Roche v. Aetna, Inc.

165 F. Supp. 3d 180, 2016 WL 780844, 2016 U.S. Dist. LEXIS 24733
CourtDistrict Court, D. New Jersey
DecidedFebruary 29, 2016
DocketCivil No. 13-3933 (NLH/KMW)
StatusPublished
Cited by4 cases

This text of 165 F. Supp. 3d 180 (Roche v. Aetna, Inc.) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Roche v. Aetna, Inc., 165 F. Supp. 3d 180, 2016 WL 780844, 2016 U.S. Dist. LEXIS 24733 (D.N.J. 2016).

Opinion

OPINION

HILLMAN, United States District Judge:

This suit concerns alleged violations of New Jersey’s insurance regulation laws brought by Plaintiff Michelle Roche (“Plaintiff’ or “Roche”) both individually and as a putative class representative 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. 12 & 60]. For the reasons set forth below, Defendants’ Motion will be granted.

I. FACTUAL BACKGROUND AND PROCEDURAL HISTORY1

Roche was involved in a car accident on January 19, 2007 in Pike County, Pennsylvania. (Defs.’ Statement of Material Facts (“DSMF”) [Dkt. No. 13] ¶¶ 1-2.) The accident caused Roche serious injuries, and in the course of treatment for her injuries, she received benefits from her health insurance policies. (Compl. [Dkt. No. 1-1] ¶ 14.)

At the time, Roche was a participant in two different health insurance plans. (DSMF ¶¶ 4-5; Pl.’s Resp. to DSMF [182]*182(“PSMF”) [Dkt. No. 35-5] ¶¶4-5.) The first plan was a governmental health plan funded by the State of New Jersey State Health Benefits Program and administered by Aetna Life Insurance Company (the “State Plan”). (DSMF ¶ 5; PSMF ¶ 5.) This policy was issued through Roche’s husband’s employment. (PL’s Opp. [Dkt. No. 35] at 5.) Roche received $86,601.72 in benefits from the State Plan. (DSMF ¶ 12.)

The second plan was an employee group health plan sponsored by Bank of America, N.A., also administered by Aetna Life Insurance Company (the “B.O.A. Plan”). (DSMF ¶ 4; PSMF ¶4.) Roche received $1,473.57 in benefits from the B.O.A. Plan. (DSMF ¶ 13.) The B.O.A. Plan is a covered plan 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.); the State Plan is a non-ERISA plan. (See PL’s Opp. at 5 & n.2; Def.’s Mot. Br. [Dkt. No. 14] at 4.)

On December 2, 2008, Roche commenced a civil action in the Court of Common Pleas of Pike County, Pennsylvania against the alleged tortfeasor in her car accident and his insurer. (DSMF ¶ 3.) Roche eventually recovered money in that action pursuant to a settlement. (Compl. ¶¶ 89-90.) Beginning in September 2010, Rawlings contacted Roche’s personal injury attorney asserting that it had a right to reimbursement of any eventual recovery made in the lawsuit through a series of letters to both Roche’s attorney and the defendant’s attorney in her personal injury suit. (DSMF ¶ 11; PSMF ¶ 11; Van Natta Decl. Ex. 1 [Dkt. No. 11-1]; Kannebecker Deck Ex. 1-3 [Dkt. No. 35-4]; Roche Deck [Dkt. No. 35-2] ¶ 2.) As a result of these letters, Roche feared that if she did not pay Defendants, she would be sued, lose her health insurance, or suffer a negative impact on her credit score. (Roche Deck ¶3.) Based on those fears, in January 2013, Roche authorized payment of $88,075.29 for reimbursement of the benefits received under her State Plan and B.O.A. Plan. (DSMF ¶ 14; Roche Deck ¶ 4.) Subsequently, Rawlings remitted a check for $306.66 for an overpayment due to an adjustment in a paid claim. (DSMF ¶ 15; Van Natta Deck [Dkt. No. 11] ¶ 7; Kannebecker Deck Ex. 4.) At no time did Defendants sue Roche, Roche’s tortfeasor, or appear as an intervenor in her personal injury lawsuit. (DSMF ¶ 16; PSMF ¶ 16.)

