Roche v. Aetna, Inc.

167 F. Supp. 3d 700, 62 Employee Benefits Cas. (BNA) 1105, 2016 WL 797553, 2016 U.S. Dist. LEXIS 25208
District Court, D. New Jersey·Decided March 1, 2016·No. Civil No. 13-1377 (NLH/KMW)·Published·Cited by 9 cases

Opinion

OPINION

HILLMAN, United State District Judge

This suit concerns alleged violations of New Jersey’s insurance regulation laws brought by Plaintiffs Jay Minerley and Tim Singleton (“Plaintiffs”) both individu[703] ally and as putative class representatives against Defendants Aetna, Inc., Aetna Health, Inc., Aetna Health Insurance Co., and Aetna Life Insurance Co. (collectively, the “Aetna Defendants”) and The Rawl-ings Company, LLC (“Rawlings” and collectively with the Aetna Defendants, “Defendants”). Presently before the Court is Defendants’ Motion for Summary Judgment (“Defendants’ Motion” or “Defs.’ Mot.”) [Dkt. Nos. 18, 40]. For the reasons set forth below, Defendants’ Motion will be GRANTED-IN-PART and DENIED-IN-PART.

I. FACTUAL BACKGROUND AND PROCEDURAL HISTORY1

Plaintiff Jay Minerley was involved in a car accident on May 20, 2010 in Morris County, New Jersey. (Defs.’ Statement of Material Facts (“DSMF”) [Dkt. No. 20] ¶ 13.) Minerley suffered injuries, and in the course of treatment for his injuries, he received benefits under his health insurance policy issued by the Aetna Defendants. (DSMF ¶ 14; Pis.’ Responsive Statement of Material Facts (“PSMF”) [Dkt. No. 24-6] ¶ 14; Compl. [Dkt. No. 15] ¶¶ 14, 16.) Plaintiff Tim Singleton was involved in a car accident on December 4, 2006 in Pike County, Pennsylvania. (DSMF ¶¶ 22-23.) Similarly, Singleton suffered injuries and received benefits under a health insurance policy issued by the Aetna Defendants. (DSMF ¶ 25; PSMF ¶25; First Am. Compl. (“FAC”) [Dkt. No. 15] ¶¶ 15-16.)

There is some dispute about what insurance policy covered Minerley. Defendants assert that Minerley received benefits from an employee group Pennsylvania HMO plan sponsored by Weiss-Aug Company, Inc. and fully insured by Aetna Health Inc. (the ‘Weiss-Aug HMO Plan”). (DSMF ¶¶ 14, 16-17.) Minerley denies he was covered by this insurance plan and denied that the certificate of coverage that Defendants refer to with respect to this plan is applicable to him. (PSMF ¶¶ 14,16-17.) Minerley submits to the Court that he only received information about a group insurance policy from his employer. (See Minerley Deck [Dkt. No. 24-3] ¶¶ 5-8, Ex. 1.) The policy indicates that it is to be governed by the laws of New Jersey. (See Minerley Decl. Ex. 1.) Defendants submit a slightly different policy that explains it will be governed by the laws of Pennsylvania. (See Goodrich Deck Ex. 3 [Dkt. No. 21-3].)

There is also some dispute about what insurance policies covered Singleton. The parties agree that Singleton was covered by an employee group health plan of HLM Holdings, Inc. (the “HLM Plan”). (DSMF ¶ 25; PSMF ¶ 25.) Defendants submit that Singleton was also covered by an employee group health plan from Hundley CPAS Corporation (the “Hundley Plan”), which Singleton denies. (DSMF ¶25; PSMF ¶ 25.)

Minerley and Singleton both filed civil lawsuits against the respective tortfeasors in their car accidents. (See FAC ¶ 17; DSMF ¶¶ 15, 24.)2 Subsequently, Rawlings contacted both Minerley and Singleton’s personal injury attorney claiming it had a [704] right to reimbursement of any eventual recovery made in their respective lawsuits under the terms of their insurance policies. (DSMF ¶ 19; Kannebecker Deck [Dkt. No. 24-2] Ex. 1, 3; Van Natta Decl. Ex. 2 [Dkt. No. 22-2].) As a result of these letters, Minerley fearing negative credit ratings and a potential loss of health insurance authorized payment to Rawlings of $3,512.82 for reimbursement of benefits received. (DSMF ¶ 20; Minerley Deck ¶ 9.) Singleton does not appear to have paid anything to Defendants at this time. Defendants assert that they have not asserted subrogation claims against either of Minerley or Singleton’s respective tortfea-sors. (DSMF ¶ 31.)

On January 25, 2013, Plaintiffs along with a third person — Michelle Roche— .filed a complaint against the Defendants in the New Jersey Superior Court, Law Division, Atlantic County. (See Original Compl. [Dkt. No. 1-1].) Defendants removed the action to this Court on March 7, 2013. (See Notice of Removal [Dkt. No. 1].) Before any defendant answered or made a motion for summary judgment, Plaintiffs amended the complaint to remove Roche as a plaintiff from this suit. (See generally FAC.) Plaintiffs complain on behalf of themselves and a putative class of persons similarly situated that the recovery actions taken by Defendants violate New Jersey’s anti-sub-rogation laws — codified at N.J.S.A. 2A:15-97 and N.J.A.C. 11:4-42.10 — as well as the New Jersey Consumer Fraud Act (“NJCFA”), N.J.S.A. 56:8-19, and other common law torts. (See generally FAC.)

Defendants brought the instant motion, and afterwards Plaintiffs filed a motion to consolidate this case with Roche’s separately filed action, Civil Action No. 13-3933 (the “Roche Action”). Magistrate Judge Karen Williams denied the motion to consolidate due to a pending motion to remand in the Roche Action. See .Order, Dec. 4, 2013 [Dkt. No. 34]. Subsequently, Judge Joseph H. Rodriguez3 dismissed without prejudice the summary judgment motion with the right to reinstate the motion by letter due to a potential jurisdictional issue in the Roche Action. See Order, Mar. 31, 2014 [Dkt. No. 38].

Plaintiffs informed this Court by way of letter on July 2, 2015 that the request for remand in the Roche Action was being withdrawn, and urged the Court to proceed with the litigation. (See Ercole Letter [Dkt. No. 39].) Defendants then requested the Court reinstate the motion for summary judgment. (See Cohen Letter [Dkt. No. 40].) The motion was subsequently reinstated.

II. JURISDICTION

Plaintiffs have brought suit as a representative of a putative class on issues of New Jersey law. Plaintiffs initially filed this suit in the New Jersey Superior Court, Law Division, and Defendants timely removed to this Court on the grounds that Plaintiffs’ complaint stated a claim under the Employee Retirement Income Security Act of 1974 (“ERISA”), Pub. L. No. 93-406, 88 Stat. 829 (codified as amended at 29 U.S.C. § 1001, et seq.). (See Notice of Removal [Dkt. No. 1].) As will explained in Section PV.C, infra, all of Plaintiffs’ state law claims are completely preempted by ERISA § 502.4 As such, this [705] Court exercises jurisdiction pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(f).5

III. STANDARD OF REVIEW

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Roche v. Aetna, Inc., 167 F. Supp. 3d 700, 62 Employee Benefits Cas. (BNA) 1105, 2016 WL 797553, 2016 U.S. Dist. LEXIS 25208 (D.N.J. 2016).

167 F. Supp. 3d 700 (Roche v. Aetna, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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