Lind v. Aetna Health, Inc.

466 F.3d 1195, 39 Employee Benefits Cas. (BNA) 1225, 2006 U.S. App. LEXIS 26996, 2006 WL 3072606
Court of Appeals for the Tenth Circuit·Decided October 31, 2006·No. No. 05-5055·Published·Cited by 50 cases

Opinion

McCONNELL, Circuit Judge.

The Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, can be a fruitless and thorny ground for plaintiffs, and many seek to avoid it entirely by bringing their insurance claims under state law. The Supreme Court has increasingly circumscribed such state-law claims, however, finding the pre-emptive sweep of ERISA to be so “extraordinary” that it bars all claims of close relation. Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58, 65, 107 S.Ct. 1542, 95 L.Ed.2d 55 (1987). Nonetheless, James D. Lind (“Lind”) and Linda Stillwell-Lind sought to bring claims against their insurer, Aetna Health, Inc. (“Aetna”), under Oklahoma common law. The Linds believe that their tort and contract claims are not pre-empted by ERISA, because they challenge not the insurance plan itself, but actions by Aetna that Appellants claim are outside the scope of that plan. In the alternative, the Linds seek leave to amend their complaint to include claims under ERISA for compensatory and punitive damages. The private-action provisions of ERISA have been narrowly construed, however, to exclude most forms of make-whole relief.

The Linds fall in a long — and growing— line of plaintiffs who find themselves squeezed between the broad preemptive sweep of ERISA and narrow construction of remedies under the Act itself. We find that the Linds have viable claims neither inside ERISA nor outside it, and we AFFIRM the district court’s grant of summary judgement and denial of leave to amend the claim.

I. Facts and Procedural Background

James D. Lind, a construction manager, was covered by Aetna under his wife’s health insurance plan. In July 2002, he was diagnosed with Multiple Sclerosis (“MS”). His symptoms, including recurrent and severe headaches, dizziness, and depression, left him unable to work. Shortly after the diagnosis, Aetna referred Mr. Lind to Dr. Jorge Gonzalez, a neurologist, for treatment. Dr. Gonzalez prescribed a three-drug regime — Copaxone, Provigil, and Klonopin — which successfully reversed Mr. Lind’s symptoms, allowing him to return to work.

In February 2003, Mr. Lind went to a pharmacy to pick up his Provigil renewal, only to be told by the pharmacist that no further renewals had been authorized. Mr. Lind informed Dr. Gonzalez of the denial, who in turn informed Aetna of his vigorous objections to the change. Aetna told Dr. Gonzalez that Mr. Lind must first try Ritalin, a “step drug,” before the company would authorize payment for further Provigil prescriptions. Dr. Gonzalez, after protesting, wrote Mr. Lind a prescription for Ritalin. Mr. Lind filled the prescription, began taking the drug, and almost immediately experienced a renewal of his symptoms. Aetna re-authorized payment for Provigil several days later, but the new symptoms proved irreversible, and Mr. Lind remains disabled and unable to work.**

On May 21, 2004, the Linds filed a petition in the District Court of Tulsa County, Oklahoma, against Aetna, alleging medical [1198] negligence, medical negligence under respondeat superior, tortious interference with doctor/patient relationship, reckless endangerment, loss of consortium, and punitive damages. Aetna removed the action to the United States District Court for the Northern District of Oklahoma pursuant to 28 U.S.C. § 1331 and 28 U.S.C. § 1446(a). On June 21, 2004, the day Aetna’s answer was due, the United States Supreme Court issued its decision in Aetna Health, Inc. v. Davila, 542 U.S. 200, 124 S.Ct. 2488, 159 L.Ed.2d 312 (2004), which reaffirmed a broad interpretation of ERISA’s preemptive scope. Aetna filed a motion to dismiss, based largely on Davila, and the Linds moved to amend their complaint to include claims under ERISA. The district court granted Aetna’s motion and denied the Linds’. The Linds appeal both rulings.

II. Preemption of state-law claims

We begin by addressing whether the Linds’ state-law claims are barred by ERISA, which preempts all state laws that “relate to” employee benefit plans. 29 U.S.C. § 1144(a). It is undisputed that the Linds’ original claims are based on state law and that Aetna’s plan is an employee benefit plan; the issue is whether the claims “relate to” the Aetna plan. This court reviews the district court’s determination of preemption de novo. Airparts Co. v. Custom Benefit Servs. of Austin, Inc., 28 F.3d 1062, 1064 (10th Cir.1994).

Both the language of the statute and its legislative history indicate that Congress intended ERISA to sweep with broad force. The Act’s stated purpose is to protect the participants in employee benefit plans by “providing for appropriate remedies, sanctions, and ready access to the Federal courts.” 29 U.S.C. § 1001(b). The conference report shows that such language was intended to parallel that of the Labor-Management Relations Act of 1947, which “pre-empts any ‘state-law claim [whose resolution] is substantially dependent upon the analysis of the terms of an agreement made between the parties in a labor contract.’ ” Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 55, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987) (quoting Allis-Chalmers Corp. v. Lueck, 471 U.S. 202, 220, 105 S.Ct. 1904, 85 L.Ed.2d 206 (1985)). As a result, the Supreme Court has found ERISA to preempt nearly all state claims relating to causes of action against covered health insurers, even when “the elements of the state cause of action [do] not precisely duplicate the elements of an ERISA claim.” Davila, 542 U.S. at 216, 124 S.Ct. 2488.

Appellants face an unenviable task in distinguishing their case from Davila, in which the Supreme Court found preemption on similar claims and nearly identical facts. Juan Davila’s treating physician prescribed Vioxx to remedy Mr. Davila’s arthritis, but Aetna refused to authorize payment until Mr. Davila tried a “step drug,” Naprosyn, first. Davila, 542 U.S. at 205, 124 S.Ct. 2488; Roark v. Humana, Inc., 307 F.3d 298, 303 (5th Cir.2002). When Mr. Davila began taking Naprosyn, he suffered a severe reaction that required extensive treatment and hospitalization. Davila, 542 U.S. at 205, 124 S.Ct. 2488. He brought claims to recover his medical costs against Aetna under the Texas Health Care Liability Act, which provided for broader remedies than did ERISA. Id. The Court held that Mr. Davila’s claims were entirely pre-empted: “[A]ny state-law cause of action that duplicates, supplements, or supplants the ERISA civil enforcement remedy conflicts with the clear congressional intent to make the ERISA remedy exclusive and is therefore pre-empted.” Id. at 209, 124 S.Ct. 2488.

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Lind v. Aetna Health, Inc., 466 F.3d 1195, 39 Employee Benefits Cas. (BNA) 1225, 2006 U.S. App. LEXIS 26996, 2006 WL 3072606 (10th Cir. 2006).

466 F.3d 1195 (Lind v. Aetna Health, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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