Wurtz v. Rawlings Co., LLC

933 F. Supp. 2d 480, 57 Employee Benefits Cas. (BNA) 1556, 2013 WL 1248631, 2013 U.S. Dist. LEXIS 45008
CourtDistrict Court, E.D. New York
DecidedMarch 28, 2013
DocketNo. 12-CV-1182 (JFB)(ETB)
StatusPublished
Cited by3 cases

This text of 933 F. Supp. 2d 480 (Wurtz v. Rawlings Co., LLC) is published on Counsel Stack Legal Research, covering District Court, E.D. New York 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., LLC, 933 F. Supp. 2d 480, 57 Employee Benefits Cas. (BNA) 1556, 2013 WL 1248631, 2013 U.S. Dist. LEXIS 45008 (E.D.N.Y. 2013).

Opinion

MEMORANDUM AND ORDER

JOSEPH F. BIANCO, District Judge.

Plaintiffs Meghan Wurtz (“Wurtz”) and Mindy Burnovski (“Burnovski”) bring this class action on behalf of themselves and all others similarly situated (collectively, “plaintiffs”)1 against The Rawlings Company, LLC (“Rawlings”), Oxford Health Plans (NY), Inc. (“Oxford Health”), and UnitedHealth Group, Inc. (“United-[486]*486Health”) . (collectively, “defendants”). Plaintiffs seek compensatory and punitive damages, restitution, attorneys’ fees, and declaratory relief arising from defendants’ allegedly improper enforcement of claims/ liens for reimbursement following Oxford Health’s payment of plaintiffs’ medical expenses pursuant to its health benefit plans with plaintiffs’ employers. In particular, plaintiffs assert that New York General Obligations Law § 5-335 (“N.Y. GOL § 5-335”) trumps any reimbursement rights that defendants might have under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001 et seq., and/or the terms of their health benefit plans, and furthermore, that defendants are in violation of N.Y. GOL § 5-335 by virtue of their assertion of such rights. Plaintiffs accordingly argue that (1) declaratory judgment is warranted because N.Y. GOL § 5-335 bars reimbursement or subrogation under defendants’ health benefit plans; (2) defendants’ actions constitute deceptive acts and practices pursuant to Section 349 of New York’s General Business Law (“N.Y. GBL § 349”); and (3) defendants wrongfully benefited from their unlawful acts, misrepresentations, and omissions, and accordingly, have been unjustly enriched at plaintiffs’ expense.

Defendants move to dismiss pursuant to Rule 12(b)(6) of the Federal Rules of Civil Procedure on the following grounds: (1) plaintiffs’ claims are completely preempted pursuant to Section 502 of ERISA, as they directly concern rights under their ERISA-governed benefit plans and do not implicate a legal duty independent of the plans; (2) plaintiffs’ claims are expressly preempted pursuant to Section 514 of ERISA; (3) even if plaintiffs were to try and bring their claims under ERISA § 502(a)(1)(B), their claims would be deficient, thereby requiring dismissal; and (4) plaintiffs’ state law claims fail on their own terms.

After careful consideration of the parties’ arguments, and for the reasons set forth herein, the Court grants defendants’ motion to dismiss.

I. Facts

The following facts are taken from the complaint and are not findings of fact by the Court. The Court assumes these facts to be true for purposes of deciding the pending motion to dismiss. The Court construes the facts in the light most favorable to plaintiffs, the non-moving party.

A. Accidents, Legal Actions, Liens, and State Laws

Both Wurtz and Burnovski are participants in health benefit plans (“Plans” or “Oxford Health Plans”) that are provided by their employers and insured by Oxford Health. Pursuant to the express terms of these Plans, Oxford Health is entitled to be reimbursed for health benefits provided to a member if he or she recovers the cost of those benefits from a third party. (Pis.’ Opp’n to Defs.’ Mot. to Dismiss (“Pis.’ Opp’n”) at 2.) As discussed in greater detail swpra, Wurtz and Burnovski suffered injuries arising from separate accidents; each then received medical benefits from Oxford Health and brought suit against those parties allegedly responsible for their injuries. (Compl. ¶¶ 6-7.) Because of this, Rawlings, acting as Oxford Health’s subrogation claims recovery vendor, corresponded with plaintiffs and/or their counsel, asserting “claims/liens” for reimbursement of Oxford Health’s coverage of such expenses, and requesting notification prior to any settlement of their claims. (Id. ¶¶ 18-19, 21.)

1. Background on the Health Care Entities

UnitedHealth is a self-described “leader in the health benefits and services industry,” offering various services in the health care field. (Id. ¶ 10.) Oxford Health is a health insurance company that provides health insurance benefit plans. (Id. ¶ 11.) [487]*487In 2004, Oxford Health and UnitedHealthcare (an operating division of defendant UnitedHealth) joined forces and merged. (Id.)2

Rawlings is a self-described “recognized leader in the healthcare subrogation services field.” (Id. ¶ 8.) The company acts as a collection agent, or subrogation claims recovery vendor, on behalf of Oxford Health,3 helping it to process claims and recover money for debts owed for-prior healthcare services. (Id.) For purposes of the underlying dispute, these companies’ respective roles in the healthcare industry all became intertwined following events involving Wurtz, Burnovski, and incidents leading to their individual personal injuries and damages. Before addressing the events leading to the underlying dispute, the Court addresses N.Y. GOL § 5-335.

2. New York Statutory Law

On November 10, 2009, Senate Bill S66002 was passed by both the New York State Senate and Assembly; it became effective on November 12, 2009. (Id. ¶ 13.) Senate Bill S66002, in effect, amended New York’s General Obligations Law by adding a new section, Section 5-335, around which this dispute centers.' The relevant portions of Section 5-335, at least for purposes of this dispute, are as follows:

§ 5-335. Limitation of Non-Statutory Reimbursement and Subrogation Claims in Personal Injury and Wrongful Death Actions.
(a) When a plaintiff settles with one or more defendants in an action for personal injxxries ..., it shall be conclusively presumed that the settlement does not include any compensation for the cost of .health care services, loss of earnings or other economic loss to the extent those losses or expenses have been or are obligated to be paid or reimbursed by a benefit provider, except for those payments as to which there is a statutory 'right of reimbursement. By entering into any such settlement, a plaintiff shall not be deemed to have taken an action in derogation of any nonstatutory right of any benefit provider that paid or is obligated to pay those losses or expenses; nor shall a plaintiffs entry into •such settlement constitute a violation of any contract between the plaintiff and such benefit provider.
Except where there is a statutory right of reimbursement, no party entering into such a settlement shall be subject to a subrogation claim or claim for reimbursement by a benefit provider and a benefit provider shall have no lien or right of subrogation or reimbursement against any such settling party, with respect to those losses or expenses that have been or are obligated to be paid or reimbursed by said benefit provider.

(Id. ¶ 14 (emphasis added).)

3. Wurtz and Burnovski

Wurtz is a resident of Little Rock, Arkansas who, on April 4, 2008, sustained personal injuries and damages in an accident. (Compl. ¶ ,6.)4 Due to her injuries, Wurtz received medical benefits from her Oxford Health Plan, entitled “Freedom [488]

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Cite This Page — Counsel Stack

Bluebook (online)
933 F. Supp. 2d 480, 57 Employee Benefits Cas. (BNA) 1556, 2013 WL 1248631, 2013 U.S. Dist. LEXIS 45008, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wurtz-v-rawlings-co-llc-nyed-2013.