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Johnson-Barbato v. Anthem Blue Cross Blue Shield

United States District Court, D. New Jersey

May 25, 2017

CYNTHIA JOHNSON-BARBATO, Plaintiff,
v.
ANTHEM BLUE CROSS BLUE SHIELD, Defendant.

          OPINION

          John Michael Vazquez, U.S.D.J.

         I. INTRODUCTION

         This matter comes before the Court on Defendant Anthem Blue Cross Blue Shield's ("Anthem" or "Defendant") unopposed motion to dismiss. D.E. 7. The Court reviewed all submissions in support of the motion and considered it without oral argument pursuant to Federal Rule of Civil Procedure 78 and Local Civil Rule 78.1(b). For the reasons that follow, the Court grants Defendant's motion.

         II. BACKGROUND[1]

         Plaintiff alleges that she is employed by "Cardinal Health" and is an account holder with Anthem through a Cardinal Health group plan. Compl., Count 1, ¶¶ 3-4. During 2015 and 2016, Plaintiff submitted medical claims to Anthem, primarily related to a foot injury that ultimately required surgery. Id. ¶ 5. Plaintiff alleges that her claims were submitted timely and "in all other ways complied with the contract of insurance." Id. ¶ 6. According to the Complaint, Anthem refused to make "full and proper payment, " by either reducing reimbursement or denying payment altogether. Id. ¶ 7.

         Plaintiff filed the Complaint in the Superior Court of New Jersey, Essex County. Defendants removed the matter to this Court on the basis of federal question and diversity jurisdiction. D.E. 1. Plaintiffs two-count Complaint alleges breach of contract and breach of the covenant of good faith and fair dealing. Defendant moved to dismiss the Complaint. Plaintiff did not file an opposition.

         III. LAW AND ANALYSIS

         A. Standard of Review

         According to Rule 12(b)(6) of the Federal Rules of Civil Procedure, a court should dismiss a complaint when it fails "to state a claim upon which relief can be granted." In analyzing a motion to dismiss under Rule 12(b)(6) the court will "accept all factual allegations as true, construe the complaint in the light most favorable to the plaintiff, and determine whether, under any reasonable reading of the complaint, the plaintiff may be entitled to relief." Phillips v. Cty. of Allegheny, 515 F.3d 224, 231 (3d Cir. 2008) (quoting Pinker v. Roche Holdings Ltd., 292 F.3d 361, 374 n.7 (3d Cir. 2002)). In addition to the complaint, the Court may also consider any exhibits attached thereto. See Pension Ben. Guar. Corp. v. White Consol. Indus., Inc., 998 F.2d 1192, 1196 (3d Cir. 1993) (noting that when deciding a motion to dismiss, courts generally consider "the allegations contained in the complaint, exhibits attached to the complaint and matters of public record").

         To survive dismissal, "a complaint must contain sufficient factual matter, accepted as true, to 'state a claim to relief that is plausible on its face.'" Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). Determining whether a complaint is plausible is a "context-specific task that requires the reviewing court to draw on its judicial experience and common sense." Id. at 679. While not a "probability requirement, " plausibility means "more than a sheer possibility that a defendant has acted unlawfully." Id. at 678. "A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged." Id. Even if plausibly pled, however, a complaint will not withstand a motion to dismiss if the facts alleged do not state "a legally cognizable cause of action." Turner v. J.P. Morgan Chase & Co., No. 14-7148, 2015 WL 12826480, at *2 (D.N.J. Jan. 23, 2015). Additionally, a court is "not compelled to accept unwarranted inferences, unsupported conclusions or legal conclusions disguised as factual allegations." Baraka v. McGreevey, 481 F.3d 187, 211 (3d Cir. 2007).

         B. ERISA Preemption

         Defendant argues that Plaintiffs claims are completely preempted under Section 502(a) of the Employee Retirement Income Security Act ("ERISA"). The Court agrees.

         ERISA applies to "any employee benefit plan if it is established or maintained ... by any employer engaged in commerce." 29 U.S.C. § 1003(a). ERISA defines "employee welfare benefit plan" as

any plan, fund, or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund, or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase ...

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