S. Fulton Dialysis, LLC v. Caldwell

428 F.Supp.3d 1346

SOUTH FULTON DIALYSIS, LLC, Plaintiff,

v.Anita Taylor CALDWELL and United Healthcare, Defendants.

CIVIL ACTION FILE No. 1:19-cv-00979-SCJ

United States District Court, N.D. Georgia, Atlanta Division.

Signed December 17, 2019

Agbor Adolph Ebot Tabi, The Law Office of Agbor Ebot Tabi, PC., Acworth, GA, for Plaintiff.

Anita Taylor Caldwell, Atlanta, GA, pro se.

Cavender C. Kimble, Balch & Bingham, Birmingham, AL, Tashwanda Pinchback Dixon, Balch & Bingham LLP, for Defendants.

ORDER

HONORABLE STEVE C. JONES, UNITED STATES DISTRICT JUDGE

This matter comes before the Court on, inter alia , Defendant United Healthcare's¹ ("Defendant" or "United") Motion to Dismiss and Motion to Strike Jury Demand and Plaintiff South Fulton Dialysis, LLC's ("Plaintiff" or "South Fulton Dialysis") Motion to Remand. Doc. Nos. [4]; [5].²

I. BACKGROUND

The facts are drawn from the Complaint (Doc. No. [1-1] ), accepting all the well-pleaded facts as true and viewing them in the light most favorable to Plaintiff, as this Court must do. See Am. United Life Ins. Co. v. Martinez, 480 F.3d 1043, 1057 (11th Cir. 2007).

This case involves a claim for health benefits under a self-funded group health benefit plan (hereinafter, the "Plan") sponsored by Old Dominion Freight Line, Inc., a national trucking company. Doc. No. [1-2].³ Old Dominion established the Plan to provide group health benefits to its eligible employees and their dependents. Id. at p. 26 ("You are eligible to participate in this Plan if you are classified as a full-time employee of Old Dominion Freight Line Inc.... [and] [y]our eligible dependents may also participate."). United serves as the Claims Administrator of the Plan. Id. at p. 84 ("Effective October 1, 2014, United Healthcare is the designated third party administrator for health coverage claims and appeals ....").

Defendant Anita Taylor Caldwell ("Caldwell") is a beneficiary of the Plan. Doc. No. [1-1], ¶ 7. Between May 16, 2013 and March 31, 2015, Caldwell received dialysis treatment from Plaintiff "approximately three to four times a week." Id. ¶¶ 8–9. Plaintiff alleges that it had a "contract for medical services" with Caldwell, appointing Plaintiff "as an intended beneficiary of the insurance agreement between [Caldwell] and United," where Caldwell promised to pay for her dialysis treatment if United did not pay for the full cost of the treatment. Id. ¶¶ 6–7. Plaintiff further alleges it received an assignment of benefits from Caldwell that she reaffirmed with each treatment she received from Plaintiff. Id. ¶ 8.

Plaintiff claims Caldwell accumulated $1,327,695.00 in medical bills for her dialysis treatment, which has not been paid. Id. ¶¶ 10–11. Consequently, on March 7, 2018, Plaintiff filed a Complaint in the State Court of Clayton County, Georgia against United and Caldwell. See id. Plaintiff asserts state law claims for breach of contract, open account, account stated, unjust enrichment, and quantum meruit against said Defendants. Id. ¶¶ 12–35.

On February 28, 2019, United filed a Notice of Removal in this Court, asserting that this Court has jurisdiction pursuant to 28 U.S.C. § 1331 and 29 U.S.C. § 1132(e)(1). Doc. No. [1]. Specifically, United contends that all Plaintiff's claims asserted in the Complaint are completely preempted, as they involve exclusive federal remedies available to participants and beneficiaries of employee benefit plans governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (hereinafter, "ERISA"). Id. at p. 1.

Thereafter, on April 16, 2019, United filed a Motion to Dismiss and Motion to Strike Jury Demand based on ERISA preemption. Doc. No. [4]. On May 29, 2019, Plaintiff filed a Motion to Remand. Doc. No. [5]. These matters are now ripe for review, and the Court rules as follows.

II. DISCUSSION

The Court must determine whether this case is properly in federal court and, if so, whether Plaintiff's claims must be dismissed.

Removal is proper "in 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). To establish original jurisdiction, an action must satisfy the jurisdictional prerequisite of either federal question jurisdiction, pursuant to 28 U.S.C. § 1331, or diversity jurisdiction, pursuant to 28 U.S.C. § 1332. Federal question jurisdiction exists when the civil action arises "under the Constitution, laws, or treaties of the United States." Id. § 1331. The burden of establishing federal jurisdiction falls on the party attempting to invoke the jurisdiction of the federal court. See McNutt v. Gen. Motors Acceptance Corp. of Indiana, 298 U.S. 178, 189, 56 S.Ct. 780, 80 L.Ed. 1135 (1936). Courts must strictly construe the requirements of removal jurisdiction and remand all cases in which jurisdiction is doubtful. See Shamrock Oil & Gas Corp. v. Sheets, 313 U.S. 100, 108–09, 61 S.Ct. 868, 85 L.Ed. 1214 (1941).

