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Andre-Pearson v. Grand Valley Health Plan, Inc.

United States District Court, W.D. Michigan

August 28, 2013

ANNE FLORENCE ANDRE-PEARSON, Plaintiff,
v.
GRAND VALLEY HEALTH PLAN, INC., Defendant

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[Copyrighted Material Omitted]

Page 768

For Anne Florence Andre-Pearson, plaintiff: Michelle Marie McLean, LEAD ATTORNEY, Bolhouse Baar & Lefere PC, Grandville, MI.

For Grand Valley Health Plan, Inc., a Michigan corporation, defendant: Brian Mark Schwartz, LEAD ATTORNEY, Michael A. Alaimo, Miller Canfield Paddock & Stone PLC (Detroit), Detroit, MI.

OPINION

HONORABLE Paul L. Maloney, Chief United States District Judge.

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OPINION AND ORDER DENYING PLAINTIFF'S MOTION TO REMAND, GRANTING DEFENDANT'S MOTION TO DISMISS, AND GRANTING PLAINTIFF'S MOTION FOR LEAVE TO AMEND

Plaintiff Anne Florence Andre-Pearson filed a complaint in the Circuit Court for Kent County, Michigan. The complaint included a claim for breach of contract and a claim for exemplary damages. Plaintiff generally asserted that Defendant Grand Valley Health Plan declined to pay insurance claims for approximately $325,000 she incurred for her health care and treatment. Defendant removed the lawsuit to the United States District Court for the Western District of Michigan. Defendant then filed a motion to dismiss (ECF No. 6), asserting that the two claims in the complaint are preempted by the Employee Retirement Income Security Act (" ERISA" ). Plaintiff filed a motion to remand (ECF No. 8), asserting that the claims arise solely under state law and, therefore, this Court lacks subject-matter jurisdiction. As part of her motion to remand, Plaintiff requests, in the event that this Court concludes that her claims fall under ERISA, she be granted leave to amend the complaint to state a claim under the federal statute. (ECF No. 9 Pl. Brief in Support PgID 171-72.) A hearing on both motions occurred on August 26, 2013.

FRAMEWORK

Before this Court may consider the merits of a claim or a motion, it must first determine whether subject-matter jurisdiction exists over the case or controversy. See Green Party of Tennessee v. Hargett, 700 F.3d 816, 827 (6th Cir. 2012); see, e.g., Gardner v. Heartland Indus. Partners, LP, 715 F.3d 609, 615 (6th Cir. 2013) (involving the removal of lawsuit on ERISA preemption grounds and cross-motions to dismiss and for remand and resolving the remand motion against the defendants). A defendant may remove an action filed in the state courts to the federal district court when the federal district court would have original jurisdiction. 28 U.S.C. § 1441(a). " As courts of limited jurisdiction, federal courts may exercise only those powers authorized by the Constitution and statute." Fisher v. Peters, 249 F.3d 433, 444 (6th Cir. 2001). Removal statutes are therefore narrowly construed

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as the removal of a case raises significant federalism concerns. Shamrock Oil & Gas Corp. v. Sheets, 313 U.S. 100, 109, 61 S.Ct. 868, 85 L.Ed. 1214 (1941); Palkow v CSX Transp., Inc., 431 F.3d 543, 555 (6th Cir. 2005). The Sixth Circuit Court of Appeals follows a policy that " all doubts as to the propriety of removal are resolved in favor of remand." Jacada (Europe), Ltd. v. Int'l Mktg. Strategies, Inc., 401 F.3d 701, 704 (6th Cir. 2005) (quoting Coyne v. American Tobacco Co., 183 F.3d 488, 493 (6th Cir. 1999)). If a district court determines, at any time before the entry of final judgment, that it lacks subject-matter jurisdiction over a removed action, the action must be remanded. 28 U.S.C. § 1447(c).

Federal courts have original jurisdiction over all civil actions arising under the Constitution, laws, and treaties of the United States. 28 U.S.C. § 1331. In determining whether a claim arises under federal law, courts rely on the " well-pleaded complaint" rule: the plaintiff's statement of his or her cause of action shows that the claim is based on the Constitution, laws, or treaties of the United States. Beneficial Nat'l Bank v. Anderson, 539 U.S. 1, 6, 123 S.Ct. 2058, 156 L.Ed.2d 1 (2003). As the master of the complaint, a plaintiff may avoid federal jurisdiction by relying exclusively on state law. Caterpillar, Inc. v. Williams, 482 U.S. 386, 392, 107 S.Ct. 2425, 96 L.Ed.2d 318 (1997). When a plaintiff relies exclusively on state law to establish a claim, a federal defense does not create federal subject-matter jurisdiction, including the defense of preemption. Id. at 393; see Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 63, 107 S.Ct. 1542, 95 L.Ed.2d 55 (1987).

The complete-preemption doctrine serves as limited exception to the well-pleaded complaint rule. Caterpillar, 482 U.S. at 393. Complete preemption occurs when Congress has so completely legislated a particular area that any civil complaint raising claims falling within that area of law is necessarily federal in nature. Metro. Life Ins. v. Taylor, 481 U.S. at 63-64. " When a federal statute completely pre-empts the state law cause of action, a claim which comes within the scope of that cause of action, even if pleaded in terms of state law, is in reality based on federal law." Beneficial Nat'l Bank, 539 U.S. at 6. The Supreme Court has held that ERISA is one such federal statute that wholly displaces state-law claims and pre-empts state law causes of action. Aetna Health Inc. v. Davila, 542 U.S. 200, 208, 124 S.Ct. 2488, 159 L.Ed.2d 312 (2004); Metro. Life Ins., 481 U.S. at 67; see Gentek Bldg. Prods. Inc. v. Sherwin-Williams Co., 491 F.3d 320, 325 (6th Cir. 2007)

Any claim that falls within ERISA's civil enforcement provision, 29 U.S.C. § 1132(a), even though couched in state-law terms, is completely preempted and is removable by the defendant. Metro. Life Ins., 481 U.S. at 67. Section 1132 authorizes civil actions

( 1) by a participant or beneficiary --
***
(B) to recover benefits due him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan;

29 U.S.C. § 1132(a)(1)(B). The Sixth Circuit uses a two-part test for determining when a state-law claim falls within ERISA's § 1132(a). Gardner, 715 F.3d at 613. First, " the plaintiff complains about the denial of benefits to which he is entitled 'only because of the terms of an ERISA-regulated employee benefit plan[.]'" Id. (quoting Davila, 542 U.S. at 201). Second, " the plaintiff

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does not allege the violation of any 'legal duty (state or federal) independent of ERISA or the plan terms[.]'" Id. (quoting Davila ). Plaintiff has not pleaded any legal duty independent of the terms of her insurance policy.

Both motions thus turn on whether Plaintiff's insurance policy falls under ERISA's civil enforcement provision. When a state-law claim falls within § 1132(a)(1)(B), two consequences follow: (1) the claim is deemed to be one brought under federal law and removal is authorized, and (2) the claim is preempted. Gardner, 715 F.3d at 613 (citing Davila, 542 U.S. at 209). If the policy does not fall under ERISA, Plaintiff's claim is based in state law, and her motion to remand must be granted. If the policy does fall under ERISA, ...


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