Gallagher v. Cigna Healthcare of Maine, Inc.

538 F. Supp. 2d 286, 43 Employee Benefits Cas. (BNA) 2789, 2008 U.S. Dist. LEXIS 20653, 2008 WL 697585
CourtDistrict Court, D. Maine
DecidedMarch 14, 2008
Docket07-cv-162-GZS
StatusPublished
Cited by4 cases

This text of 538 F. Supp. 2d 286 (Gallagher v. Cigna Healthcare of Maine, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Gallagher v. Cigna Healthcare of Maine, Inc., 538 F. Supp. 2d 286, 43 Employee Benefits Cas. (BNA) 2789, 2008 U.S. Dist. LEXIS 20653, 2008 WL 697585 (D. Me. 2008).

Opinion

ORDER ON MOTION TO DISMISS

GEORGE Z. SINGAL, Chief District Judge.

Before the Court is a Motion to Dismiss filed by Defendant CIGNA Healthcare of Maine, Inc. (“CIGNA”) (Docket # 9), and Defendant Uday Deshmukh M.D. has joined the Motion (Docket # 21). CIGNA and Dr. Deshmukh move to dismiss Counts I through VI and Count X of Plaintiffs First Amended Complaint. For the reasons stated below, the Court GRANTS the Motion.

I. LEGAL STANDARD

Pursuant to Rule 12(b)(6), a party is entitled to have a claim against it dismissed when the allegations on which the claim depends “fail[ ] to state a claim upon which relief can be granted.” Fed. R.Civ.P. 12(b)(6). When considering a motion under Rule 12(b)(6), the Court must accept as true the well-pleaded factual alie- *290 gations of the complaint, draw all reasonable inferences in the plaintiffs favor, and determine whether the complaint, when taken in the light most favorable to the plaintiff, sets forth sufficient facts to support the claim for relief. Clorox Co. v. Proctor & Gamble Commercial Co., 228 F.3d 24, 30 (1st Cir.2000); LaChapelle v. Berkshire Life Ins. Co., 142 F.3d 507, 508 (1st Cir.1998). Pursuant to Rule 8(a), the pleader need only make “a short and plain statement of the claim showing that the pleader is entitled to relief.” Fed.R.Civ.P. 8(a)(2). Despite the liberal pleading standard of Rule 8, to survive a motion to dismiss, a complaint must allege “a plausible entitlement to relief.” Bell Atlantic Corp. v. Twombly, — U.S.-,-, 127 S.Ct. 1955, 1967, 167 L.Ed.2d 929 (2007).

II. BACKGROUND

Plaintiff Janice Gallagher is the personal representative of her deceased husband, Bradley Gallagher. Mr. Gallagher was an employee of Bath Iron Works (“BIW”), a General Dynamics Corporation (“General Dynamics”), from 1968 until he was unable to work due to his deteriorating health. CIGNA administered and was the claims fiduciary of BIW’s group health care plan (“the health care plan” or “the plan”) and General Dynamics was the Plan Administrator and Plan Sponsor of the health care plan. The health care plan is an employee benefit plan within the meaning of Section 3(b) of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1002(3). Mr. Gallagher was a participant in the plan.

This case arises out of Defendant CIG-NA’s denial of health insurance benefits to Mr. Gallagher in the form of skilled nursing care. In short, Mr. Gallagher suffered from a host of serious medical conditions, including Type II diabetes. On September 6, 2006, Mr. Gallagher underwent amputation of his right leg below the knee. Following the amputation, Mr. Gallagher commenced rehabilitation until September 22, 2006, when he developed septicemia and a urinary tract infection. He was admitted to acute care at Central Maine Medical Center (“CMMC”). Upon discharge from CMMC on October 4, 2006, Mr. Gallagher was admitted to the Win-ship Green Nursing Home 1 (“Winship Green”) for skilled, 24-hour nursing care.

On October 31, 2006, CIGNA notified Winship Green that further in-patient skilled nursing care was denied. Numerous individuals, including his doctor, nurse and social worker, appealed CIGNA’s decision on behalf of Mr. Gallagher. At the time CIGNA denied further inpatient skilled nursing care, Mr. Gallagher’s amputation site was open, with his femur bone protruding. CIGNA, via Dr. Desh-mukh, 2 the head Medical Director for CIG-NA, upheld its decision. On November 6, 2006, Mr. Gallagher was discharged from Winship Green to the care of his wife, who had no medical training. On November 19, 2006, Mr. Gallagher was seen at CMMC for emergency treatment. Mr. Gallagher was admitted to CMMC on the same day and diagnosed with sepsis. He died later that day.

On August 16, 2007, Plaintiff filed her Complaint in the Sagadahoc Superior Court in the State of Maine. On September 13, 2007, Defendant CIGNA removed *291 the case to Federal Court (Docket # 1). After removal, Plaintiff filed an Amended Complaint asserting ten claims and naming as Defendants CIGNA, General Dynamics, Winship Green and Dr. Desh-mukh. (Docket # 5). 3 Specifically, the Complaint asserts causes of action for carrier liability under the Health Improvement Act, 24-A M.R.S.A. § 4313 against CIGNA (Count I), violation of Maine’s Unfair Claims Settlement Practices Act, 24-A M.R.S.A. § 2436-A against CIGNA and General Dynamics (Count II), breach of contract against CIGNA and General Dynamics (Count III), intentional infliction of emotional distress against CIGNA, General Dynamics and Winship Green (Count IV), negligent infliction of emotional distress against CIGNA, General Dynamics and Winship Green (Count V), health plan negligence against CIGNA and General Dynamics (Count VI), violation of Maine law regarding care at a long-term care facility against Winship Green (Count VII), wrongful denial of health benefits under ERISA against CIGNA and General Dynamics (Count VIII), breach of fiduciary duty under ERISA against CIGNA, General Dynamics and Dr. Deshmukh (Count X) and failure to comply with terms of the plan document against CIGNA and General Dynamics (Count XI).

On October 15, 2007, CIGNA filed a Motion to Dismiss (Docket # 9). Through the Motion to Dismiss, CIGNA asserts that Counts I through VI are preempted by ERISA, 29 U.S.C. § 1132(a) et seq., and that Count X for breach of fiduciary duty cannot survive because Plaintiff has available a remedy under § 1132(a)(1)(B). On November 29, 2007, Dr. Deshmukh joined CIGNA’s Motion to Dismiss (Docket # 21). 4

III. DISCUSSION

ERISA is a comprehensive statute designed to promote the interests of employees and their beneficiaries by regulating the creation and administration of employee benefit plans. Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 44, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987). In furtherance of ensuring that employee benefit plan regulation 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), ERISA includes expansive preemption provisions.

A. ERISA Preemption

There are two components to ERISA’s extensive preemptive force.

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538 F. Supp. 2d 286, 43 Employee Benefits Cas. (BNA) 2789, 2008 U.S. Dist. LEXIS 20653, 2008 WL 697585, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gallagher-v-cigna-healthcare-of-maine-inc-med-2008.