Kalifano, LLC v. Sierra Health and Life Insurance Company

CourtDistrict Court, D. Nevada
DecidedMarch 24, 2020
Docket2:19-cv-00916
StatusUnknown

This text of Kalifano, LLC v. Sierra Health and Life Insurance Company (Kalifano, LLC v. Sierra Health and Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. Nevada primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kalifano, LLC v. Sierra Health and Life Insurance Company, (D. Nev. 2020).

Opinion

1 UNITED STATES DISTRICT COURT

2 DISTRICT OF NEVADA

3 KALIFANO, INC., ) 4 ) Plaintiff, ) Case No.: 2:19-cv-00916-GMN-DJA 5 vs. ) ) ORDER 6 SIERRA HEALTH AND LIFE INSURANCE ) 7 COMPANY, INC., ) ) 8 Defendant. ) ) 9 10 Pending before the Court is Defendant Sierra Health and Life Insurance Company, Inc.’s 11 (“Defendant’s”) Motion to Dismiss, (ECF No. 4). Plaintiff Kalifano, Inc. (“Plaintiff”) filed a 12 Response, (ECF No. 6), and Defendant filed a Reply, (ECF No. 11). Also pending before the 13 Court are Plaintiff’s Motion to Remand, (ECF No. 7), and Motion to Amend/Correct the 14 Complaint, (ECF No. 9). Defendant filed Responses, (ECF Nos. 13, 14), and Plaintiff filed 15 Replies, (ECF Nos. 15, 16). For the reasons discussed below, the Court GRANTS Plaintiff’s 16 Motion to Remand and DISMISSES as moot Defendant’s Motion to Dismiss and Plaintiff’s 17 Motion to Amend/Correct the Complaint. 18 I. BACKGROUND 19 This action arises from Defendant’s health care coverage of Plaintiff’s employees, which 20 began on August 22, 2001 (“Sierra Health Plan”). (Compl. ¶¶ 6–7, Ex. A to Pet. Removal, ECF 21 No. 1). At the inception of coverage, Ismat Khalaf (“Khalaf”) was one of Plaintiff’s 22 employees who became enrolled in the Sierra Health Plan. (Id. ¶ 10). Khalaf moved out of the 23 United States in 2005 to the country of Jordan and then to China as part of Plaintiff’s 24 international operation—all while continuing to serve as a full-time employee for Plaintiff. (Id. 25 ¶ 11). 1 On July 17, 2017, Defendant informed Plaintiff that Khalaf was ineligible for health care 2 coverage under the Sierra Health Plan as of the time Khalaf moved outside the United States. 3 (Id. ¶ 15). Defendant then terminated Khalaf’s health care coverage retroactively, effective 4 May 31, 2017. (Id. ¶ 16). However, between 2005 and July 17, 2017, Defendant had 5 “continued to charge [Plaintiff] for Mr. Khalaf’s health benefits under the Sierra Health Plan.” 6 (Id. ¶ 14). Also, according to Plaintiff, “[a]t no time prior to July 17, 2017 did [Defendant] or 7 any of its agents advise [Plaintiff] that the Sierra Health Plan does not provide health benefits to 8 employees who reside out of the United States, that an employee’s move outside of the United 9 States makes them ineligible under the Sierra Health Plan, or that an employee’s move outside 10 of the United States needs to be reported to Sierra Health.” (Id. ¶ 13). 11 In light of Defendant’s July 17, 2017 notice of Khalaf’s non-coverage, Plaintiff requested 12 a refund from Defendant for “health insurance premiums paid on behalf of Mr. Khalaf from the 13 time he moved out of the USA through May 31, 2017.” (Id. ¶ 17). Defendant refunded 14 $3,972.35 (roughly sixty-days’ worth of premiums), but refused to refund more. (Id. ¶ 18). 15 To recover the premiums that Plaintiff paid for Khalaf’s coverage under the Sierra Health 16 Plan between 2005 and 2017, Plaintiff commenced this action in the Eighth Judicial District 17 Court for Clark County, Nevada (“Nevada state court”) by filing its Complaint on April 25, 18 2019. (Compl., ECF No. 1). Plaintiff asserts eight claims for relief in the Complaint: (1) fraud; 19 (2) breach of contract; (3) breach of covenant of good faith and fair dealing/common law bad 20 faith; (4) mutual mistake; (5) unilateral mistake; (6) negligent misrepresentation; (7) unjust 21 enrichment; and (8) declaratory judgment. (Id. ¶¶ 20–74). 22 On May 30, 2019, Defendant removed this case from Nevada state court to this Court by

