Lisa Michael v. Blue Cross of California

CourtDistrict Court, C.D. California
DecidedAugust 7, 2020
Docket2:20-cv-01836
StatusUnknown

This text of Lisa Michael v. Blue Cross of California (Lisa Michael v. Blue Cross of California) is published on Counsel Stack Legal Research, covering District Court, C.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lisa Michael v. Blue Cross of California, (C.D. Cal. 2020).

Opinion

JS-6 1

2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 CENTRAL DISTRICT OF CALIFORNIA 10 LISA MICHAEL, 11 Case No. 2:20-cv-01836-ODW (AFMx) 12 Plaintiff, 13 v. ORDER RE DEFENDANT’S MOTION 14 TO DISMISS [9] AND PLAINTIFF’S 15 BLUE CROSS OF CALIFORNIA dba MOTION TO REMAND [11] ANTHEM BLUE CROSS and DOES 16 1 through 20, inclusive, 17 Defendant. 18

19 I. INTRODUCTION 20 Before the Court are two motions. First, a Motion to Dismiss filed by 21 Defendant Blue Cross of California dba Anthem Blue Cross (“Anthem”). (Mot. 22 Dismiss (“MTD”), ECF No. 9.) Second, a Motion to Remand filed by Plaintiff Lisa 23 Michael. (Mot. Remand (“MTR”), ECF No. 11.) For the following reasons, 24 Plaintiff’s Motion to Remand is GRANTED and Defendant’s Motion to Dismiss is 25 DENIED as moot.1 26 27

