JOHN A. MENDEZ, District Judge.
Defendants Connecticut General Life Insurance Company and Cigna Health and Life Insurance Company (collectively "CIGNA") move to dismiss (Doc. #8) Plaintiffs Patient One, Patient Two, Patient Three (three unnamed Plaintiffs collectively "the Patients") and Nutrishare, Inc.'s ("Nutrishare") (with the Patients, collectively "Plaintiffs") Complaint (Doc. #1).
Nutrishare is a healthcare provider specializing in Total Parenteral Nutrition ("TPN") services. CIGNA sells healthcare plans to consumers. The Patients each have Preferred Provider Organization ("PPO") plans with CIGNA and have received services from Nutrishare.
Nutrishare has provided services to CIGNA members since 1994, but does not have a contract with CIGNA and is considered an out-of-network provider. Nutrishare's practice is to obtain an assignment of the patients' benefits under their health benefits plan with CIGNA.
Plaintiffs allege that Nutrishare has submitted a bill to CIGNA for the services provided to CIGNA members, setting forth the charges incurred. CIGNA has refused to pay for the services provided by Nutrishare, regardless of whether the patients have met their coinsurance or copayment obligations. In addition, CIGNA has placed calls to the Patients and their physicians urging them to seek TPN services from an in-network provider rather than Nutrishare.
Plaintiffs filed the Complaint, stating eight causes of action: (1) enforcement pursuant to 29 U.S.C. § 1132(a)(1)(B) for failure to pay ERISA plan benefits on behalf of all Plaintiffs; (2) enforcement pursuant to 29 U.S.C. § 1132(a)(2) for breach of fiduciary duty on behalf of all Plaintiffs; (3) violation of California Business & Professions Code §§ 17200 et seq., California's unfair competition law ("UCL"), on behalf of Nutrishare; (4) breach of implied contract on behalf of Nutrishare; (5) services rendered on behalf of Nutrishare; (6) breach of covenant of good faith and fair dealing on behalf of the Patients; (7) intentional interference with prospective economic advantage on behalf of Nutrishare; and (8) negligent interference with prospective economic advantage on behalf of Nutrishare.
CIGNA first contends that Nutrishare's state law claims are preempted under ERISA. Although it is disputed by Plaintiffs in their Opposition (Doc. #10, at p. 3 n.1) it does appear CIGNA is arguing that these claims are subject to conflict preemption under ERISA § 514(a), as amended, 29 U.S.C. § 1144(a) ("§ 514(a)"), and are completely preempted under ERISA § 502(a) ("§ 502(a)"). For the reasons discussed below, the Court finds Nutrishare's claims are completely preempted pursuant to § 502(a).
As noted by the Supreme Court, a state law claim may be "completely preempted" under ERISA because § 502(a) reflects Congress' intent to "so completely pre-empt a particular area that any civil complaint raising this select group of claims is necessarily federal in character."
The Ninth Circuit has continuously reaffirmed the principle that "`ERISA preempts the state law claims of a provider suing as an assignee of a beneficiary's rights to benefits under an ERISA plan.'"
When faced with claims from healthcare providers against insurers, it is imperative that "[c]ourts distinguish between claims brought in the provider's derivative capacity as an assignee of plan benefits, which are preempted by ERISA, and those brought in its independent status as a third-party health care provider, which are not preempted."
"A party can avoid ERISA preemption if it identifies a separate contract between the parties or alleges a specific misrepresentation that does not require interpretation of the ERISA plan and would not affect the relationships of the ERISA participants."
CIGNA contends Nutrishare is "proceeding based solely on assignments of benefits from patients under their respective ERISA health benefit plans" and that Nutrishare "does not allege any basis for seeking payment from CIGNA other than the patient assignments." Reply at pp. 3-4. It points to specific allegations in the Complaint itself that Nutrishare is asserting rights as an assignee of its patients. In the Opposition, Plaintiffs argue that Nutrishare's state law claims "assert directly enforceable rights to payment arising under independent state law duties between parties whose relationship is not governed by ERISA." Opp. at p. 4.
