Joseph A. Radici, Theresa A. Radici, Michelle E. Radici v. Associated Insurance Companies, Blue Cross Blue Shield of Indiana

217 F.3d 737, 2000 Cal. Daily Op. Serv. 5314, 2000 Daily Journal DAR 7065, 24 Employee Benefits Cas. (BNA) 2581, 2000 U.S. App. LEXIS 15104, 2000 WL 855028
CourtCourt of Appeals for the Ninth Circuit
DecidedJune 29, 2000
Docket98-17437
StatusPublished
Cited by8 cases

This text of 217 F.3d 737 (Joseph A. Radici, Theresa A. Radici, Michelle E. Radici v. Associated Insurance Companies, Blue Cross Blue Shield of Indiana) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Joseph A. Radici, Theresa A. Radici, Michelle E. Radici v. Associated Insurance Companies, Blue Cross Blue Shield of Indiana, 217 F.3d 737, 2000 Cal. Daily Op. Serv. 5314, 2000 Daily Journal DAR 7065, 24 Employee Benefits Cas. (BNA) 2581, 2000 U.S. App. LEXIS 15104, 2000 WL 855028 (9th Cir. 2000).

Opinion

KELLEHER, District Judge:

Plaintiffs Joseph, Theresa and Michelle Radici (together, “the Radicis”) brought an action against their group health insurer's, Associated Insurance Companies, Inc., and Blue Cross and Blue Shield of Indiana (together, “AICI”). The Radicis’ amended *739 complaint alleged that AICI unlawfully terminated Michelle’s health insurance coverage, resulting in her death. The district court dismissed all of the Radicis’ state-law claims for relief, holding that state-law remedies are preempted by the continuation health care coverage provisions of the federal Public Health Services Act (“PHSA”). See 42 U.S.C. §§ 300bb-l to bb-8. The Radicis appeal. We reverse the district court’s decision, holding that the continuation health care coverage provisions of the PHSA lack preemptive force.

FACTUAL BACKGROUND

Michelle Radici was born in 1982 with debilitating medical conditions that left her totally disabled: a brain stem anomaly, hydrocephalus, spina bifida and the congenital absence of one kidney. Since 1990, Michelle’s substantial medical bills were paid by her father’s health insurer, AICI.

Between 1989 and 1995, Joseph Radici worked for two school districts in Indiana, both of which provided health coverage through AICI (the “Indiana policy”). In 1992, AICI and the Radicis reached an agreement that permitted Michelle to remain at home with the care of round-the-clock skilled nursing, thereby avoiding expensive and time-consuming hospital stays.

In August 1995, the Radici family moved to Las Vegas, Nevada, where Joseph had obtained a new position with a local school district. By virtue of his new position, Joseph and his family became enrolled in the health care plan offered by the Las Vegas school district (the “Nevada policy”). The Nevada policy excluded coverage of pre-existing medical conditions (such as Michelle’s) for the first year of enrollment. To preserve Michelle’s skilled nursing care, Joseph exercised his PHSA and contractual rights to continue health coverage under the Indiana policy, which did provide coverage for Michelle’s ailments. Joseph elected continuation coverage on Michelle’s behalf on September 1, 1995.

During the first year in Nevada, Michelle received her normal course of treatment under the Indiana policy. But in late August 1996, with two days’ notice, AICI informed the Radicis that Michelle’s continuation coverage under the Indiana policy would be terminated on September 1, 1996. AICI apparently canceled Michelle’s coverage because the Nevada policy’s one-year exclusion of coverage for pre-existing conditions had lapsed. AICI contended that the lapse of that exclusion automatically terminated AICI’s obligation to provide continuation coverage under the Indiana policy, because Michelle could now be covered under the Nevada policy.

After AICI canceled Michelle’s continuation coverage, the Radicis struggled for several months to provide the necessary care under the Nevada policy. Although Michelle became covered under the Nevada policy, the Nevada insurer would not agree to provide round-the-clock skilled nursing care. Despite her family’s efforts, Michelle Radici died on December 11, 1996.

PROCEDURAL HISTORY

The Radicis filed suit against AICI in the District of Nevada on September 11, 1996 — less than two weeks after AICI denied further continuation coverage to Michelle. The Radicis pursued state law claims for injunctive relief, breach of contract, breach of the duty of good faith and fair dealing, and unfair insurance practices, see Nev.Rev.Stat. § 686A.310. The Radicis also sought relief under the PHSA’s continuation-coverage enforcement provision. See 42 U.S.C. § 300bb-7. After Michelle died, the Radicis amended their complaint to remove the state-law claim for injunctive relief.

On April 6, 1998, the district court dismissed the Radicis’ three remaining state-law claims on preemption grounds. The Court explained that the PHSA preempted state law claims by analogy to the type of preemption employed in ERISA cases.

*740 On November 23,1998, the district court dismissed the Radici’s PHSA claim, because it sought purely equitable and declaratory relief. The court concluded that the claim for equitable relief was moot because Michelle had died and restitution was unavailable. In addition, the court held that the claim for declaratory relief was likewise mooted by Michelle’s death. The court then dismissed the case for lack of subject matter jurisdiction.

The district court entered judgment against,the Radicis on November 24, 1998. The Radicis timely filed a notice of appeal. On appeal, the Radicis challenge only the district court’s order dismissing the state-law claims on preemption grounds. They do not challenge the district court’s decision to dismiss the PHSA claim.

JURISDICTION

Although the Radicis apparently based their claim of subject matter jurisdiction on diversity of citizenship, the district court had proper subject matter jurisdiction because the presence of the PHSA claim conferred federal question jurisdiction. See Andrus v. Charlestone Stone Prod. Co., Inc., 436 U.S. 604, 608 n. 6, 98 S.Ct. 2002, 56 L.Ed.2d 570 (1978) (“Nor does it matter that the complaint does not in so many words assert § 1331(a) as a basis of jurisdiction, since the facts alleged in it are sufficient to establish such jurisdiction and the complaint appeared jurisdictionally correct when filed.”). We have jurisdiction to hear the appeal, because the appeal arises from a final judgment of the district court. See 28 U.S.C. § 1291.

STANDARD OF REVIEW

We review de novo a district court’s decision preempting state law claims. See Associated Builders & Contractors, Inc. v. Local 302 Int’l Bhd. of Elec. Workers, 109 F.3d 1353, 1354-55 (9th Cir.1997).

THE PUBLIC HEALTH SERVICES ACT

On April 7, 1986, Congress passed the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”), Pub.L. 99-272. Some of COBRA’s many provisions concern “continuation health care coverage.” Continuation coverage enables employees (and their dependents) who leave their jobs to retain, for 18-36 months after their departure, the same health coverage they enjoyed while working. 2 COBRA’s provisions mandating that group health plans provide continuation coverage benefits were placed in both the PHSA and the Employee Retirement Income Security Act (“ERISA”). See 42 U.S.C. §§ 300bb-l to bb-8 (PHSA); 29 U.S.C. §§ 1161-69 (ERISA).

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217 F.3d 737, 2000 Cal. Daily Op. Serv. 5314, 2000 Daily Journal DAR 7065, 24 Employee Benefits Cas. (BNA) 2581, 2000 U.S. App. LEXIS 15104, 2000 WL 855028, Counsel Stack Legal Research, https://law.counselstack.com/opinion/joseph-a-radici-theresa-a-radici-michelle-e-radici-v-associated-ca9-2000.