23 filing its Petition for Removal, (ECF No. 1). Defendant asserts that the Court has subject- 24 matter jurisdiction over this case pursuant to 28 U.S.C. § 1331 because Plaintiff’s Complaint 25 arises under the Employee Retirement Income Security Act (“ERISA”) of 1974, 29 U.S.C. 1 § 1001 et. seq. since it seeks “to recover payment for employee health care coverage from an 2 employer based plan governed by ERISA.” (Pet. Removal ¶ 4). 3 Four days after removing this action, Defendant filed its Motion to Dismiss, (ECF No. 4). 4 Then, just over two weeks later, Plaintiff filed its Motion to Remand, (ECF No. 7), and a 5 Motion to Amend/Correct the Complaint, (ECF No. 9). 6 II. LEGAL STANDARD 7 A. Motion to Dismiss 8 Federal Rule of Civil Procedure 12(b)(6) mandates that a court dismiss a cause of action 9 that fails to state a claim upon which relief can be granted. See N. Star Int’l v. Ariz. Corp. 10 Comm’n, 720 F.2d 578, 581 (9th Cir. 1983). When considering a motion to dismiss under Rule 11 12(b)(6) for failure to state a claim, dismissal is appropriate only when the complaint does not 12 give the defendant fair notice of a legally cognizable claim and the grounds on which it rests. 13 See Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007). In considering whether the 14 complaint is sufficient to state a claim, the Court will take all material allegations as true and 15 construe them in the light most favorable to the plaintiff. See NL Indus., Inc. v. Kaplan, 792 16 F.2d 896, 898 (9th Cir. 1986). 17 The Court, however, is not required to accept as true allegations that are merely 18 conclusory, unwarranted deductions of fact, or unreasonable inferences. See Sprewell v. Golden 19 State Warriors, 266 F.3d 979, 988 (9th Cir. 2001). A formulaic recitation of a cause of action 20 with conclusory allegations is not sufficient; a plaintiff must plead facts showing that a 21 violation is plausible, not just possible. Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citing 22 Twombly, 550 U.S. at 555).

23 A court may also dismiss a complaint pursuant to Federal Rule of Civil Procedure 41(b) 24 for failure to comply with Federal Rule of Civil Procedure 8(a). Hearns v. San Bernardino 25 Police Dept., 530 F.3d 1124, 1129 (9th Cir. 2008). Rule 8(a)(2) requires that a plaintiff’s 1 complaint contain “a short and plain statement of the claim showing that the pleader is entitled 2 to relief.” Fed. R. Civ. P. 8(a)(2). 3 “Generally, a district court may not consider any material beyond the pleadings in ruling 4 on a Rule 12(b)(6) motion . . . . However, material which is properly submitted as part of the 5 complaint may be considered on a motion to dismiss.” Hal Roach Studios, Inc. v. Richard 6 Feiner & Co., 896 F.2d 1542, 1555 n.19 (9th Cir. 1990) (citations omitted). Similarly, 7 “documents whose contents are alleged in a complaint and whose authenticity no party 8 questions, but which are not physically attached to the pleading, may be considered in ruling on 9 a Rule 12(b)(6) motion to dismiss” without converting the motion to dismiss into a motion for 10 summary judgment. Branch v. Tunnell, 14 F.3d 449, 454 (9th Cir. 1994). Under Federal Rule 11 of Evidence 201, a court may take judicial notice of “matters of public record.” Mack v. S.

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Kalifano, LLC v. Sierra Health and Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kalifano-llc-v-sierra-health-and-life-insurance-company-nvd-2020.