Sarkisyan v. CIGNA Healthcare of California, Inc.

613 F. Supp. 2d 1199, 2009 U.S. Dist. LEXIS 42281, 2009 WL 1349734
CourtDistrict Court, C.D. California
DecidedApril 16, 2009
DocketCase CV 09-00335 GAF (RCx)
StatusPublished
Cited by9 cases

This text of 613 F. Supp. 2d 1199 (Sarkisyan v. CIGNA Healthcare of California, Inc.) 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
Sarkisyan v. CIGNA Healthcare of California, Inc., 613 F. Supp. 2d 1199, 2009 U.S. Dist. LEXIS 42281, 2009 WL 1349734 (C.D. Cal. 2009).

Opinion

MEMORANDUM & ORDER REGARDING MOTION TO DISMISS

GARY ALLEN FEESS, District Judge.

I. INTRODUCTION

Plaintiffs Grigor and Hilda Sarkisyan initiated the present lawsuit against defen *1201 dants CIGNA Healthcare of California, Inc. and CIGNA Healthcare, Inc. (collectively, “CIGNA”) on December 18, 2008 in Los Angeles Superior Court for injuries they suffered after their minor daughter, Nataline, died of liver failure. Plaintiffs allege that CIGNA, the administrator of Plaintiffs’ employee benefit health plan, wrongfully denied coverage for a liver transplant that may have saved Nataline’s life, and have asserted claims of breach of contract, breach of the implied covenant of good faith and fair dealing, unfair business practices under section 17200 of the California Business & Professions Code, and intentional infliction of emotional distress. Plaintiffs seek compensatory and punitive damages and permanent injunctive relief, as well as prejudgment interest, reasonable attorneys’ fees, and court costs.

CIGNA removed the ease to this Court on January 15, 2009. Presently before the Court is CIGNA’s motion to dismiss Plaintiffs’ claims under Rule 12(b)(6) of the Federal Rules of Civil Procedure. CIGNA contends that Plaintiffs’ claims are preempted by sections 502(a) and 514(a) of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1132(a), 1144(a), because the claims challenge or relate to a denial of benefits under an employee benefit plan that is subject to ERISA. The Court agrees that ERISA preempts Plaintiffs’ breach of contract, breach of the implied covenant of good faith and fair dealing, and unfair business practices claims because they are directly related to CIGNA’s denial of benefits. Accordingly, CIGNA’s motion to dismiss those claims is GRANTED, and the claims are DISMISSED WITH PREJUDICE. The Court concludes, however, that ERISA does not preempt Plaintiffs’ intentional infliction of emotional distress claim insofar as that claim is based on events that occurred during Plaintiffs’ visit to CIGNA’s headquarters more than one year after the coverage decision. Accordingly, the motion to dismiss the emotional distress claim is DENIED. The Court explains its reasoning in detail below.

II. BACKGROUND

In April 2005, Sonic Automotive, Inc. (“Sonic”) and non-party Connecticut General Life Insurance Company (“CGLIC”), a CIGNA affiliate, entered into an Administrative Services Only Agreement whereby Sonic agreed to pay CGLIC to administer an employee health benefit plan that Sonic funds and provides to its employees (“Sonic Benefit Plan” or “Plan”). (See Lipar Decl. (Not. Removal) ¶ 3, Ex. A [Administrative Services Only Agreement at 1-5].) As a Sonic employee, plaintiff Grigor Sarkisyan enrolled himself and his wife in the Sonic Benefit Plan as of May 1, 2007. (Lipar Deck (Not. Removal) ¶ 2.) Nataline was a beneficiary under the Plan. (Id.)

In 2004, when she was fourteen years old, Nataline was diagnosed with Acute Lymphoblastic Leukemia. (Compl. ¶ 16.) After Nataline underwent chemotherapy treatment, her physicians determined that her cancer was in remission. (Id.) In or about August 2007, however, Nataline relapsed and again underwent chemotherapy treatment. (Compl. ¶ 17.) Nataline’s physicians subsequently determined that she required a bone marrow transplant, and in late-November 2007, Nataline underwent a transplant procedure using her brother’s bone marrow. (Compl. ¶¶ 17-18.) Although the transplant was initially considered a success, Nataline’s liver soon began to fail while she was still recovering from the procedure. (Compl. ¶¶ 18-19.) Nataline’s physicians immediately informed her parents that a liver transplant was necessary to save Nataline’s life. (Compl. ¶ 19.)

In early December 2007, Plaintiffs and Nataline’s physicians from the UCLA Medical Center in Los Angeles, California *1202 contacted CIGNA to report that Nataline would need a life-saving liver transplant, and to seek pre-authorization for the procedure. (Compl. ¶ 20.) CIGNA immediately sent a “Notice of Denial of Coverage” letter to Plaintiffs, declining to authorize the transplant. (Compl. ¶ 21.) Plaintiffs and Nataline’s physicians appealed the denial of coverage, and on December 11, 2007, four of Nataline’s physicians sent a joint letter to CIGNA requesting reconsideration of the coverage decision. (Compl. ¶¶ 22-23.) The physicians’ letter highlighted the urgency of Nataline’s situation, and their belief that Nataline was an excellent candidate for a liver transplant. (Compl. ¶ 23.) Nevertheless, CIGNA denied coverage on the ground that Nataline’s medical benefits did not cover “experimental, investigational and unproven services.” (Compl. ¶ 24.) Over the course of the next few days, Nataline’s condition worsened. (Compl. ¶ 25.) On the afternoon of December 20, 2007, Nataline died of acute liver failure. (Compl. ¶ 26.)

III. DISCUSSION

A. Legal Standard

On a Rule 12(b)(6) motion to dismiss for failure to state a claim, a court must accept all factual allegations pleaded in the complaint as true, and construe those facts and draw all reasonable inferences therefrom “in the light most favorable to the nonmoving party.” Cahill v. Liberty Mut. Ins. Co., 80 F.3d 336, 337-38 (9th Cir.1996); see also Stoner v. Santa Clara County Office of Educ., 502 F.3d 1116, 1120-21 (9th Cir.2007). A court may dismiss a complaint under Rule 12(b)(6) only if it appears beyond doubt that the alleged facts, even if true, will not entitle the plaintiff to relief on the theories asserted. See Bell Atl. Corp. v. Twombly, 550 U.S. 544, 127 S.Ct. 1955, 1968-69, 167 L.Ed.2d 929 (2007); Stoner, 502 F.3d at 1120-21; see also Cahill, 80 F.3d at 338. While a complaint need not contain detailed factual allegations, “a plaintiffs obligation to provide the grounds of his entitlement to relief requires more than labels and conclusions, and a formulaic recitation of a cause of action’s elements will not do.” Twombly, 127 S.Ct. at 1964-65 (citation, alteration, and internal quotation marks omitted). Moreover, the court is not “required to accept as true allegations that are merely conclusory, unwarranted deductions of fact, or unreasonable inferences.” Sprewell v. Golden State Warriors, 266 F.3d 979, 988 (9th Cir.2001). Finally, although the court generally cannot look beyond the pleadings, it may consider (1) any documents attached to the pleadings, Warren v. Fox Family Worldwide, Inc., 328 F.3d 1136, 1141 n.

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613 F. Supp. 2d 1199, 2009 U.S. Dist. LEXIS 42281, 2009 WL 1349734, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sarkisyan-v-cigna-healthcare-of-california-inc-cacd-2009.