LANCE M. AFRICK, District Judge.
The Court has pending before it a motion
This case arises out of the death of plaintiff's wife, Marcia Milton ("Mrs. Milton"). According to the state-court petition, Mrs. Milton "had a valid policy of health insurance in effect with defendant, Blue Cross and Blue Shield of Texas, through plaintiff, Kevin Milton and Debusk Services Group."
Mrs. Milton "was diagnosed with neurological sarcoidosis" in January 2012 and was prescribed "Remicade," which "controlled her sarcoidosis and the symptoms thereof."
BCBS removed the above-captioned matter to this Court, asserting both diversity jurisdiction and federal question jurisdiction.
A district court may dismiss a complaint, or any part of it, for failure to state a claim upon which relief can be granted if the plaintiff has not set forth a factual allegation in support of his claim that would entitle him to relief. Bell Atl. Corp. v. Twombly, 550 U.S. 544, 555 (2007); Cuvillier v. Taylor, 503 F.3d 397, 401 (5th Cir. 2007). As the U.S. Court of Appeals for the Fifth Circuit explained in Gonzalez v. Kay:
577 F.3d 600, 603 (5th Cir. 2009).
This Court will not look beyond the factual allegations in the pleadings to determine whether relief should be granted. See Spivey v. Robertson, 197 F.3d 772, 774 (5th Cir. 1999); Baker v. Putnal, 75 F.3d 190, 196 (5th Cir. 1996). Nonetheless, the Court may consider the terms of the healthcare benefits plan at issue because it is attached to the motion to dismiss, referred to in the petition, and central to plaintiff's claims. See In re Katrina Canal Breaches Litig., 495 F.3d 191, 205 (5th Cir. 2007).
In assessing the complaint, a court must accept all well-pleaded facts as true and liberally construe all factual allegations in the light most favorable to the plaintiff. Spivey, 197 F.3d at 774; Lowrey v. Tex. A&M Univ. Sys., 117 F.3d 242, 247 (5th Cir. 1997).
BCBS moves to dismiss plaintiff's claims because the health insurance at issue allegedly was an ERISA plan and, therefore, (1) ERISA preempts plaintiff's state-law tort claims, and (2) plaintiff's ERISA claims are barred because he failed to exhaust administrative remedies. For the following reasons, the Court finds that the preemption issue is dispositive and requires dismissal of plaintiff's claims with prejudice.
BCBS contends that pursuant to 29 U.S.C. § 1144(a), ERISA preempts plaintiff's state-law tort claims which are essentially wrongful death and survivor claims based on Mrs. Milton's death. ERISA preemption is an affirmative defense and the defendant asserting preemption has the burden of proof. See Access Mediquip L.L.C. v. UnitedHealthcare Ins. Co., 662 F.3d 376, 378 (5th Cir. 2011). The Fifth Circuit has "frequently stated that the existence of an ERISA plan within the statutory definition is a question of fact." House v. Am. United Life Ins. Co., 499 F.3d 443, 448 (5th Cir. 2007) (citing Meredith, 980 F.2d at 353). "However, where the factual circumstances are established as a matter of law or undisputed, [the Fifth Circuit has] treated the question as one of law to be reviewed de novo." Id. Accordingly, "while not so stating," the Fifth Circuit "treat[s] the existence of an ERISA plan as a mixed question of fact and law." Id. at 449.
The Court notes that in the past it has decided the existence of an ERISA plan through a motion for summary judgment. See McGinn v. Metropolitan Life Ins. Co., No. 11-3025, 2014 WL 3489736 (E.D. La. July 14, 2014) (Africk, J.). As BCBS points out, however, in some circumstances it may be possible to determine the existence of an ERISA plan from the face of the pleadings and the plan document itself.
In analyzing preemption of state-law claims pursuant to § 1144(a), the Court "first ask[s] whether the benefit plan at issue constitutes an ERISA plan; if it is, [the Court] must then determine whether the state-law claims `relate to' the plan." Woods v. Tex. Aggregates, L.L.C., 459 F.3d 600, 602 (5th Cir. 2006).
To determine whether a plan or policy "is a benefit plan regulated by ERISA," the Fifth Circuit asks "whether a plan (1) exists; (2) falls within the safe-harbor provision established by the Department of Labor; and (3) satisfies the primary elements of an ERISA `employment benefit plan'—establishment or maintenance by an employer intending to benefit employees.'" See House, 499 F.3d at 448 (quoting Meredith, 980 F.2d at 355).
