Carducci v. Aetna U.S. Healthcare

247 F. Supp. 2d 596, 30 Employee Benefits Cas. (BNA) 1014, 2003 U.S. Dist. LEXIS 2943
CourtDistrict Court, D. New Jersey
DecidedMarch 4, 2003
DocketCivil Action 01-4675 (JBS), 01-4964(JBS), 01-5217(JCL), 01-5237(JWB), 01-5339(JBS), 01-5812(JBS), 02-417(JBS), 02-1155(JBS)
StatusPublished
Cited by17 cases

This text of 247 F. Supp. 2d 596 (Carducci v. Aetna U.S. Healthcare) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Carducci v. Aetna U.S. Healthcare, 247 F. Supp. 2d 596, 30 Employee Benefits Cas. (BNA) 1014, 2003 U.S. Dist. LEXIS 2943 (D.N.J. 2003).

Opinion

SIMANDLE, District Judge:

TABLE OF CONTENTS

I. BACKGROUND.604

II. DISCUSSION.

A. Motion to Dismiss Standard of Review.

B. Motion to Dismiss Analysis.

1. Complete Preemption Dismissal under Section 502(a).

(a) Failure to allege ERISA cause of action.

(b) Failure to plead plan as section 502(a)(1)(B) defendant ....

(e) Failure to exhaust administrative remedies.

2. Conflict Preemption Dismissal under Section 511(a).

(a) Whether N.J.S.A. 2A:15-97 “relates to” plaintiffs’ employee benefit plans .

(b) Whether N.J.S.A. 2A:15-97 is “saved” as a state law that regulates insurance. ^ tH Cfl

(c) Whether N.J.S.A. 2A:15-97 applies in spite of the deemer clause t-t*H CO

C. Additional Arguments for Motion to Dismiss. t-1—I CO

1. Retrospective effect ofPerreira v. Rediger, 169 N.J. 399 (2001). i> t—i ÍD

2. Voluntary payment doctrine as applied to Levine, Bogurski and Edmonson claims. Í— 1 1 CO

3. Standing doctrine as applied to Collins and West claims. ui tO O

D. Bibbs v. AmeriHealth, Inc., Civ. No. 02-1155(JBS) Summary Judgment Motion. 05 tO

1. Compensatory Relief Claims 05 tO DO

2. Prospective Relief Claims... DO 4^

III. CONCLUSION. .625

Under New Jersey law, a health insurer which paid benefits on behalf of an insured may not recoup those funds through a subrogation or reimbursement lien upon the insured’s recovery from a third-party tortfeasor, and any such subrogation provision in a New Jersey insurance contract is therefore void. Perreira v. Rediger, 169 N.J. 399, 778 A.2d 429 (2001) (interpreting N.J.S.A. 2A:15-97). The principal issues in the present consolidated cases involve whether this prohibition of subrogation arising at state law applies to the health insurance contracts of New Jersey employee benefit plans governed under federal law through the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001, et seq., and thus whether the plaintiff-insureds are entitled to repayment of such subrogated funds, or whether such a claim is preempted by ERISA section 502(a), 29 U.S.C. § 1132(a) (complete preemption) or by ERISA section 514(a), 29 U.S.C. § 1144(a) (conflict preemption).

The present motion to dismiss thus requires the Court to consider the doctrines of complete preemption and conflict preemption under ERISA. Congress passed ERISA to “safeguard the establishment, operation, and administration of em *604 ployee benefit plans,” and included the statute’s two preemption provisions to ensure that the federal ERISA statute would set “minimum standards [to] assur[e] the equitable character of such plans and their financial soundness.” Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355, 122 S.Ct. 2151, 153 L.Ed.2d 375 (2002) (quoting 29 U.S.C. § 1001(a)). By preempting many state regulations, ERISA makes clear that the regulation of employee benefit plans is “exclusively a federal concern.” Alessi v. Raybestos-Manhattan, Inc., 451 U.S. 504, 523, 101 S.Ct. 1895, 68 L.Ed.2d 402 (1981).

Complete preemption arises under ERISA section 502(a)’s civil enforcement provision; it completely preempts state law claims within its scope and converts them into federal ERISA claims. Conflict preemption arises under ERISA section 514(a); it expressly preempts any state law which relates to an ERISA plan unless the law “regulates insurance, banking, or securities.”

The matter is presently before the Court on seven motions to dismiss by defendants in each of the seven consolidated actions other than Carducci itself. 1 [Docket Items 40-1, 42-1, 48-1, 50-1, 50-2, 52-1, and 54-1 in Carducci, et al. v. Aetna U.S. Healthcare, No. 01-4675.] The consolidated defendants assert that plaintiffs’ complaints should be dismissed pursuant to Fed.R.Civ.P. 12(b)(6) for failure to state a claim upon which relief may be granted because their state law claims are completely preempted and conflict preempted by ERISA.

The Court has considered the submissions of all of the parties and has decided that defendants’ motions to dismiss on the basis of complete and conflict preemption must be denied. The Court will then consider, and deny, three additional arguments presented for dismissal, namely whether the 2001 Perreira case on which the claims are based should apply retrospectively, whether certain claims should be barred by the voluntary payment doctrine, and whether certain plaintiffs have standing to bring suit. Then, the Court will consider, and will grant, the motion for summary judgment brought in Bibbs.

1. BACKGROUND

On January 28, 2002, this Court granted the motion of defendants in six cases to consolidate their actions for the limited purpose of considering motions for remand and motions to dismiss. As a result, the cases of Levine v. United Healthcare Corp., Civ. No. 01-4964(JBS); West v. Health Net of the Northeast, Civ. No. 01-5217(JCL); Collins v. Oxford Health Plans, Civ. No. 01-5237(JWB); Borgurski v. Horizon Blue Cross Blue Shield of New Jersey, Civ. No. 01-5339(JBS); and Edmonson v. Horizon Blue Cross Blue Shield of New Jersey, Civ. No. 01-5812(JBS), were consolidated under the caption of the earliest docket, Carducci et al. v. Aetna U.S. Healthcare, No. 01-4675(JBS). Parties in another action, Bibbs v. AmeriHealth, Inc., Civ. No. 02-1155(JBS), agreed to have their case consolidated under the Carducci docket for purposes of the remand motion; they have since joined the present motion to dismiss. 2 *605 Parties in another action, Barbour v. CIGNA Corp., Civ. No. 02-417(JBS), agreed to consolidate under the Carducci

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Bluebook (online)
247 F. Supp. 2d 596, 30 Employee Benefits Cas. (BNA) 1014, 2003 U.S. Dist. LEXIS 2943, Counsel Stack Legal Research, https://law.counselstack.com/opinion/carducci-v-aetna-us-healthcare-njd-2003.