Tolani v. Medical Mutual of Ohio

CourtDistrict Court, N.D. Ohio
DecidedApril 22, 2020
Docket1:19-cv-02388
StatusUnknown

This text of Tolani v. Medical Mutual of Ohio (Tolani v. Medical Mutual of Ohio) is published on Counsel Stack Legal Research, covering District Court, N.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tolani v. Medical Mutual of Ohio, (N.D. Ohio 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF OHIO EASTERN DIVISION

AJIT TOLANI, et al., CASE NO. 1:19-CV-02388

Plaintiffs, -vs- JUDGE PAMELA A. BARKER

MEDICAL MUTUAL OF OHIO, MEMORANDUM OF OPINION AND Defendant. ORDER

This matter comes before the Court upon the Motion to Remand of Plaintiffs Ajit Tolani (“Mr. Tolani”), Shruti Tolani, and their minor daughter (collectively, “Plaintiffs”). (Doc. No. 9.) Defendant Medical Mutual of Ohio (“MMO”) filed a brief in opposition on December 4, 2019, to which Plaintiffs replied on December 11, 2019. (Doc. Nos. 15, 16.) For the following reasons, Plaintiffs’ Motion to Remand (Doc. No. 9) is GRANTED IN PART and DENIED IN PART. I. Background a. Factual Background According to Plaintiffs’ Complaint, Mr. Tolani is an internationally-respected attorney that specializes in transfer pricing and international tax issues. (Doc. No. 1-1 at ¶ 7.) Plaintiffs allege Mr. Tolani worked for KPMG in New York from 2005 to 2008, but that he and his family relocated to India at KPMG’s request in 2008. (Id. at ¶¶ 8-9.) Plaintiffs contend, however, that they always desired to move back to the United State permanently. (Id. at ¶ 12.) Plaintiffs assert that, in 2015, Mr. Tolani was diagnosed with interstitial lung disease, a debilitating condition that can cause permanent scarring of the lungs, making it difficult to breathe. (Id. at ¶ 14.) Plaintiffs further aver that, in April 2016, Mr. Tolani met with Dr. Atul Mehta from the Cleveland Clinic, who informed Mr. Tolani that he likely needed a lung transplant. (Id. at ¶¶ 15-17.) Plaintiffs state that Mr. Tolani’s deteriorating medical condition accelerated the timing of Plaintiffs’ decision to make a permanent move back to the United States, and, that same month, Plaintiffs decided to take all necessary steps to move back. (Id. at ¶¶ 18-19.) Plaintiffs allege that, in December 2016, they moved to Cleveland, Ohio and applied for health insurance through the federally facilitated marketplace established by the Patient Protection and

Affordable Care Act (“ACA”). (Id. at ¶¶ 20-21.) Plaintiffs claim that they purchased a Qualified Health Plan (“QHP”) from MMO and received medical care under the policy in February 2017, but that MMO rescinded the policy after Plaintiffs submitted a pre-authorization request for Mr. Tolani’s lung transplant procedure. (Id. at ¶¶ 25-30.) According to Plaintiffs, MMO rescinded the policy because it found that Plaintiffs were not eligible to purchase a QHP pursuant to regulations under the ACA. (Id. at ¶¶ 37-38.) Specifically, MMO determined that Plaintiffs did not meet the residency requirements enumerated in 45 C.F.R. § 155.305, as MMO claimed Plaintiffs were only in their service area to obtain medical care, would leave after that care was completed, and therefore did not intend to reside in the area as required by the regulation. (Id. at ¶¶ 37-39.) Plaintiffs appealed the termination of their policy, but MMO reaffirmed its decision. (Id. at ¶¶ 41-44.)

Plaintiffs contend MMO’s decision was improper because Plaintiffs intended to reside in Ohio not just for the medical procedures that Mr. Tolani required, but thereafter. (Id. at ¶¶ 43-48.) As a result of MMO’s actions, Plaintiff claim they were forced to pay hundreds of thousands of dollars out of pocket for Mr. Tolani’s lung transplant procedure. (Id. at ¶ 35.)

