United States District Court, D. New Jersey
THOMAS R. PETERSON, M.D. PC, Plaintiff,
CIGNA HEALTH AND LIFE INSURANCE COMPANY d/b/a CIGNA HEALTH CARE, PHX, WINE LIQUOR AND DISTILLERY WORKERS LOCAL 1-D, MAJOR MEDICAL PLAN, and MAGNA CARE, Defendants.
D. WIGENTON, U.S.D.J.
this Court are Plaintiff Thomas R. Peterson, M.D. PC's
(“Plaintiff”) Motion to Remand pursuant to 28
U.S.C. § 1447(c), Defendant Zelis Claims Integrity
Inc.'s (“Zelis”)Motion to Dismiss pursuant to
Federal Rule of Civil Procedure (“Rule”)
12(b)(6), and Cigna Health and Life Insurance Company's
(“Cigna”) Motion to Dismiss pursuant to Rules
12(b)(5) and 12(b)(6). This opinion is issued without oral
argument pursuant to Rule 78. For the reasons stated herein,
Plaintiff's Motion to Remand is GRANTED
and Cigna and Zelis' Motions to Dismiss are
DISMISSED as moot.
BACKGROUND AND PROCEDURAL HISTORY
action concerns outstanding payments for surgical services
that Plaintiff provided to its patient Olga Mendoza
(“Patient”). (Compl. ¶¶ 10, 20, ECF No.
1.) According to the Complaint, Patient had medical coverage
through Defendant Wine, Liquor and Distillery Workers Union,
Local 1-D Major Medical Plan (“Workers Union”) at
all relevant times. (Id. ¶ 7.) Plaintiff
alleges that on April 28, 2016, it received authorization to
perform Patient's procedure. (Id. ¶ 9.)
After performing surgery on Patient, Plaintiff submitted a
bill in the amount of $222, 539.00 to Cigna, the
administrator of Workers Union's insurance plan at the
time. (Id. ¶¶ 8, 10-11.) Cigna then
engaged Zelis, a cost-management company, to submit a
settlement proposal to Plaintiff. (Id. ¶¶
3, 12.) On July 11, 2016, Plaintiff's office manager
signed a settlement agreement whereby Plaintiff accepted a
reduced amount of $140, 000.00 in consideration for
“receiv[ing] payment within 15-20 working days”
from the date Zelis received the agreement. (Id.
¶¶ 13, 15; see also Settlement Proposal,
ECF No. 1 at 15-16.) Sometime thereafter, Defendant Magna
Care (“Magna Care”) replaced Cigna as the
administrator of Workers Union's insurance plan.
(Compl. ¶ 17.) Plaintiff alleges that upon
Magna Care's advice, Workers Union reneged on the
settlement agreement, and only issued payment in the amount
of $21, 079.10. (Id. ¶¶ 18-19.)
about February 22, 2018, Plaintiff filed suit against
Defendants Cigna, Zelis, Workers Union, and Magna Care in the
Superior Court of New Jersey, Law Division, Bergen County,
seeking the remaining balance of the agreed upon settlement.
(See generally id.) Plaintiff's four-count
Complaint asserts two claims for breach of contract, as well
as claims for promissory estoppel, and interference with
contractual relations. (Id.) On March 29, 2018,
Workers Union removed the action to this Court pursuant to 28
U.S.C. § 1446. (Notice of Removal, ECF No. 1.) On April
9, 2018, Plaintiff filed a Motion to Remand. (ECF No. 13.)
The following defendants filed opposition: Workers Union
opposed on April 17, 2018; Zelis opposed on April 23, 2018;
and Cigna opposed on May 15, 2018. (ECF Nos. 15, 17, 33.)
Plaintiff replied on April 30, 2018, and again on May 18,
2018. (ECF Nos. 24, 34.) While Plaintiff's Motion to
Remand was pending, on April 23, 2018, Zelis filed a Motion
to Dismiss. (ECF No. 20.) Plaintiff opposed on April 30,
2018, and Zelis replied on May 9, 2018. (ECF Nos. 23, 30.)
Cigna also filed a Motion to Dismiss on May 2, 2018. (ECF No.
26.) Plaintiff opposed on May 10, 2018, and Cigna replied on
June 11, 2018. (ECF Nos. 31, 37.)
defendant may remove “any civil action brought in a
State court of which the district courts of the United States
have original jurisdiction.” 28 U.S.C. § 1441(a).
