Komarnisky v. United Healthcare Insurance Company

Filing 13

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)

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IN THE UNITED STATES DISTRICT COURT

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FOR THE DISTRICT OF ARIZONA

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Chris Komarnisky,

No. CV-12-01768-PHX-DGC
Plaintiff,

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v.

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ORDER

United Healthcare Insurance Company,

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Defendant.
Plaintiff, Dr. Chris Komarnisky, filed a complaint against Defendant on July 16,

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2012 in the San Marcos Justice Court for Maricopa County.

Defendant United

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Healthcare Insurance Company (“UHIC”) removed the matter to this Court on

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August 17, 2012. Doc. 1. On August 24, 2012, UHIC filed a motion to dismiss pursuant

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to Rule 12(b)(6) on the grounds that the claims are pre-empted by the exclusive remedial

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provisions of the Employee Retirement Income Security Act of 1974 (“ERISA”), 29

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U.S.C §§ 1001. Doc. 7. Plaintiff filed a response on December 6, 2012 (Doc. 11), and

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UHIC filed a reply on December 17, 2012 (Doc. 12). No party has requested oral

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argument. For the reasons that follow, the Court will grant UHIC’s motion to dismiss.

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UHIC is the administrator of an ERISA health plan sponsored by Wells Fargo &

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Company. Doc. 7 at 1-2. Plaintiff is a doctor that provided chiropractic services for

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Terri Genevay, a participant in the Wells Fargo health plan. Doc. 7 at 1-2. Plaintiff

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alleges that the plan applied payment for 27 chiropractic visits to Ms. Genevay’s

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deductible rather than compensating him. Plaintiff brings state law breach of contract

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claims, presumably as his patient’s assignee, against UHIC.

Defendant argues that

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Plaintiff’s state law claims are preempted by exclusive remedial provisions of ERISA and

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that the plan participant did not exhaust administrative remedies.

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State causes of action that duplicate, supplement, or supplant the civil enforcement

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provisions of ERISA are preempted by § 502(a). Aetna Health, Inc. v. Davila, 542 U.S.

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200, 208-09 (2004). The state law claims do not need to precisely duplicate the elements

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of an ERISA claim to be preempted. Id at 216. In the Ninth Circuit, ERISA participants

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also must exhaust the plan’s internal administrative procedures before bringing suit.

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Vaught v. Scottsdale Healthcare Corp. Health Plan, 546 F.3d 620, 626 (9th Cir. 2008).

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UHIC argues that the state law breach of contract claims arise from a dispute

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regarding coverage under an ERISA plan, 29 U.S.C. § 1002(1), and are preempted.

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Plaintiff argues that UHIC’s preemption arguments are attempts to delay the litigation

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and, because the claim is relatively small, the parties should “keep it simple and get this

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over with.” Doc. 11 at 2. Plaintiff’s arguments do not respond to the legal merits of the

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UHIC’s motion, nor does he dispute that the plan is governed by ERISA. In the absence

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of any argument to the contrary, the Court finds that the state law claims “duplicate,

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supplement, or supplant[]” the ERISA civil enforcement remedy and are preempted.

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Davila, 542 U.S. at 208.

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Additionally, Plaintiff does not respond directly to UHIC’s argument that the plan

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participant failed to exhaust her administrative remedies. Plaintiff does not dispute that

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Mrs. Genevay never availed herself of the plan’s internal procedures for benefit denial

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disputes, and his appeal on her behalf was not initiated until several months after he filed

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this complaint. The Court also finds that this claim is barred by failure to exhaust

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administrative remedies. Vaught, 546 F.3d at 626.

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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.

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