White v. Aetna Life Insurance Company

CourtDistrict Court, D. Connecticut
DecidedFebruary 9, 2021
Docket3:21-cv-00171
StatusUnknown

This text of White v. Aetna Life Insurance Company (White v. Aetna Life Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
White v. Aetna Life Insurance Company, (D. Conn. 2021).

Opinion

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF NORTH CAROLINA CHARLOTTE DIVISION 3:20-cv-204-MOC-DSC

YANIQUE WHITE, ) by and through her legal guardians, ) Michelle and Deryck White, ) ) Plaintiff, ) ) vs. ) ) ) ORDER ) AETNA LIFE INSURANCE CO., ) ) Defendant. ) ____________________________________)

THIS MATTER comes before the Court on a Motion to Dismiss for Lack of Jurisdiction, filed by Defendant Aetna Life Insurance Company. (Doc. No. 5). This Court held a hearing on the motion on December 2, 2020. I. BACKGROUND On February 28, 2020, Plaintiff Yanique White, by and through her legal guardians Michelle and Deryck White, filed this case against Defendant Aetna Life Insurance Company in the Union County Superior Court in Union County, North Carolina. See (Compl. Doc. No. 1-1). On April 2, 2020, Defendant timely removed the action to this Court based on diversity of citizenship under 28 U.S.C. § 1332. See (Notice of Removal, Doc. No. 1). The Complaint alleges that Deryck, Michelle, and Yanique White are all citizens of the State of North Carolina, residing in Matthews, North Carolina. Plaintiff Yanique White is incapacitated, and her parents Michelle White and Deryck White are her legal guardians. The Complaint further alleges that Defendant Aetna is an insurance company organized and existing under the laws of the State of Connecticut, with its principal place of business in Hartford, Connecticut. This action involves a dispute regarding coverage under a group health insurance policy between Defendant and the City of New York (the “Policy”). Deryck White was insured under the policy. The facts underlying this lawsuit show that Plaintiff Yanique White suffered from a brain injury at birth in 1998, and she has been in a persistent, vegetative state since then. (Doc.

No. 1-2 at ¶ 5). At the time the Complaint was filed, Plaintiff was 21 years old. (Id. at ¶ 6). Throughout her life, Plaintiff has required 24-hour skilled nursing care and close surveillance. (Id. at ¶¶ 6, 22). Plaintiff has been diagnosed with the following medical conditions: hypoxic/anoxic brain injury, persistent vegetative state, spastic quadriplegia, seizure disorder, scoliosis, osteopenia, chronic right hip dislocation, chronic lung disease, gastro-esophageal reflux disease, and incomplete eye closure with history of exposure keratitis. (Id. at ¶ 7). She suffers from violent seizures, and she depends on a tracheostomy, tracheostomy tubes, and ventilator to breathe. (Id. at ¶¶ 6, 7, 8). If Plaintiff’s tracheostomy or ventilator were to malfunction, she would be unable to breathe and would die. (Id. at ¶¶ 9–10). Plaintiff also

regularly experiences mucus plugs that form and impede her breathing. (Id. at ¶ 11). If the mucus plus are not readily identified and treated, Plaintiff would be unable to breathe and would die. Because Plaintiff cannot clear her own oral and tracheal secretions, she requires her airway to be suctioned multiple times a day. (Id. at ¶¶ 11–12). She also requires emergency trach-tube replacement and constant oral suctioning due to constant drooling. (Id. at ¶¶ 13–14). Plaintiff cannot communicate, walk, move, or bear weight. (Id. at ¶ 16). She is fed through a gastronomy tube and provided water through boluses three times a day. (Id. at ¶ 17). Plaintiff has numerous skilled nursing needs, including constant monitoring for wheezing, hypoxia, respiratory congestion, and signs of respiratory distress, and immediate emergent skilled treatment if these signs appear; tracheostomy care; tracheal, oropharyngeal, and nasopharyngeal suctioning; monitoring for frequent and dangerous seizure activity and prompt administration of appropriate anti-seizure medications, positioning and repositioning during tube feeding; and regular monitoring of her entire integumentary system for signs of infection and sores. (Id. at ¶ 23). Without skilled nursing care, Plaintiff is at serious risk for serious medical complications,

