine eligibility for benefits and to adjudicate claims. (Id. ¶¶ 6–8.) And, BCBSM alleges, the Plan agreed under Section 4.4 of the Agreement that it will

indemnify, defend, and hold [BCBSM] forever harmless, from and against, any and all claims, demands, actions, litigation, judgments, liabilities, fines, penalties, awards, expenses and/or associated costs and legal fees which are made or incurred by any third party or parties and which arise from any dispute regarding coverage, denial of benefits, claims payments, claims administration or claims adjudication in connection with [the Plan] or its Eligible Persons use of the Network pursuant to this Agreement and in accordance with current law or otherwise, except to the extent such third party claims, demands, actions, litigation, decrees, judgments, losses, damages, liabilities, fines, penalties, awards, expenses and/or associated costs and legal fees result directly from the breach of [BCBSM] its agents or subcontractors of any obligations of [BCBSM] under this Agreement.

(Id. ¶ 10; see also BCBSM-Plan Agreement at 52.)1 From August 2017 to September 2018, Fairview Health Services (“Fairview”) provided services to a beneficiary of the Plan totaling $3,638,778.23. (Compl. ¶ 11.) Fairview was a member of the network that BCBSM provided the Plan access to, and the BCBSM-Fairview relationship was governed by a separate “Master Agreement.” (Sealed Exs. for Aff. of Amanda R. Cefalu, Ex. 3 (“BCBSM-Fairview Master Agreement”), Aug. 27, 2021, Docket No. 10; see also Notice of Removal ¶¶ 6, 10; Compl. ¶ 21.) In April 2020, Fairview submitted claims to BCBSM for these services. (Compl. ¶ 12.) According to the

1 For clarity, all citations to page numbers refer to the CM/ECF pagination. Complaint, BCBSM forwarded Fairview’s claims to the Plan’s Claim Administrator under the terms of the Agreement who then denied the claims. (Id. ¶¶ 12–13.)

Fairview appealed the denial of the claims but lost the appeal. (Id. ¶ 13.) The Master Agreement between BCBSM and Fairview provides that disputes between BCBSM and Fairview will be resolved via mandatory binding arbitration.2 (BCBSM-Fairview Master Agreement at 11.) After Fairview lost its appeal of the denial, Fairview sent

BCBSM a notice of arbitration which BCBSM claims it forwarded to the Plan with a demand that the Plan indemnify and defend BCBSM in accordance with the Agreement. (Compl. ¶¶ 14–15; Aff. of Amanda R. Cefalu (“Cefalu Aff.”), Ex. 4, Aug. 27, 2021, Docket

No. 9.) BCBSM alleges that although the Plan acknowledged the claims arose from services provided to a Plan beneficiary, the Plan twice denied BCBSM’s demand. (Compl. ¶¶ 16–17.) II. PROCEDURAL HISTORY

BCBSM served its Minnesota state court complaint on the Plan without filing it in state court. (Notice of Removal ¶¶ 1–2.) On August 20, 2021, the Plan removed the case to federal court. (Id.) The Plan asserts the Court has original subject matter jurisdiction over the case under federal question jurisdiction because the claims arise under the

2 The Court notes the Master Agreement submitted to the Court indicates it is effective July 1, 2008 to December 31, 2009. (BCBSM-Fairview Master Agreement at 2.) No party disputes, however, that the material terms of this Master Agreement were still in effect at all times relevant to this case. federal statutes and regulations governing ERISA and are preempted by ERISA §§ 502 and 514 and the Court has supplemental jurisdiction over any state-law claims made in

addition to those for which the Court has original jurisdiction. (Id. ¶¶ 12–16.) On August 27, 2021, the Plan moved to dismiss (1) all BCBSM’s claims under Rule 12(b)(6) asserting they are preempted by ERISA and (2) BCBSM’s claim for a declaratory judgment under Rule 12(b)(1) asserting this claim is not yet ripe. (Mot. Dismiss, Aug. 27,

2021, Docket No. 7; Mem. Supp. Mot. Dismiss at 13–28, Aug. 27, 2021, Docket No. 12.) On September 7, 2021, BCBSM moved to remand the case to state court and for its attorney fees and costs responding to the removal. (Mot. Remand & Att’y Fees, Sept.

7, 2021, Docket No. 15.) BCBSM argues the face of the Complaint asserts a state-law cause of action arising out of an agreement between Minnesota citizens and that complete ERISA preemption does not apply. (Mem. Supp. Mot. Remand & Att’y Fees at 3–8, Sept. 7, 2021, Docket No. 17.) In support of its request for fees, BCBSM argues the

Plan had no objectively reasonable basis for removal. (Id. at 8–9.) BCBSM also requested the Court rule on its Motion to Remand before ruling on the Plan’s Motion to Dismiss. (Mot. Remand & Att’y Fees.) In addition to this case, the trustees for the Plan filed their own action in this Court

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BCBSM, Inc. v. I.B.E.W. 292 Health Care Plan, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bcbsm-inc-v-ibew-292-health-care-plan-mnd-2022.