The test ordinarily applied for determining whether a claim arises under federal law is whether a federal question appears on the face of the plaintiff's well-pleaded complaint. Louisville & Nashville R.R. v. Mottley, 211 U.S. 149, 152, 29 S.Ct. 42, 53 L.Ed. 126 (1908). Complete preemption, however, is an exception to the well-pleaded complaint rule and exists where the preemptive force of a federal statute is so extraordinary that it converts an ordinary state law claim into a statutory federal claim. Caterpillar, Inc. v. Williams, 482 U.S. 386, 393, 107 S.Ct. 2425, 96 L.Ed.2d 318 (1987) ; see also Butero v. Royal Maccabees Life Ins. Co., 174 F.3d 1207, 1212 (11th Cir. 1999) ("When Congress comprehensively occupies a field of law, any civil complaint raising this select group of claims is necessarily federal in character and thus furnishes subject-matter jurisdiction under 28 U.S.C. § 1331.") (citation omitted). The Court looks at the plaintiff's complaint at the time of removal to determine jurisdiction. See Ehlen Floor Covering, Inc. v. Lamb, 660 F.3d 1283, 1287 (11th Cir. 2011). The Court may also review evidence outside of the removal petition so long as it relates to the time of removal. See Sierminski v. Transouth Financial Corp., 216 F.3d 945, 949 (11th Cir. 2000) ("[T]here is no good reason to keep a district court from eliciting or reviewing evidence outside the removal petition.").

A. ERISA Preemption and Subject Matter Jurisdiction

ERISA provides a uniform regulatory regime over employee benefit plans and includes expansive preemption provisions which are intended to ensure that employee benefit plan regulation remains "exclusively a federal concern." Alessi v. Raybestos-Manhattan, Inc., 451 U.S. 504, 523, 101 S.Ct. 1895, 68 L.Ed.2d 402 (1981). Namely, ERISA provides for two types of preemption: conflict preemption and complete preemption. Conflict preemption, or defensive preemption, is a substantive defense to preempted state law claims. Jones v. LMR Int'l, Inc., 457 F.3d 1174, 1179 (11th Cir. 2006). This type of preemption arises from ERISA's express preemption provision, Section 514(a), which preempts any state law claim that "relate[s] to" an ERISA plan. 29 U.S.C. § 1144(a). Because conflict preemption is merely a defense, it is not a basis for removal. See Gully v. First Nat'l Bank, 299 U.S. 109, 115–16, 57 S.Ct. 96, 81 L.Ed. 70 (1936) ; see also Ervast v. Flexible Prods. Co., 346 F.3d 1007, 1012 n.6 (11th Cir. 2003) (stating that "defensive preemption ... provides only an affirmative defense to state law claims and is not a basis for removal").

Complete preemption, or super preemption, is a judicially-recognized exception to the well-pleaded complaint rule. It differs from defensive preemption because it is jurisdictional in nature rather than an affirmative defense. Jones, 457 F.3d at 1179 (citing Ervast, 346 F.3d at 1014 ). Complete preemption under ERISA derives from ERISA's civil enforcement provision, Section 502(a), which has such "extraordinary" preemptive power that it "converts an ordinary state common law complaint into one stating a federal claim for purposes of the well-pleaded complaint rule." Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 65–66, 107 S.Ct. 1542, 95 L.Ed.2d 55 (1987). Consequently, any "cause of action within the scope of the civil enforcement provisions of § 502(a) [is] removable to federal court." Id. at 66, 107 S.Ct. 1542.

In 2004, the Supreme Court set forth the following, two-prong test to determine whether ERISA completely preempts a state law claim:

[I]f an individual brings suit complaining of a denial of coverage for medical care, where the individual is entitled to such coverage only because of the terms of an ERISA-regulated employee benefit plan, and where no legal duty (state or federal) independent of ERISA or the plan terms is violated, then the suit falls within the scope of ERISA § 502(a)(1)(B). In other words, if an individual, at some point in time, could have brought his claim under ERISA § 502(a)(1)(B), and where there is no other independent legal duty that is implicated by a defendant's actions, then the individual's cause of action is completely pre-empted by ERISA § 502(a)(1)(B).

Aetna Health Inc. v. Davila, 542 U.S. 200, 210, 124 S.Ct. 2488, 159 L.Ed.2d 312 (2004). In other words, the Davila two-prong test requires two inquiries: (1) whether the plaintiff could have brought its claim under Section 502(a); and (2) whether no other legal duty supports the plaintiff's claim. Id.

1. Could Plaintiff Have Brought Claims Under ERISA?

The first prong of the Davila test considers whether Plaintiff "could have brought its claim under ERISA § 502(a)(1)(B)." Id. Plaintiff's claims satisfy this test if (1) Plaintiff has standing to sue; and (2) Plaintiff's claims fall within the scope of ERISA. See Connecticut State Dental Ass'n v. Anthem Health Plans, Inc., 591 F.3d 1337, 1350 (11th Cir. 2009).

i. Standing

A "participant or beneficiary" may bring an ERISA claim. See 29 U.S.C. § 1132(a)(1...