West v. Health Net of the Northeast

217 F.R.D. 163, 31 Employee Benefits Cas. (BNA) 2076, 2003 U.S. Dist. LEXIS 13597, 2003 WL 21805224
CourtDistrict Court, D. New Jersey
DecidedAugust 7, 2003
DocketCivil Nos. 01-5217 (JBS), 01-5237(JBS)
StatusPublished
Cited by6 cases

This text of 217 F.R.D. 163 (West v. Health Net of the Northeast) 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
West v. Health Net of the Northeast, 217 F.R.D. 163, 31 Employee Benefits Cas. (BNA) 2076, 2003 U.S. Dist. LEXIS 13597, 2003 WL 21805224 (D.N.J. 2003).

Opinion

OPINION

SIMANDLE, District Judge.

Presently before the Court are two motions for summary judgment filed by defendants Health Net of the Northeast (“Health Net”) and Oxford Health Plans (“Oxford Health”) in these related putative class actions arising under the Employee Retirement Income Security Act of 1974 (“ERISA”). After almost two years of motion practice in these cases, defendants seek summary judgment arguing that plaintiffs never had standing to bring their claims for compensatory relief and that plaintiffs’ claims for injunctive relief became moot no later than November 2001.

The plaintiffs filed these actions after the New Jersey Supreme Court, in Perreira v. Rediger, 169 N.J. 399, 778 A.2d 429 (2001), held that health insurers who expended funds on behalf of an insured cannot seek to recover the funds from an insured’s tort recovery through subrogation or reimbursement liens. Plaintiffs filed the present actions seeking compensation for the amounts that their health insurers had collected from their tort recoveries, injunctive relief declaring the subrogation and reimbursement liens void and enjoining all further collection efforts, and class relief for New Jersey insureds who were also subjected to subrogation and reimbursement liens.

This motion requires the Court to determine whether and when plaintiffs’ compensatory and injunctive relief claims became moot, and whether mootness of their claims requires this Court to dismiss the entire action, including its asserted class-based relief claims. For the reasons explained herein, the Court finds (1) that neither plaintiff had standing to sue for compensatory relief because the defendants never collected any subrogation monies from them, (2) that plaintiff Collins did not have standing to sue for declaratory relief because he was not subject to a subrogation lien when he filed suit on October 4, 2001 because the lien had been abandoned on July 18, 2001, (3) that plaintiff West had standing to sue for declaratory relief when she filed suit on October 4, 2001 [166]*166because she was subject to a subrogation lien, but that her claim for declaratory relief became moot on November 9, 2001 when the lien was abandoned, and (4) that the mootness of plaintiffs’ claims prior to the filing of class certification motions in September, 2002, requires this Court to dismiss all claims of the uncertified putative class without prejudice to their reassertion by proper class representatives. Therefore, this Court will grant defendants’ motions for summary judgment and will dismiss plaintiffs’ complaints.

I. BACKGROUND

A. Procedural History

In January 2002, this Court consolidated, for the limited purpose of considering motions to remand and motions to dismiss, the present two actions and four other actions under the docket of the earliest-filed action, Carducci v. Aetna U.S. Healthcare, Civil No. 01-4675.1 This Court has previously detailed the procedural history of these consolidated eases, which has involved the addition of three more cases.2 See Carducci v. Aetna U.S. Healthcare, 247 F.Supp.2d 596 (D.N.J.2003); Carducci v. Aetna U.S. Healthcare, Civ. No. 01-4675, 2002 WL 31262100 (D.N.J. Jul.24, 2002); Carducci v. Aetna U.S. Healthcare, 204 F.Supp.2d 796 (D.N.J.2002).

The eases were consolidated for the limited purposes of deciding their motions to remand and motions to dismiss because the motions dealt with similar issues arising under ERISA. Each case was originally filed as a class action complaint in New Jersey Superi- or Court based on Perreira v. Rediger, 169 N.J. 399, 778 A.2d 429 (2001), where the New Jersey Supreme Court held that, under New Jersey’s collateral source statute N.J.S.A. 2A:15-97, a health insurer who expended funds on behalf of an insured may not recoup the funds through subrogation or reimbursement liens if the insured recovers from a third-party tortfeasor. In each case, the plaintiff was insured under an employee benefit health plan which paid health benefits for plaintiff’s personal injuries, but which included a subrogation and reimbursement provision allowing the plan to recoup the benefits should the plaintiff recover from a third party tortfeasor.3

The plaintiffs involved in the present motions filed identically-worded complaints in state court. In Count I of the West and Collins complaints, each alleges that his or her health insurance company was unjustly enriched because “Defendant required Plaintiff and the Class to reimburse Defendant for those funds expended on behalf of Plaintiff and Class members when Plaintiff and Class members recovered a judgment or settled any personal injury action against a tortfea-sor.”4 In Count II, plaintiffs allege that [167]*167“Defendant has taken, reserved, received, collected and converted thousands of dollars in subrogation and reimbursement payments from Plaintiff and the Class based on a false and illegal claim of right.”5 In Count III, plaintiffs seek an amendment of the terms of their health plans to comply with the Per-reira decision.6 In Count IV, plaintiffs seek a declaratory judgment that defendants be ordered to cease all collection efforts on reimbursement and subrogation liens.

Plaintiffs, thus, seek three types of relief: (1) compensatory relief “for damages in the amount of the reimbursements paid by Plaintiff to Defendant for payments made by Defendant to third parties on behalf of Plaintiff, together with interest thereon,” (2) injunctive relief declaring all asserted reimbursement and subrogation liens void and enjoining further collection efforts by Defendants, and (3) class relief in the form of compensatory and injunctive relief. (See Complaints, Prayer for Relief.)

After hearing oral argument on the remand motions of the plaintiffs in January and April 2002, the Court denied the motions in a May 28, 2002 decision, finding that the monies that plaintiffs alleged were taken by the defendant insurers pursuant to the subrogation clauses in their employee benefit healthcare contracts were “benefits due” under ERISA section 502(a)(1)(B), meaning that the state law unjust enrichment claims were completely preempted by federal law and were properly removed to federal court. See Carducci, et al. v. Aetna U.S. Healthcare, 204 F.Supp.2d 796 (D.N.J.2002).7 The Court explained that the relief was for “benefits due” because the “classification of the monies sought by plaintiff was addressed at length in oral argument,” id. at 801, and that “[essentially plaintiffs seek to regain the whole benefit provided to them by defendants, including those amounts paid in subrogation pursuant to the terms of the plans,” id. at 803.

In September, 2002, the consolidated defendants, including Health Net and Oxford Health, filed a joint motion to dismiss the Complaint, asserting that plaintiffs’ complaints should be dismissed because the claims were completely preempted by ERISA § 502(a)(1)(B), were conflict preempted by ERISA § 514(a), and were barred by the voluntary payment doctrine, the law regarding the retrospective application of court decisions, the standing doctrine or the mootness doctrine.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
217 F.R.D. 163, 31 Employee Benefits Cas. (BNA) 2076, 2003 U.S. Dist. LEXIS 13597, 2003 WL 21805224, Counsel Stack Legal Research, https://law.counselstack.com/opinion/west-v-health-net-of-the-northeast-njd-2003.