Komarnisky v. United Healthcare Insurance Company
ORDER that Defendant's 7 Motion to Dismiss is granted. The Clerk is directed to terminate this action. Signed by Judge David G Campbell on 2/12/2013.(LFIG)
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ARIZONA
United Healthcare Insurance Company,
Plaintiff, Dr. Chris Komarnisky, filed a complaint against Defendant on July 16,
2012 in the San Marcos Justice Court for Maricopa County.
Healthcare Insurance Company (“UHIC”) removed the matter to this Court on
August 17, 2012. Doc. 1. On August 24, 2012, UHIC filed a motion to dismiss pursuant
to Rule 12(b)(6) on the grounds that the claims are pre-empted by the exclusive remedial
provisions of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29
U.S.C §§ 1001. Doc. 7. Plaintiff filed a response on December 6, 2012 (Doc. 11), and
UHIC filed a reply on December 17, 2012 (Doc. 12). No party has requested oral
argument. For the reasons that follow, the Court will grant UHIC’s motion to dismiss.
UHIC is the administrator of an ERISA health plan sponsored by Wells Fargo &
Company. Doc. 7 at 1-2. Plaintiff is a doctor that provided chiropractic services for
Terri Genevay, a participant in the Wells Fargo health plan. Doc. 7 at 1-2. Plaintiff
alleges that the plan applied payment for 27 chiropractic visits to Ms. Genevay’s
deductible rather than compensating him. Plaintiff brings state law breach of contract
claims, presumably as his patient’s assignee, against UHIC.
Defendant argues that
Plaintiff’s state law claims are preempted by exclusive remedial provisions of ERISA and
that the plan participant did not exhaust administrative remedies.
State causes of action that duplicate, supplement, or supplant the civil enforcement
provisions of ERISA are preempted by § 502(a). Aetna Health, Inc. v. Davila, 542 U.S.
200, 208-09 (2004). The state law claims do not need to precisely duplicate the elements
of an ERISA claim to be preempted. Id at 216. In the Ninth Circuit, ERISA participants
also must exhaust the plan’s internal administrative procedures before bringing suit.
Vaught v. Scottsdale Healthcare Corp. Health Plan, 546 F.3d 620, 626 (9th Cir. 2008).
UHIC argues that the state law breach of contract claims arise from a dispute
regarding coverage under an ERISA plan, 29 U.S.C. § 1002(1), and are preempted.
Plaintiff argues that UHIC’s preemption arguments are attempts to delay the litigation
and, because the claim is relatively small, the parties should “keep it simple and get this
over with.” Doc. 11 at 2. Plaintiff’s arguments do not respond to the legal merits of the
UHIC’s motion, nor does he dispute that the plan is governed by ERISA. In the absence
of any argument to the contrary, the Court finds that the state law claims “duplicate,
supplement, or supplant” the ERISA civil enforcement remedy and are preempted.
Davila, 542 U.S. at 208.
Additionally, Plaintiff does not respond directly to UHIC’s argument that the plan
participant failed to exhaust her administrative remedies. Plaintiff does not dispute that
Mrs. Genevay never availed herself of the plan’s internal procedures for benefit denial
disputes, and his appeal on her behalf was not initiated until several months after he filed
this complaint. The Court also finds that this claim is barred by failure to exhaust
administrative remedies. Vaught, 546 F.3d at 626.
IT IS ORDERED that Defendant’s motion to dismiss (Doc. 7) is granted. The
Clerk is directed to terminate this action.
Dated this 12th day of February, 2013.
Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.
Why Is My Information Online?