Wurtz v. Rawlings Co.

761 F.3d 232, 59 Employee Benefits Cas. (BNA) 1081, 2014 WL 3746801, 2014 U.S. App. LEXIS 14877
CourtCourt of Appeals for the Second Circuit
DecidedJuly 31, 2014
Docket13-1695-cv
StatusPublished
Cited by82 cases

This text of 761 F.3d 232 (Wurtz v. Rawlings Co.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Second Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wurtz v. Rawlings Co., 761 F.3d 232, 59 Employee Benefits Cas. (BNA) 1081, 2014 WL 3746801, 2014 U.S. App. LEXIS 14877 (2d Cir. 2014).

Opinion

JOHN M. WALKER, JR., Circuit Judge:

Plaintiffs initially filed the complaint in this case in New York state court, seeking, among other things, to enjoin defendant insurers under N.Y. Gen. Oblig. Law § 5-335 from obtaining reimbursement of medical benefits from plaintiffs’ tort settlements. Defendants removed this action to the Eastern District of New York (Joseph F. Bianco, District Judge), where the district court granted defendants’ motion to dismiss under Rule 12(b)(6) for failure to state a claim on the basis that plaintiffs’ claims were subject to both “complete” and “express” preemption under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq.

We hold that plaintiffs’ claims do not satisfy the Supreme Court’s test for being subject to complete ERISA preemption, which would have conferred federal subject-matter jurisdiction. See Aetna Health Inc. v. Davila, 542 U.S. 200, 210, 124 S.Ct. 2488, 159 L.Ed.2d 312 (2004). Such jurisdiction exists, however, under the Class Action Fairness Act (“CAFA”), 28 U.S.C. § 1332(d). We thus reach the merits of the express preemption defense and conclude that N.Y. Gen. Oblig. Law § 5-335 is saved from express preemption under ERISA § 514, 29 U.S.C. § 1144, as a law that “regulates insurance.” Accordingly, we VACATE the district court’s judgment and REMAND for further proceedings on plaintiffs’ claims.

BACKGROUND

The New York statute at issue in this appeal, N.Y. Gen. Oblig. Law § 5-335, 1 states that a personal injury settlement presumptively “does not include any compensation for the cost of health care services” or other losses that “are obligated to be paid or reimbursed by a benefit provider” (such as an insurer), and that benefit providers have no “right of subro-gation or reimbursement against any such settling party.” 2 When section 5-335 was enacted in 2009, it eliminated an asymmetry between jury verdicts and settlements that tended to discourage the settlement of personal injury lawsuits. 3

*237 In February 2012, plaintiffs Meghan Wurtz and Mindy Burnovski filed a class action complaint in New York state court, alleging section 5-335 violations by the three defendants, which are related companies in the insurance business: The Rawlings Company, LLC; Oxford Health Plans (N.Y.), Inc.; and UnitedHealth Group, Inc. 4 According to the complaint, both named plaintiffs had received medical benefit payments from defendants for personal injuries. Wurtz also settled her personal injury lawsuit, thereby recovering from the tortfeasor. Defendants had asserted liens under plaintiffs’ insurance plans to recover medical expenses that they had paid to plaintiffs, and Wurtz paid a reimbursement sum of $1,316.87 to The Rawlings Company, LLC. In filing their action, plaintiffs sought a declaration that (based on section 5-335) defendants did not have a right to seek reimbursement or subrogation of medical benefits against plaintiffs’ tort settlements, and they also sought damages for unjust enrichment and deceptive business practices under N.Y. Gen. Bus. Law § 349.

Defendants removed this action to the Eastern District of New York and then moved to dismiss under Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim based on ERISA preemption. The district court granted defendants’ motion to dismiss, holding that plaintiffs’ claims “are superseded under two parallel and independent principles of preemption: (1) complete preemption under ERISA § 502(a), and (2) express preemption under ERISA § 514.” Wurtz v. Rawlings Co., LLC, 933 F.Supp.2d 480, 489 (E.D.N.Y.2013). The complete preemption holding permitted plaintiffs’ claims to be recast as claims under ERISA, but the district court concluded that the claims could not successfully proceed under ERISA because plaintiffs had not exhausted their administrative remedies and because the terms of their plans allow reimbursement. Id. at 507-09. The district court also held that plaintiffs’ claims for damages were “simply a reassertion of their declaratory judgment claim” and were thus “also expressly preempted.” Id. at 507 n. 10. Plaintiffs timely appealed.

DISCUSSION

“We review a district court’s ERISA preemption ruling and 12(b)(6) dismissal for failure to state a claim de novo.” Arditi v. Lighthouse Int’l, 676 F.3d 294, 298 (2d Cir.2012). “The purpose of ERISA is to provide a uniform regulatory regime over employee benefit plans.” Davila, 542 U.S. at 208, 124 S.Ct. 2488. However, “because the States are independent sovereigns in our federal system, we *238 have long presumed that Congress does not cavalierly pre-empt state-law causes of action.” Medtronic, Inc. v. Lohr, 518 U.S. 470, 485, 116 S.Ct. 2240, 135 L.Ed.2d 700 (1996). Thus, “analysis of ERISA preemption must start with the presumption that ‘Congress does not intend to supplant state law.’ ” Stevenson v. Bank of N.Y. Co., 609 F.3d 56, 59 (2d Cir.2010) (quoting Gerosa v. Savasta & Co., 329 F.3d 317, 323 (2d Cir.2003)).

I. Federal Subject-Matter Jurisdiction

We begin by addressing our “special obligation to satisfy [ourselves] ... of [our] own jurisdiction.” Arnold v. Lucks, 392 F.3d 512, 517 (2d Cir.2004) (internal quotation mark omitted) (quoting Bender v. Williamsport Area Sch. Dist., 475 U.S. 534, 541, 106 S.Ct. 1326, 89 L.Ed.2d 501 (1986)). The district court held that plaintiffs’ claims were subject to both “complete” preemption and “express” preemption. As explained below, complete preemption can be the basis for federal subject-matter jurisdiction, but express preemption cannot. Because we hold below that the district court erred in finding N.Y. Gen. Oblig. Law § 5-335 to be completely preempted by ERISA, we normally would decline to reach the merits of the express preemption defense. In this case, however, there is another basis for federal subject-matter jurisdiction under CAFA, 28 U.S.C. § 1332(d).

A.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
761 F.3d 232, 59 Employee Benefits Cas. (BNA) 1081, 2014 WL 3746801, 2014 U.S. App. LEXIS 14877, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wurtz-v-rawlings-co-ca2-2014.