Rievley Ex Rel. Rievley v. Blue Cross Blue Shield of Tennessee

69 F. Supp. 2d 1028, 1999 U.S. Dist. LEXIS 15566, 1999 WL 798919
CourtDistrict Court, E.D. Tennessee
DecidedSeptember 29, 1999
Docket1:99-cv-00147
StatusPublished
Cited by9 cases

This text of 69 F. Supp. 2d 1028 (Rievley Ex Rel. Rievley v. Blue Cross Blue Shield of Tennessee) is published on Counsel Stack Legal Research, covering District Court, E.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rievley Ex Rel. Rievley v. Blue Cross Blue Shield of Tennessee, 69 F. Supp. 2d 1028, 1999 U.S. Dist. LEXIS 15566, 1999 WL 798919 (E.D. Tenn. 1999).

Opinion

MEMORANDUM

EDGAR, Chief Judge.

This matter comes before the Court on plaintiff Virginia Rievley’s (“Rievley”) motion to remand (Court File No. 5). In April 1999, Rievley filed a complaint in the Chancery Court of Hamilton County, Tennessee, claiming breach of insurance contract, breach of fiduciary duty, and bad-faith denial of insurance benefits under Tenn. Code AnN. § 56-7-105 (1994). Defendants Blue Cross Blue Shield of Tennessee (“BCBS-TN”) and PCS Health Systems (“PCS”) removed the case to the United States District Court for the Eastern District of Tennessee (Court File No. 1). Plaintiff moves to remand the case to state court, arguing that there is no basis for federal subject matter jurisdiction. 1

The- issue to be resolved is whether Rievley’s state law claims stemming from the defendants’ denial of insurance benefits are preempted under the Federal Employee Health Benefits Act (“FEHBA”) or federal common law. Rievley asserts that the Court must remand for lack of subject matter jurisdiction because her claims for breach of contract, breach of fiduciary duty, and bad-faith benefits denial are not preempted by federal law and that the state court’s jurisdiction is proper. Defendants argue that the case is properly before this federal district court because the contract and tort claims are completely preempted by or require the construction of federal law. The Court agrees with defendants, and the courts which have most recently addressed the scope of FEHBA’s preemption, that the plaintiffs claims are completely preempted by federal law. Alternatively, because this case involves an area of significant federal interest and highlights an area of conflict between federal policy and state law, federal law will govern. The plaintiffs motion to remand will be DENIED.

I. Background

Congress enacted the Federal Employee Health Benefits Act (“FEHBA”), 5 U.S.C. §§ 8901-8914, in 1959 to provide health insurance coverage for federal employees and their dependents. FEHBA authorizes the Office of Personnel Management (OPM) to contract with insurance carriers to provide health care benefits and to supervise the administration of FEHBA plans. 5 U.S.C. §§ 8902-8903. Rievley and her husband, a retired employee of the United States Postal Service, párticipate in the Service Benefit Plan (“the Plan”), a federal health insurance plan under FEH-BA. The Plan is a contract between OPM and the Blue Cross Blue Shield Association, on behalf of Blue Cross Blue Shield companies nationally. No insurance contract exists, however, between the Riev-leys and Blue Cross Blue Shield. Caudill v. Blue Cross Blue Shield of North Carolina, 999 F.2d 74, 76-77 (4th Cir.1993); Hanson v. Blue Cross Blue Shield of Iowa, 953 F.Supp. 270, 272 (N.D.Iowa 1996). Instead, the Rievleys are enrollees in a federal health insurance plan underwritten by BCBS-TN and they are subject to regulations promulgated by OPM. Id.; see also 5 C.F.R. § 890.101-.104, .301-308 (prescribing terms of FEHBA enrollment program). Defendant BCBS-TN administers the Plan in Tennessee. As authorized by the Plan, BCBS-TN subcontracted the processing of pharmaceutical claims to defendant PCS.

*1031 Rievley was diagnosed with Alzheimer’s disease. Rievley’s physician, Aloys T. Mangan, M.D., prescribed the drug Cog-nex/Arieept to treat her Alzheimer’s disease. Rievley submitted the bills for Cog-nex/Aricept to defendants, and BCBS-TN denied payment for the drugs. Rievley then appealed the denial, submitting supplemental information concerning the medication and treatment. On July 8, 1998, Blue Cross Blue Shield affirmed the denial of coverage, and informed Rievley that she could obtain further review from OPM to determine if the denial comports with the Plan.

Rather than seeking OPM review, Riev-ley filed this lawsuit in state court on April 5, 1999. Rievley claims that in denying coverage for Cognex/Aricept, BCBS-TN and PCS breached their contractual duty to provide benefits to her and breached their fiduciary duty to her as their insured. Moreover, Rievley contends that defendants’ denial of coverage is in bad faith, thus subjecting them to additional liability pursuant to Tenn. Code Ann. § 56-7-105. Defendants timely removed the action to federal district court pursuant to 28 U.S.C. § 1441. (Court File No. 1). Rievley thereafter filed a motion to remand to state court (Court File No. 5). In August, 1999, several months after her complaint was filed and defendants removed the case to this Court, Rievley requested that OPM review the denial of coverage. On September 2, 1999, OPM upheld the denial.

II. Complete Preemption

A case, such as this one, initially brought in state court may be removed to federal district court only where “the district courts of the United States have original jurisdiction.” 28 U.S.C. § 1441(a). Removal is thus proper only where the state court complaint could have been brought initially in the federal district court. Caterpillar Inc. v. Williams, 482 U.S. 386, 392, 107 S.Ct. 2425, 96 L.Ed.2d 318 (1987); Ahearn v. Charter Township of Bloomfield, 100 F.3d 451, 456 (6th Cir.1996). The defendants who removed the case and are seeking to invoke this Court’s subject matter jurisdiction have the burden to establish that the instant action arises under federal law. Ahearn, 100 F.3d at 453-54; Gotlib v. Paul Revere Life Ins. Co., 26 F.Supp.2d 989, 991 (E.D.Mich.1998); see also Alexander v. Electronic Data Systems Corp., 13 F.3d 940, 948-49 (6th Cir.1994) (defendants as removing party bear the burden to establish federal subject matter jurisdiction).

The district courts of the United States have original jurisdiction over “all civil actions arising under the Constitution, laws, or treaties of the United States.” 28 U.S.C. § 1331. Whether a claim raised in a complaint “arises under” federal law is determined by application of the well-pleaded complaint rule. Caterpillar, 482 U.S. at 398-99, 107 S.Ct. 2425, 96 L.Ed.2d 318; Franchise Tax Board v. Laborers Vacation Trust Corp., 463 U.S. 1, 9-10, 103 S.Ct. 2841, 77 L.Ed.2d 420 (1983); Her Majesty the Queen v. City of Detroit, 874 F.2d at 338-39 (6th Cir.1989).

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Bluebook (online)
69 F. Supp. 2d 1028, 1999 U.S. Dist. LEXIS 15566, 1999 WL 798919, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rievley-ex-rel-rievley-v-blue-cross-blue-shield-of-tennessee-tned-1999.