On January 25, 2013, Roche along with two others filed a complaint against the Defendants in the New Jersey Superior Court, Law Division, Atlantic County (the “Minerley Action”). (See Minerley Action Original Compl. [Dkt. No. 1-1, Civ. No. 13-1377].) The Minerley Action was removed to this Court as Civil Action No. 13-1377, and the complaint was subsequently amended to remove Roche from the case. (See Minerley Action Notice of Removal [Dkt. No. 1, Civ. No. 13-1377]; Minerley Action First Am. Compl. [Dkt. No. 15, Civ. No. 13-1377].)

On May 28, 2013, Roche filed the instant case in the New Jersey Superior Court, Law Division, Atlantic County. (See Compl.) Roche complains on behalf of herself and a putative class of persons covered by non-ERISA governmental health plans that the recovery actions by Defendants violate New Jersey’s anti-subrogation 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. 56:88-19, and other common law torts. (See generally Compl.) Roche’s suit is specifically targeted toward the efforts undertaken by Defendants to obtain subro-gation for benefits she received under the State Plan only, and not under the B.O.A. Plan. (Pl.’s Opp. at 5 n.2.)

[183]*183Defendants removed this action on June 25, 2013. Notice of Removal [Dkt. No. 1]. Roche attempted to remand this action, and the motion was granted in part by Judge Joseph H. Rodriguez2 to permit jurisdictional discovery to determine if the home state exception to jurisdiction under the Class Action Fairness Act of 2005 (“CAFA”), Pub. L. No. 109-2, 119 Stat. 4 (relevant portion codified at 28 U.S.C. § 1332(d)) applied. See Roche v. Aetna Health Inc. (Roche I), Civ. No. 13-3933 (JHR), 2014 WL 1309963 (D.N.J. Mar. 31, 2014), modified on reconsideration, Roche v. Aetna Health Inc. (Roche II), 2014 WL 7179614 (D.N.J. Dec. 17, 2014). While the motion for remand was pending, the instant summary judgment motion was filed and briefed. In granting jurisdictional discovery, Judge Rodriguez also dismissed without prejudice the summary judgment motion with the right to reinstate the motion by letter. (Order, Mar. 31, 2014 [Dkt. No. 43].)

Roche informed this Court by way of letter on July 2, 2015 that she was withdrawing her request for remand and urged the Court to proceed with the litigation. (See Ercole Letter [Dkt. No. 56].) Defendants then requested the Court reinstate the motion for summary judgment. (See Cohen Letter [Dkt. No. 57].)3 The motion was subsequently reinstated.

II. JURISDICTION

Roche has brought suit as a representative of a putative class on issues of New Jersey law. It has already been determined that no federal question jurisdiction exists, and so the only means of jurisdiction in this Court is under CAFA. See Roche, 2014 WL 1309963, at *2. “CAFA provides federal courts with jurisdiction over civil class actions if [1] the ’matter in controversy exceeds the sum or value of $5,000,000,’ [2] the aggregate number of proposed class members is 100 or more, and [3] any class member is a citizen of a state different from any defendant.” Vodenichar v. Halcon Energy Props., Inc., 733 F.3d 497, 503 (3d Cir.2013) (citing 28 U.S.C. § 1332(d)(2), (d)(2)(A), (d)(5)(B)).

Each requirement is satisfied here. Roche pleads that the class is comprised of over 100,000 members in New Jersey. (Compl. ¶ 23.) Defendants further aver that the putative class would consist of citizens of other states who receive benefits under New Jersey governmental plans.

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Cite This Page — Counsel Stack

Bluebook (online)
165 F. Supp. 3d 180, 2016 WL 780844, 2016 U.S. Dist. LEXIS 24733, Counsel Stack Legal Research, https://law.counselstack.com/opinion/roche-v-aetna-inc-njd-2016.