28 1 After carefully considering the papers filed in connection with the Motions, the Court deemed the matters appropriate for decision without oral argument. Fed. R. Civ. P. 78; C.D. Cal. L.R. 7-15. 1 II. FACTUAL AND PROCEDURAL BACKGROUND 2 Plaintiff Lisa Michael is an employee of the Pacific Collegiate School (“PCS”). 3 (MTR 4.) PCS is a California public charter school established in 1999. (MTR 5.) 4 Anthem is a health care service plan licensed by the Department of Managed 5 Health Care. (Compl. ¶ 6, ECF No. 1-1.) A person covered by Anthem’s plan is 6 called a “subscriber” or “member” of the plan, and the contract provided to the 7 member is called an evidence of coverage (“EOC”). (Compl. ¶ 6.) Plaintiff alleges 8 that she is a member of Anthem’s plan. (Compl. ¶ 7.) 9 Plaintiff alleges that her dependent son required certain treatment covered under 10 the terms of her EOC. (Compl. ¶¶ 8–9.) Yet, Anthem denied coverage for the 11 treatment sought based on an erroneous standard governing such claims. (Compl. 12 ¶ 10.) Plaintiff then filed a grievance pursuant to Health & Safety Code section 1368, 13 which Anthem rejected on March 30, 2018. (Compl. ¶¶ 11–12.) 14 Following the rejection of her grievance, Plaintiff sought an Independent 15 Medical Review (“IMR”) of the denied services. (Compl. ¶ 13.) The IMR 16 determined that a portion of the denied treatment sought was medically necessary and 17 a portion was not. (Compl. ¶ 13.) After the IMR determination, Anthem paid the 18 portion found to found to be medically necessary. (Compl. ¶ 14.) However, Anthem 19 only paid a fraction of the billed charges determining that the provider was out of 20 network. (Compl. ¶ 14.) As a result, Plaintiff was forced to incur significant debt to 21 pay for her son’s needed treatment. (Compl. ¶ 15.) 22 Plaintiff alleges that Anthem’s rejection of her grievance is part of a systemic 23 failure to properly investigate and resolve grievances as required by Health & Safety 24 Code section 1368, and that despite numerous citations, Anthem has continued to 25 ignore the substance of member grievances. (Compl. ¶ 16.) 26 Plaintiff filed this action in Los Angeles County Superior Court on December 27 16, 2019, bringing two causes of action for breach of contract and breach of the 28 implied covenant of good faith and fair dealing. (See generally Compl.) Anthem 1 timely removed the action to this Court on February 26, 2020. (Not. of Removal, ECF 2 No. 1.) Anthem asserts that each of Plaintiff’s causes of action are preempted by the 3 Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et 4 seq. (Not. of Removal.) 5 III. LEGAL STANDARDS 6 A. Motion to Remand 7 Federal courts have subject matter jurisdiction only as authorized by the 8 Constitution and by Congress. U.S. Const. art. III, § 2, cl. 1; Kokkonen v. Guardian 9 Life Ins. Co. of Am., 511 U.S. 375, 377 (1994). Federal courts have original 10 jurisdiction where an action arises under federal law, or where each plaintiff’s 11 citizenship is diverse from each defendant’s citizenship and the amount in controversy 12 exceeds $75,000. 28 U.S.C. §§ 1331, 1332(a). A defendant may remove a case from 13 state court to federal court only if the federal court would have had original 14 jurisdiction over the suit. 28 U.S.C. § 1441(a). The removal statute is strictly 15 construed against removal, and “[f]ederal jurisdiction must be rejected if there is any 16 doubt as to the right of removal in the first instance.” Gaus v. Miles, Inc., 980 F.2d 17 564, 566 (9th Cir. 1992). The party seeking removal bears the burden of establishing 18 federal jurisdiction. Durham v. Lockheed Martin Corp., 445 F.3d 1247, 1252 (9th 19 Cir. 2006). 20 B. Motion to Dismiss 21 A court may dismiss a complaint under Rule 12(b)(6) for lack of a cognizable 22 legal theory or insufficient facts pleaded to support an otherwise cognizable legal 23 theory. Balistreri v. Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir. 1988). To 24 survive a dismissal motion, a complaint need only satisfy the minimal notice pleading 25 requirements of Rule 8(a)(2)—a short and plain statement of the claim. Porter v. 26 Jones, 319 F.3d 483, 494 (9th Cir. 2003). The factual “allegations must be enough to 27 raise a right to relief above the speculative level.” Bell Atl. Corp. v. Twombly, 550 28 U.S. 544, 555 (2007). That is, the complaint must “contain sufficient factual matter, 1 accepted as true, to state a claim to relief that is plausible on its face.” Ashcroft v. 2 Iqbal, 556 U.S. 662, 678 (2009) (internal quotation marks omitted). 3 The determination of whether a complaint satisfies the plausibility standard is a 4 “context-specific task that requires the reviewing court to draw on its judicial 5 experience and common sense.” Id. at 679. A court is generally limited to the 6 pleadings and must construe all “factual allegations set forth in the complaint . . . as 7 true and . . . in the light most favorable” to the plaintiff. Lee v. City of Los Angeles, 8 250 F.3d 668, 679 (9th Cir. 2001). However, a court need not blindly accept 9 conclusory allegations, unwarranted deductions of fact, and unreasonable inferences. 10 Sprewell v. Golden State Warriors, 266 F.3d 979, 988 (9th Cir. 2001). 11 Where a district court grants a motion to dismiss, it should generally provide 12 leave to amend unless it is clear the complaint could not be saved by any amendment. 13 See Fed. R. Civ. P. 15(a); Manzarek v. St. Paul Fire & Marine Ins. Co., 519 F.3d 14 1025, 1031 (9th Cir. 2008). Leave to amend may be denied when “the court 15 determines that the allegation of other facts consistent with the challenged pleading 16 could not possibly cure the deficiency.” Schreiber Distrib. Co. v. Serv-Well Furniture 17 Co., 806 F.2d 1393, 1401 (9th Cir. 1986). Thus, leave to amend “is properly 18 denied . . . if amendment would be futile.” Carrico v. City and Cty.

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Lisa Michael v. Blue Cross of California, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lisa-michael-v-blue-cross-of-california-cacd-2020.