The Court looks to the Complaint itself for guidance. Each of Nutrishare's state law claims is based on CIGNA's alleged failure to pay benefits rightfully owed to Nutrishare based on its patients' healthcare plans provided by CIGNA. Comp. ¶¶ 48-64; 93-110; 121-143. The Complaint does not assert a basis for Nutrishare's right to payment outside of the assignment of its patients' rights. In fact, the Complaint specifically points out that no contract exists between Nutrishare and CIGNA and that Nutrishare "has not agreed to comply with, or be bound by, any [CIGNA] insurance contracts, policies or procedures." Comp. ¶ 26. Because recovery is based on Nutrishare's status as assignee, the Court finds Nutrishare's state law claims in the third, fourth, fifth, seventh and eighth causes of action are preempted and the Court grants CIGNA's motion to dismiss these derivative claims with prejudice.
The Court need not address any remaining preemption arguments put forth by CIGNA regarding these claims.
In response to CIGNA's motion to dismiss the Patients' sixth claim for breach of the covenant of good faith and fair dealing, plaintiffs first argue that the claim is a "tort cause of action" not "related to" the ERISA plan "but rather is simply a state law that regulates the relationship between insureds and insurance companies. See
Plaintiffs next argue that even if the Patients' claim relates to an ERISA plan, it is saved from preemption by ERISA's savings clause. Opp. at pp. 5-6. The clause provides that the statute shall not be "construed to exempt or relieve any person from any law of any State which regulates insurance." 29 U.S.C. § 1144(b)(2)(A). Plaintiffs rely on
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CIGNA moves the Court to dismiss Plaintiffs' second cause of action for breach of fiduciary duty pursuant to 29 U.S.C. § 1132(a)(2). CIGNA contends that claims under § 1132(a)(2) can only be asserted for the benefit of the ERISA plan and because Plaintiff's claim is based on denials of benefits to these specific parties, not the plan as a whole, it should be dismissed. MTD at pp. 11-12.
Section 1132(a)(2) provides a right of action to a "participant, beneficiary or fiduciary for appropriate relief under § 1109," which deals with liability for breach of fiduciary duties with respect to ERISA plans. "Individual beneficiaries may bring fiduciary actions against the plan fiduciaries, but they must do so for the benefit of the plan and not their individual benefit."
Plaintiffs argue that they have alleged a "systematic and willful failure to pay benefits" and thus their claim meets the standards set for a claim under § 1132(a)(2). Opp. at pp. 6-9. Furthermore, they contend relief granted "under this claim would benefit not only the Patients, but
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CIGNA contends the Patients have failed to establish exceptional circumstances necessary to proceed anonymously in this litigation. MTD at pp. 14-17. Plaintiffs contend anonymity is necessary to protect the sensitive medical information of the Patients. Opp. at pp. 12-13.
As they relate to identification of parties in a complaint, the Federal Rules of Civil Procedure require the caption to include the names of all the parties. Fed. R. Civ. Proc. 10(a). There is a presumption that litigants will use their real names.
The Complaint states: "The names and identities of Patient One, Patient Two, and Patient Three have been withheld to protect the Patients' confidential health information." Comp. at p. 1 n.1. It goes on to explain: "Anonymity in this case is necessary . . . to preserve privacy in a matter of a sensitive and highly personal nature. The Patients' identifying information will be separately provided to [CIGNA] and be disclosed to this Court as necessary and subject to appropriate protective measures."
Plaintiffs have privately identified to CIGNA the identities of the Patients. The Court finds the prejudice to the public and to CIGNA at this stage in the litigation is minimal. However, as the Ninth Circuit has stated, "the balance between a party's need for anonymity and the interests weighing in favor of open judicial proceedings may change as the litigation progresses."
The Court GRANTS CIGNA's motion to dismiss Plaintiffs' second cause of action WITHOUT PREJUDICE. The Court GRANTS the motion to dismiss Nutrishare's state law claims in the third, fourth, fifth, seventh and eighth causes of action WITH PREJUDICE. And finally, the Court GRANTS the motion to dismiss the Patients' sixth cause of action WITH PREJUDICE. The Patients will be allowed to proceed anonymously; however, the issue may be revisited as this litigation progresses. Plaintiffs shall file an Amended Complaint within twenty days of this Order and CIGNA shall file its responsive pleading within twenty days thereafter. If Plaintiffs elect not to amend their complaint, the case shall proceed on the remaining first cause of action.