District courts have “original jurisdiction of all
civil actions arising under the Constitution, laws, or
treaties of the United States.” 28 U.S.C. § 1331
(concerning federal question jurisdiction). A claim
“arises under” federal law if “a
well-pleaded complaint establishes either that federal law
creates the cause of action or that the plaintiff's right
to relief necessarily depends on resolution of a substantial
question of federal law.” Franchise Tax Bd. of Cal.
v. Constr. Laborers Vacation Tr. for S. Cal., 463 U.S.
1, 27-28 (1983), superseded by statute, 28 U.S.C.
§ 1441; see also Caterpillar, Inc. v. Williams,
482 U.S. 386, 392 (1987). District courts also have
“original jurisdiction of all civil actions where the
matter in controversy exceeds the sum or value of $75, 000, .
. . and is between . . . citizens of different
states[.]” 28 U.S.C. § 1332(a) (concerning
at any time before final judgment it appears that the
district court lacks subject matter jurisdiction, ” a
removed action must be remanded. 28 U.S.C. § 1447(c).
Removal statutes are “strictly construed, with all
doubts to be resolved in favor of remand.” Brown v.
JEVIC, 575 F.3d 322, 326 (3d Cir. 2009) (citations
omitted); see also Samuel-Bassett v. KIA Motors Am.,
Inc., 357 F.3d 392, 396, 403 (3d Cir. 2004) (citations
omitted). The removing party bears the burden of showing that
removal is appropriate. See Frederico v. Home Depot,
507 F.3d 188, 193 (3d Cir. 2007).
a plaintiff “may avoid federal jurisdiction” when
the complaint exclusively relies on state law. Trans Penn
Wax Corp. v. McCandless, 50 F.3d 217, 228 (3d Cir. 1995)
(quoting Caterpillar, 482 U.S. at 392). In certain
limited cases, however, federal question jurisdiction exists
over state-law claims where the “state-law claim
necessarily raise[s] a stated federal issue, actually
disputed and substantial, which a federal forum may entertain
without disturbing any congressionally approved balance of
federal and state judicial responsibilities.”
Grable & Sons Metal Prods., Inc. v. Darue Eng'g
& Mfg., 545 U.S. 308, 314 (2005). One such limited
circumstance exists if the action “falls within the
narrow class of cases to which the doctrine of
‘complete pre-emption' applies.” Pascack
Valley Hosp., Inc. v. Local 464A UFCW Welfare Reimbursement
Plan, 388 F.3d 393, 399 (3d Cir. 2004) (citing Aetna
Health, Inc. v. Davila, 542 U.S. 200, 207 (2004)).
“[C]omplete pre-emption recognizes ‘that Congress
may so completely pre-empt a particular area that any civil
complaint raising this select group of claims is necessarily
federal in character.'” Id. (quoting
Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 63-64
(1987)); see also Progressive Spine & Orthopaedics,
LLC v. Anthem Blue Cross Blue Shield, No. 17-536, 2017
WL 4011203, at *4 (D.N.J. Sept. 11, 2017).
Employee Retirement Income Security Act of 1974's
(“ERISA”) “civil enforcement mechanism,
§ 502(a), ‘is one of those provisions with such
extraordinary pre-emptive power that it converts an ordinary
state common law complaint into one stating a federal claim
for purposes of the well-pleaded complaint rule,' and
permits removal.” N.J. Carpenters v. Tishman
Constr. Corp., 760 F.3d 297, 303 (3d Cir. 2014) (quoting
Davila, 542 U.S. at 209); see also Garrick
Cox MD LLC v. Cigna Healthcare, No. 16-4611,
2016 WL 6877778, at *2 (D.N.J. Oct. 28, 2016), report and
recommendation adopted by 2016 WL 6877740 (D.N.J. Nov.
21, 2016) (remanding case to state court). Under §
502(a), a claim is completely pre-empted and removable only
if: “(1) the plaintiff could have brought the claim
under § 502(a); and (2) no other independent
legal duty supports the plaintiff's claim.”
N.J. Carpenters, 760 F.3d at 303 (citing Pascack
Valley Hosp., 388 F.3d at 400). Some decisions have
further disaggregated the first prong . . . into two
1(a) Whether the plaintiff is the type of party that
can bring a claim pursuant to Section 502(a)(1)(B), and
1(b) whether the actual claim that the plaintiff
asserts can be construed as a colorable claim for benefits