morbidity, and death, and there has been no marked improvement in her medical condition since infancy. (Id. at ¶¶ 24–25). At all relevant times, Plaintiff’s father was a New York City employee, insured under a group health policy issued by Defendant. (Id. at ¶ 26). Plaintiff has been insured under the Policy since birth as a dependent. (Id. at ¶ 27). For most of her life, Plaintiff has received in- patient treatment at a skilled nursing facility specializing in the treatment of individuals with conditions like Plaintiffs. (Id. at ¶ 30). From Plaintiff’s infancy until April 2015, when Plaintiff was 17 years old, Aetna paid the required health insurance benefits for Plaintiff’s medical care and for the 24-hour skilled nursing care at the skilled nursing facility where she resided in New

York. (Id. at 31). On some unspecified date in 2015, Plaintiff’s parents moved from the New York area to Matthews, North Carolina. Plaintiff alleges that “[o]n or before September 2015, the White family resolved to dedicate a space in their home in Matthews, North Carolina to the care of Yanique White,” they outfitted their home to meet Plaintiff’s medical needs, and they “planned to transfer Plaintiff to their medically-fitted home on or about September 2015.” (Id. at 32–34). On or before August 27, 2015, while Plaintiff was still residing in the skilled nursing facility in the State of New York, Plaintiff’s parents sought pre-authorization from Defendant for 24-hour, in-home nursing care for Plaintiff. (Id. ¶¶ 32, 34–35). Despite that Plaintiff’s needs had not changed at all, and contrary to medical professionals’ opinions that Plaintiff still required 24-hour, skilled in-home nursing care, Defendant denied Plaintiff’s pre-authorization claim for such care, claiming that such care was not medically necessary. (Id. ¶¶ 36–38). Then, immediately after the August 2015 request for pre-authorization, and despite no improvement by Plaintiff or any significant change in her vegetative condition, Defendant suddenly also denied

all future, in-patient coverage for the remainder of Plaintiff’s time at the skilled nursing facility where she resided in New York. (Id. ¶ 37). In September 2015, Plaintiff’s parents moved her from the skilled nursing facility in New York to their home in Matthews, North Carolina. (Id. ¶ 42). After Defendant denied Plaintiff’s claims, Plaintiff submitted an internal appeal to Aetna under the Policy’s optional appeals process. (Id. ¶¶ 49–59; Policy’s New York Complaint and Appeals Health Rider at 4). On February 28, 2017, Aetna upheld the denial. (Id. ¶¶ 68–74). While living in her parents’ home in North Carolina, Plaintiff has been under the care of Bayada Pediatrics, a subdivision of Bayada Home Health Care. (Id. at ¶ 43). Bayada provides 24-hour, in-home skilled nursing care for Plaintiff. (Id. at ¶ 44). The Whites continue to seek

pre-authorization from Defendant to have 24-hour, skilled nursing care provided by Bayada, and Defendant continues to deny the requests, alleging that the care provided for Plaintiff for seventeen years is no longer medically necessary. (Id. at ¶¶ 46–48). On February 28, 2020, Plaintiff filed this action in North Carolina state court, asserting claims against Defendant for breach of contract, breach of the covenant of good faith and fair dealing, bad faith, and violation of the North Carolina Unfair and Deceptive Trade Practices Act, N.C. GEN. STAT. 75-1.1 et seq. (Id. ¶¶ 75–109). Defendant removed the action to this Court on April 4, 2020. On May 26, 2020, Defendant filed the pending motion to dismiss, seeking dismissal of this action for lack of personal jurisdiction under Federal Rule of Civil Procedure Rule 12

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White v. Aetna Life Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/white-v-aetna-life-insurance-company-ctd-2021.