First, the Court finds that BCBS has established that the plan exists.
Second, BCBS has established that the safe-harbor provision does not apply. When an employer contributes to its employees' plan premiums, the policy falls outside the safe-harbor provision because it fails the first safe-harbor requirement: that "No contributions are made by an employer or employee organization." 29 C.F.R. § 2510.3-1(j)(1); see also Read v. Sun Life Assurance Co. of Canada, 268 F. App'x 369, 371 (5th Cir. 2008). As noted above, the Benefit Booklet plainly contemplates the employer paying at least a portion of the premiums.
Third, BCBS has established that plaintiff's allegations and the Benefit Booklet demonstrate satisfaction of "the primary elements of an ERISA `employee benefit plan'—establishment or maintenance by an employer intending to benefit employees." House, 499 F.3d at 450. The plan expressly states that it was "offered by [Milton's] Employer as one of the benefits of [his] employment" for the purpose of "assist[ing] [him] with many of [his] health care expenses for Medically Necessary services and supplies."
Plaintiff's arguments in opposition are unpersuasive. His bare assertion that the existence of an ERISA plan is a fact question and that BCBS "cannot present, at this early stage of the litigation, sufficient evidence to prove the benefit plan is in fact an ERISA plan," is unconvincing.
The Court also attaches no weight to plaintiff's observation that the Benefit Booklet does not expressly "state that the benefit plan at issue is an ERISA benefit plan."
Because the benefit plan at issue is an ERISA plan, the next step in the § 1144(a) preemption analysis is whether plaintiff's "state-law claims `relate to' the plan." Woods, 459 F. 3d at 602. Wrongful death and survival action tort claims based on a denial of benefits pursuant to an ERISA plan plainly relate to that plan for the purposes of the preemption analysis, as numerous courts have held. See Corcoran v. United Healthcare, Inc., 965 F.2d 1321 (5th Cir. 1992), abrogated on other grounds by Rogers v. Hartford Life & Acc. Ins. Co., 167 F.3d 933 (5th Cir. 1999); Hammann v. AmeriHealth Adm'rs, Inc., No. 12-2545, 2013 WL 663760 (E.D. La. Feb. 25, 2013) (Barbier, J.), aff'd 543 F. App'x 355 (5th Cir. 2013); Conway v. La. Health & Serv. & Indem. Co., No. 14-34, 2015 WL 1348501 (M.D. La. Mar. 25, 2015). Plaintiff does not respond to these authorities, let alone distinguish them.
Accordingly, the Court is persuaded that conflict preemption pursuant to 29 U.S.C. § 1144(a) preempts plaintiff's state-law tort claims. Claims preempted pursuant to conflict preemption should be dismissed. See, e.g., Kersh, 946 F. Supp. 2d at 631 (explaining that conflict preemption of a claim "does require dismissal of that claim").
The Court concludes that it need not address BCBS's additional argument based on failure to exhaust administrative remedies. Plaintiff's state-court petition alleges purely state-law negligence claims.
Accordingly,
Clayton v. ConocoPhillips Co., 722 F.3d 279, 294 (5th Cir. 2013) (citing Meredith, 980 F.2d at 355-56).
The cases BCBS cites do not support its argument that a plaintiff must affirmatively plead exhaustion. Medina v. Anthem Life Insurance Co. does not address pleading requirements; the failure to exhaust in that case was established by plaintiff's discovery responses and not a failure to plead exhaustion in the complaint. See 983 F.2d 29, 33 (5th Cir. 1993). In Marcella v. Ochsner Health System, this Court converted a motion to dismiss for lack of ERISA exhaustion into a motion for summary judgment and it did not address pleading requirements. See No. 10-2323, 2010 WL 4553520, at *1 & n.1 (E.D. La. Oct. 28, 2010) (Africk, J.); accord Cox v. Graphic Commc'ns Conf. of Int'l Bhd. of Teamsters, 603 F.Supp.2d 23, 27-28 (D.D.C. 2009) (deciding exhaustion defense presented in motion for summary judgment). In Piro v. Nexstar Broadcasting, Inc., a U.S. Magistrate Judge recommended dismissing an ERISA complaint because the plaintiff had "established the defense of failure to exhaust on the face of his complaint." No. 11-2049, 2012 WL 208596, at *4 (W.D. La. Apr. 10, 2012).