Hammerich v. Aetna U.S. Healthcare, Inc.

209 F. Supp. 2d 1282, 27 Employee Benefits Cas. (BNA) 2952, 2002 U.S. Dist. LEXIS 11502, 2002 WL 1164133
CourtDistrict Court, M.D. Florida
DecidedMay 29, 2002
Docket8:01-cv-01187
StatusPublished

This text of 209 F. Supp. 2d 1282 (Hammerich v. Aetna U.S. Healthcare, Inc.) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hammerich v. Aetna U.S. Healthcare, Inc., 209 F. Supp. 2d 1282, 27 Employee Benefits Cas. (BNA) 2952, 2002 U.S. Dist. LEXIS 11502, 2002 WL 1164133 (M.D. Fla. 2002).

Opinion

ORDER GRANTING PLAINTIFFS’ MOTION FOR REMAND

MOODY, District Judge.

This cause is before the Court upon the Defendant’s Notice of Removal (Dkt.# 1) of Plaintiffs’ State Court Complaint, Plaintiffs’ Motion for Remand for Lack of Subject Matter Jurisdiction (Dkt.# 13) and Defendant’s response thereto (Dkt.# 20). In the well-pleaded allegations of the Complaint, Plaintiffs do not seek “to recover benefits due under the terms of (the) plan, to enforce ... rights under the terms of the plan, or to clarify ... rights to future benefits under the terms of the plan” as those phrases are used in § 502(a)(1)(B) of ERISA, 29 U.S.C. § 1132(a)(1)(B). Therefore, this Court does not have subject matter jurisdiction and must remand this cause to state court.

BACKGROUND

According to Plaintiffs’ Complaint, Richard Hammerich and Roberta Susan Ham-merich are husband and wife living in Sarasota County, Florida. In February of 1999, the Hammerichs received colorectal cancer screening tests through the mail from Aetna U.S. Healthcare, Inc. (“Aet-na”). The tests were accompanied by a letter requesting that the test be completed and returned to Aetna. The letter indicated that both Richard and Roberta Hammerich and their primary care physicians would receive a letter from Aetna informing them of the test results. Richard Hammerich completed the stool sample test and returned it to Aetna as requested which had it analyzed. The test showed a positive test result, but Aetna did not inform Hammerich or his primary care physician of the result until a year later in February or March of 2000. At that time, Hammerich went to see Dr. DiTomasa for a follow-up evaluation and colonscopy which showed a twenty centimeter adenocarcinoma which had metastasized in two of four lymph nodes and a metastatic adenocarcinoma in the liver consistent with colonic origin. Hammerich alleges that his injuries resulted from Aet-na’s negligent delay in forwarding- the results of-the exam to him and his doctor.

The Complaint asserts two claims: one for Richard Hammerich for his injuries and a second for his wife for loss of consortium.

STANDARD FOR REMAND

A district court must remand a case removed from a state court “[i]f at any time before final judgment it appears that [the federal court] lacks subject matter jurisdiction.” 28 U.S.C. § 1447(b). The Court must review the well-pleaded facts in the Complaint to determine whether it has subject matter jurisdiction to support *1284 the removal. In general, original federal jurisdiction exists and removal is proper only when a federal question is presented on the face of the complaint. Franchise Tax Bd. v. Construction Laborers Vacation Trust, 463 U.S. 1, 103 S.Ct. 2841, 77 L.Ed.2d 420 (1983). This is known as the “well-pleaded complaint rule.” In keeping with this rule, a defense raising a federal question in response to a state law cause of action is typically insufficient to confer federal jurisdiction and justify removal. Louisville & Nashville R.R. v. Mottley, 211 U.S. 149, 29 S.Ct. 42, 53 L.Ed. 126 (1908).

However, where Congress provides specifically that a particular area of law is “necessarily federal in character,” a case may be preempted completely from the well-pleaded complaint rule, and federal jurisdiction may arise by virtue of such a federal defense to a state law cause of action. Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58, 107 S.Ct. 1542, 95 L.Ed.2d 55 (1987). To permit removal of putative ERISA claims to federal court, the state law claims must fall within § 502 of the ERISA-statute, 29 U.S.C. § 1132. Dukes v. United States Healthcare, Inc., 57 F.3d 350 (3d Cir.1995). That section provides, in pertinent part, that a participant or beneficiary of an ERISA plan may bring a civil action “to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan...” 29 U.S.C. § 1132(a)(1)(B).

DISCUSSION

' Plaintiffs contend that this matter should be remanded to the state court “[b]eeáúse this action is based in negligence and does not relate to an employee welfare benefit plan.” (Paragraph 7 of Plaintiffs Motion for Remand). Not unexpectedly, the Defendant takes the contrary view, that- both counts of Plaintiffs’ Complaint “are predicated exclusively on Aet-na’s alleged failure to properly administer the colorectal screen test benefit provided to Plaintiffs through the Health Plan.” (Page 2 of Defendant’s response).

The resolution of these polarized positions begins with a determination of whether the claims falls within the civil enforcement provision of ERISA. That is, whether the Complaint seeks “to recover [plan] benefits due ... under the terms of [the] plan, to enforce .. .rights under the terms of the plan, or to clarify ... rights to future benefits under the terms of the plan” as those phrases are used in § 502(A)(1)(B) of ERISA, 29 U.S.C. § 1132(A)(1)(B). Dukes v. U.S. Healthcare, Inc., 57 F.3d 350 (3d Cir.1995). These enforcement provisions were created by Congress to assure that promised benefits would be available when plan participants had need of them, and § 502 was intended to provide each individual participant with a remedy in the event that promises made by the plan were not kept. Dukes, 57 F.3d at 357.

Here, the Hammerichs sue not to recover benefits or enforce rights, but for negligence in failing to disclose test results. Their claims are similar to those in Tiemann v. U.S. Healthcare, Inc., 93 F.Supp.2d 585 (E.D.Pa.2000). There, a plan participant -brought an action in state court against physicians and a health maintenance organization (HMO) for breach of contract and negligence in failing to disclose, or in misrepresenting, to the participant the nature of a particular deficiency disorder which precluded him from obtaining timely medical treatment for the disorder. The HMO removed the action to federal court and the participant moved for remand. The court in Tiemann noted than an HMO may assume different roles. It may act as a “plan administrator” or as a “provider of medical services.” For *1285

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209 F. Supp. 2d 1282, 27 Employee Benefits Cas. (BNA) 2952, 2002 U.S. Dist. LEXIS 11502, 2002 WL 1164133, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hammerich-v-aetna-us-healthcare-inc-flmd-2002.