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Peterson v. Cigna Health and Life insurance Co.

United States District Court, D. New Jersey

July 25, 2018



          SUSAN D. WIGENTON, U.S.D.J.

         Before 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”)[1]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.


         This 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.)

         On or 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.[2] (ECF Nos. 31, 37.)


         A 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 diversity jurisdiction).

         “If 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).


         Generally, 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).

         The 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 inquiries:
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 ...

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