2 b. Procedural History On August 1, 2019, Plaintiffs filed suit against MMO in the Court of Common of Cuyahoga County Ohio, setting forth claims for breach of contract, bad faith, negligence, and punitive and exemplary damages based on MMO’s allegedly improper decision to terminate their health insurance policy. (Doc. No. 1-1.) MMO subsequently removed the action to this Court, asserting that federal jurisdiction exists because although Plaintiffs’ claims are styled as state-law claims, resolution of the

action depends on the interpretation, construction, and effect of federal law—i.e., the ACA regulations establishing the eligibility requirements at issue. (Doc. No. 1.) On October 16, 2019, MMO then filed a Motion to Dismiss Plaintiffs’ claims. (Doc. No. 6.) Shortly thereafter, Plaintiffs filed a Motion to Remand the case to state court. (Doc. No. 9.) Plaintiffs also requested that the Court stay briefing on MMO’s Motion to Dismiss pending resolution of Plaintiffs’ Motion to Remand. (Doc. No. 11.) The Court granted Plaintiffs’ request after MMO did not object to it. (Doc. Nos. 12, 13.) As such, briefing continued only with respect to Plaintiffs’ Motion to Remand, and MMO filed a brief in opposition to Plaintiffs’ Motion on December 4, 2019, to which Plaintiffs responded on December 11, 2019. (Doc. Nos. 15, 16.) II. Standard of Review

Pursuant to 28 U.S.C. § 1447(c), “[i]f at any time before final judgment it appears that the district court lacks subject matter jurisdiction, the case shall be remanded.” In addition, “[a]s a court of limited jurisdiction, a federal district court must proceed cautiously in determining that it has subject matter jurisdiction.” Petrofski v. Chrysler LLC, No. 5:07CV3619, 2008 WL 5725581, at *2 (N.D. Ohio Jan. 17, 2008). Accordingly, “[a]ll doubts as to the propriety of removal are resolved in favor of remand.” Coyne v. Am. Tobacco Co., 183 F.3d 488, 493 (6th Cir. 1999). The party seeking

3 removal also bears the burden of showing that federal jurisdiction exists. See Rogers v. Wal-Mart Stores, Inc., 230 F.3d 868, 871 (6th Cir. 2000). A court “has wide discretion to allow affidavits, documents and even a limited evidentiary hearing to resolve disputed jurisdictional facts.” Ohio Nat. Life Ins. Co. v. United States, 922 F.2d 320, 325 (6th Cir. 1990). III. Analysis a. Federal Subject-Matter Jurisdiction

In their Motion to Remand, Plaintiffs contend that no federal jurisdiction exists because they assert only state-law claims and are not seeking a recovery under the ACA. (Doc. No. 9.) In response, MMO contends that the resolution of Plaintiffs’ claims depends on the application of federal regulations under the ACA, such that Plaintiffs’ claims raise a substantial federal question sufficient to establish federal subject-matter jurisdiction. (Doc. No. 15.) The Court concludes that Plaintiffs’ claims do not raise a substantial federal question and thus, will remand the matter to state court. “In the absence of diversity, a defendant may remove a civil action from state court to federal court only if the plaintiff’s allegations establish ‘original jurisdiction founded on a claim or right arising under’ federal law.” Mikulski v. Centerior Energy Corp., 501 F.3d 555, 560 (6th Cir. 2007) (quoting 28 U.S.C. § 1441(b)). “Whether a cause of action arises under federal law must be apparent

from the face of the ‘well-pleaded complaint.’” Miller v. Bruenger, 949 F.3d 986, 990 (6th Cir. 2020) (quoting Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 63 (1987)). Accordingly, “for purposes of assessing whether federal-question jurisdiction exists, federal courts ignore any potential federal defenses that may arise in the course of the litigation.” Id.

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