Summit Estate, Inc. v. UnitedHealthcare Insurance Company

District Court, N.D. California·Decided September 10, 2020·No. 4:19-cv-06724·Unknown

Opinion

CASE NO. 4:19-cv-06724 YGR ORDER GRANTING IN PART AND Plaintiff, DENYING IN PART MOTION FOR JUDGMENT ON THE PLEADINGS WITH v. LEAVE TO AMEND

COMPANY, Re: Dkt. No. 22 Defendant.

Plaintiff Summit Estate, Inc., brings this action against defendant United Healthcare Insurance Company (“United”) for claims arising out of United’s alleged failure to pay for substance-abuse-treatment services at the usual, customary, and reasonable rate (“UCR”). Summit Estate provided these services to patients with health insurance policies administered by United. In the complaint, Summit Estate asserts claims for breach of contract, intentional misrepresentation, negligent misrepresentation, fraudulent concealment, negligent non-disclosure, promissory estoppel, prohibitory injunctive relief, quantum meruit, a claim under California’s Unfair Competition Law (“UCL”), and a claim under the Employee Retirement Income Security Act of 1974 (“ERISA”). Now pending is United’s motion for judgment on the pleadings, which seeks judgment with respect to all state-law claims in the operative complaint on the grounds that such claims are preempted by ERISA or, alternatively, are inadequately pleaded. Having carefully considered the pleadings and the parties’ briefs, and for the reasons set forth below, the Court GRANTS IN PART AND DENIES IN PART the motion for judgment on the pleadings WITH LEAVE TO AMEND. // Summit Estate allege as follows: Summit Estate provided substance-abuse-treatment services to patients who had health insurance policies that United administered, underwrote, or issued. First Am. Comp. ¶¶ 1-5, Docket No. 1-1. Summit Estate contacted United “to verify insurance benefits and was advised in all cases that the policies provided for and Defendants would pay for treatment at the usual, reasonable and customary rate (UCR).” Id. ¶ 6. Summit Estate relied on these representations in providing services to United-insured patients. Id. “Within the past two years,” United breached its agreement with Summit Estate “by refusing to pay Plaintiff the represented and agreed upon UCR rate but rather paid a different and significantly lower amount for treatment.” Id. ¶ 8. Summit Estate alleges that it would suffer “an unconscionable injury” if United is not required to pay “the represented/agreed to UCR rate.” Id. Summit Estate alleges that it received from United- insured patients “assignments of insurance benefits and powers of attorney whereby the insurance benefits under the plans were assigned to Plaintiff[.]” Id. ¶ 56. Summit Estate’s claims, listed above, are all predicated on the theory that United failed to pay Summit Estate for the substance-abuse-treatment services at issue at the UCR notwithstanding its representations that it would do so. Initially, plaintiff filed this action in state court on May 1, 2017. In the original complaint, Summit Estate asserted only the state-law claims, not one under ERISA. See Docket No. 1-3. Summit Estate represents that, after United indicated a desire to add an ERISA affirmative defense to its answer, the parties stipulated to permit United to file an amended answer to the original complaint, and to permit Summit Estate to file an amended complaint. See Opp’n at 6, Docket No. 25. Pursuant to that stipulation, Summit Estate filed the operative complaint in state court, which asserts an ERISA claim in addition to the state-law claims asserted in the original complaint. Docket No. 1-1. United then removed the action to this Court on October 18, 2019. Notice of Removal, Docket No. 1. “After the pleadings are closed—but early enough not to delay trial—a party may move pleadings where there are no issues of material fact and the moving party is entitled to judgment as a matter of law when taking the allegations in the pleadings as true. Gregg v. Haw. Dep’t of Pub. Safety, 870 F.3d 883, 887 (9th Cir. 2017) (citation omitted). This standard is “functionally identical” to the standard for determining a motion to dismiss under Rule 12(b)(6). Id. Accordingly, a court need not accept as true factual allegations that are conclusory or conclusions of law. See Ashcroft v. Iqbal, 556 U.S. 662, 678-79 (2009) (citation omitted). “As with a Rule 12(b)(6) motion to dismiss, a court granting judgment on the pleadings pursuant to Rule 12(c) should grant leave to amend even if no request for leave to amend has been made, unless it is clear that amendment would be futile.” Finley v. Capital One, No. 16-CV-01392-YGR, 2017 WL 1365207, at *2 (N.D. Cal. Apr. 14, 2017) (Gonzalez Rogers, J.) (citation and internal quotation marks omitted). When ruling on a motion for judgment on the pleadings, a court may consider documents that the pleadings incorporate by reference, as well as matters that are subject to judicial notice. Sprewell v. Golden State Warriors, 266 F.3d 979, 988 (9th Cir. 2001) (citation omitted). The court “need not . . . accept as true allegations that contradict matters properly subject to judicial notice or by exhibit” attached to the complaint. Id. United moves to dismiss all state-law claims in the operative complaint on the ground that such claims are preempted by ERISA under the conflict preemption provision, ERISA Section 514(a), 29 U.S.C. § 1144(a). United counters that these claims depend on the existence and terms of ERISA plans because they are premised on allegations that United represented during verification-of-benefit communications with Summit Estate that the plans of Summit Estate’s patients covered the substance-abuse-treatment services at the UCR and that United would pay for such services at the UCR in accordance with the plans. In the alternative, United argues that Summit Estate’s state-law claims are inadequately pleaded. The Court addresses each of these arguments in turn. A. Preemption ERISA Section 514(a) expressly preempts “any and all State laws insofar as they may now suggests that the phrase ‘relate to’ should be read broadly, the Supreme Court has recently admonished that the term is to be read practically, with an eye toward the action’s actual relationship to the subject plan.” Providence Health Plan v. McDowell, 385 F.3d 1168, 1172 (9th Cir. 2004) (citing New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Ins. Co., 514 U.S. 645, 655-56 (1995)). “Generally speaking, a common law claim ‘relates to’ an employee benefit plan governed by ERISA ‘if it has a connection with or reference to such a plan.’” Id. (citation omitted). “In evaluating whether a common law claim has ‘reference to’ a plan governed by ERISA, the focus is whether the claim is premised on the existence of an ERISA plan, and whether the existence of the plan is essential to the claim’s survival. If so, a sufficient ‘reference’ exists to support preemption.” Id. (citations omitted). “In determining whether a claim has a ‘connection with’ an employee benefit plan, courts in this circuit use a relationship test. Specifically, the emphasis is on the genuine impact that the action has on a relationship governed by ERISA, such as the relationship between the plan and a participant.” Id. (citations omitted). Here, Summit Estate’s state-law claims are based in tort or equitable concepts and do not necessarily depends on the existence or terms of an ERISA plan. Summit Estate’s allegations raise the inference that United confirmed that the services at issue were

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