Nealy v. U.S. Healthcare HMO

844 F. Supp. 966, 1994 U.S. Dist. LEXIS 2659, 1994 WL 72263
CourtDistrict Court, S.D. New York
DecidedMarch 2, 1994
Docket93 Civ. 1577 (CSH)
StatusPublished
Cited by27 cases

This text of 844 F. Supp. 966 (Nealy v. U.S. Healthcare HMO) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Nealy v. U.S. Healthcare HMO, 844 F. Supp. 966, 1994 U.S. Dist. LEXIS 2659, 1994 WL 72263 (S.D.N.Y. 1994).

Opinion

MEMORANDUM OPINION AND ORDER

HAIGHT, District Judge:

Plaintiff Susan Nealy commenced this action in the Supreme Court of the State of New York, County of Bronx, individually and as administratrix of the estate of Glenn Nealy, against Defendants U.S. Healthcare HMO, U.S. Healthcare Versatile Plus HMO, U.S. Health Insurance Co. Inc. (collectively “US Healthcare”), Richard H. Bernstein, M.D. (“Bernstein”) and Ralph Yung, M.D. (“Yung”). Defendant US Healthcare is a health maintenance organization in the business of issuing policies of insurance for health care coverage. Defendant Bernstein, at all relevant times, served as Vice President and Director of Defendant US Healthcare. Defendant Yung, at all relevant times, was a primary care practitioner who provided medical care to individuals enrolled in plans provided by Defendant US Healthcare. Defendants US Healthcare and Bernstein contend that neither provided direct medical services. (Defs.’ Mem.Supp. Dismiss at 2). Plaintiff does not contest any of these statements.

Plaintiffs complaint alleges breach of contract, misrepresentation, professional misconduct, medical malpractice, wrongful death, loss of services, negligent infliction of emotional distress and breach of fiduciary duty. These causes of action arise out of the death of Plaintiffs decedent husband, Glenn Nealy, while he was enrolled in a health care plan provided by defendant US Healthcare.

Defendants US Healthcare and Bernstein removed the action to this Court pursuant to 28 U.S.C. §§ 1331 and 1441(a), (b) and (c), on the ground that Plaintiffs claims are based on a federal question under the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001-1461 (“ERISA”). Those Defendants now move to dismiss the complaint pursuant to Rule 12(b)(6), Fed.R.Civ.P. Plaintiff cross-moves to remand the action to state court for want of a federal question. Defendants US Healthcare and Bernstein contend that Plaintiffs state law claims are preempted by ERISA and therefore the complaint fails to state a claim upon which relief can be granted. Defendant Yung did not join in this motion. Plaintiff argues that her claims are not preempted and thus this Court lacks subject matter jurisdiction.

BACKGROUND

Plaintiffs decedent, Glenn Nealy, was employed by Photoeircuits Corp. (Complaint ¶ 14.) During March 1992, Plaintiffs decedent enrolled in the “US Healthcare Versatile Plus” health care plan (“the plan”) offered by Defendant US Healthcare to employees of Photocircuits Corp. It is undisputed that under this plan defendant US *969 Healthcare was to provide Glenn Nealy with insurance coverage for his medical care.

Plaintiff alleges that Defendant US Healthcare represented to Plaintiffs decedent that the plan would enable him to continue treatment of his pre-existing anginal condition. According to the complaint, Defendants’ plan and policy provided “expressly and implicitly, that Plaintiffs decedent’s special medical needs would be covered, and that Plaintiffs decedent would be entitled to continue, uninterrupted” the medical treatment that had been in progress, including treatment by the doctors Glenn Nealy had been seeing. (Complaint ¶¶ 27-28.) Plaintiff further contends that Glenn Nealy followed all necessary procedures for enrollment and qualification under the plan and attempted to see Defendant Yung, a participating primary care physician. (Complaint ¶ 29.) Plaintiff alleges that as a result of US Healthcare’s failure to furnish Glenn Nealy with the proper identification, Yung refused to see him on or about April 2, 1992 and April 3, 1992. Thus, Plaintiff states, Glenn Nealy was unable to obtain the proper “referral” from Yung that defendant US Healthcare told him was necessary to continue treatment by his own doctors. (Complaint ¶¶ 30-35.)

On or about April 9, 1992, Yung agreed to see Glenn Nealy but denied any knowledge as to US Healthcare’s alleged procedures regarding the “referral” for follow-up treatment by Glenn Nealy’s own physicians. Defendant Yung renewed Glenn Nealy’s prescriptions for medication previously prescribed by his physicians, but according to Plaintiff, Glenn Nealy was unable to fill the prescriptions because “representatives of defendant[] US Healthcare provided incorrect and invalid information to the pharmaceutical provider.” (Complaint ¶ 38.)

Plaintiffs decedent, between April 9 and May 18, 1992, repeatedly tried to obtain the proper authorization from representatives of Defendant US Healthcare to continue treatment by his physicians. (Complaint ¶ 39.) According to Plaintiff, on or about April 29, 1992, Defendants US Healthcare and Bernstein, “in violation of representations previously made to Plaintiffs decedent, ... formally denied, in writing, Plaintiffs decedent’s request for ‘follow-up visits’ to [his own physicians] for the reason that they had ‘a participating provider in the area.’ ” (Complaint ¶ 40-41.)

On or about May 15,1992 Defendant Yung provided Plaintiffs decedent with a “referral” that authorized Plaintiffs decedent to visit a “participating” cardiologist on May 19, 1992. (Complaint ¶¶ 42-43.) On May 18, 1992, Glenn Nealy suffered cardiac arrest and died as a result of a massive myocardial infarction. (Complaint ¶44.)

Plaintiff contends that Defendants’ negligence and wrongful acts caused a delay in her husband’s medical treatment which eventually led to his death. Plaintiff pleads the following causes of action:

(1) Against all Defendants: breach of contract and misrepresentation,
(2) Against all Defendants: violation of “standard of professional conduct”,
(3) Against Defendants Bernstein and Yung: medical malpractice,
(4) Against all Defendants: wrongful death pursuant to New York State Estate, Powers and Trusts Law § 5 — 4.1,
(5) Against all Defendants: negligence,
(6) On behalf of Plaintiff Susan Nealy, individually, against all Defendants: loss of services,
(7) Against all Defendants: breach of fiduciary duty.

In evaluating a defendant’s motion to dismiss, the court must construe all facts in the light most favorable to the Plaintiff, and accept as true all Plaintiffs well-pleaded factual allegations. See Conley v. Gibson, 355 U.S. 41, 78 S.Ct. 99, 2 L.Ed.2d 80 (1957).

DISCUSSION

I. Propriety of Removal

In Plaintiffs motion to remand, she contends that removal to this Court was improper because her Complaint is framed solely on the basis of state law and makes no reference to ERISA. The sole case on which Plaintiff relies, Davis v. American Gen. Group Ins. Co., 732 F.Supp. 1132 (N.D.Ala.1990), stands for the proposition that a defendant’s motion *970

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Bluebook (online)
844 F. Supp. 966, 1994 U.S. Dist. LEXIS 2659, 1994 WL 72263, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nealy-v-us-healthcare-hmo-nysd-1994.