Meyers v. Louisiana Health Services and Indemnity Co. et al

Filing 18

ORDER & REASONS: denying 15 Motion to Remand to State Court. Signed by Judge Carl Barbier on 12/4/14. (sek)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF LOUISIANA
RONALD MEYERS

CIVIL ACTION

VERSUS

NO: 14-2436

LOUISIANA HEALTH SERVICES AND
INDEMNITY CO., ET AL

SECTION: J(5)

ORDER AND REASONS
Before the Court is a Motion to Remand (Rec. Doc. 15) filed by
Plaintiff, Ronald Meyers ("Plaintiff"), as well as an Opposition
(Rec. Doc. 16) by Defendant, Wal-Mart Stores, Inc. Associates'
Health

and

Welfare

Plan

("Defendant").

Having

considered

the

motion, the parties’ submissions, the record, and the applicable
law, the Court finds, for the reasons expressed below, that the
motion should be DENIED.
PROCEDURAL AND FACTUAL BACKGROUND
Plaintiff, as an employee of Defendant, Wal-Mart Stores, Inc.
("Wal-Mart"), is a beneficiary of Wal-Mart Stores, Inc. Associates'
Health and Welfare

Plan ("the Plan"). The parties do not dispute

that this Plan is a self-funded employee welfare plan governed by
the Employee Retirement Income Security Act ("ERISA"). Plaintiff
alleges that on July 30, 2011, he suffered injuries as a result of
a work-related accident for which he subsequently filed a Louisiana
workers' compensation claim against Wal-Mart on January 19, 2012.

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Wal-Mart initially denied the claim, arguing that Plaintiff's
injuries were not the result of a work-related accident, but rather
resulted from pre-existing conditions. During the time in which
Plaintiff's workers' compensation claim was pending, the Plan paid
$110,856.16 to cover Plaintiff's medical treatment for injuries
allegedly arising from the accident. Ultimately, in January 2013,
Plaintiff and Wal-Mart entered into a settlement agreement in which
Wal-Mart agreed to reimburse the Plan1 the $110,856.16 which the
Plan had already paid to cover Plaintiff's medical expenses.
Plaintiff claims that after this payment was made, the Plan
recouped the payments it had already made to cover Plaintiff's
medical treatment. As such, Plaintiff alleges that the Plan was
reimbursed for payments it effectively never made, and Plaintiff
began receiving bills directly from his medical providers for
services which he had understood had already been paid for by the
Plan.
Plaintiff then filed the present lawsuit in the Civil District
Court for the Parish of Orleans, State of Louisiana on September
11, 2014. Plaintiff first named Wal-Mart as a defendant, requesting
the Court to find Wal-Mart liable for breach of the workers'
compensation settlement agreement as Wal-Mart "did not reimburse
1

The parties dispute the entity to which this payment was actually made,
and who had control over the payments made from the Plan. While the Defendants
assert that this entity is the Plan itself, Plaintiff claims that the liable
entity who administered and accepted these payments is actually Blue Cross Blue
Shield of Louisiana, Inc. ("BCBSLA"). For the sake of simplicity, the Court will
refer to this entity as the Plan.

2

the healthcare insurer as it was required to do pursuant to the
settlement agreement." (Rec. Doc. 1-2, p. 4).2

In the event that

Wal-Mart is not found liable, Plaintiff also named BCBSLA as a
defendant, claiming that BCBSLA violated La. R.S. 23:1205(c) by
recouping payments made to Plaintiff's medical providers after
being

reimbursed

by

Wal-Mart,

and

thus

receiving

an

unjust

enrichment. La. R.S. 23:1205(c) specifically provides in relevant
part:
In the event that the workers' compensation payor has
denied that the employee's injury is compensable under
this Chapter, then any health insurer which contracts
to provide health care benefits for an employee shall
be responsible for the payment of all medical benefits
pursuant to the terms of the health insurer's policy.
Any health insurer which contracts to provide health
care benefits for an employee who violates the
provisions of this Subsection shall be liable to the
employee or health care provider for reasonable
attorney fees and costs related to the dispute and to
the employee for any health benefits payable.
LA. REV. STAT. ANN. § 1205(c)(1) (2004).
Defendant removed the lawsuit to this Court on October 23,
2014, asserting that federal jurisdiction existed over the matter
on

two

separate

completely

bases.

preempted

First,

Defendant

Plaintiff's

state

contends

law

that

claims,

and

ERISA
that

Plaintiff's complaint thus posed a federal question, which this
Court has jurisdiction to hear. Additionally, Defendant asserts

2

Plaintiff does not address its claims against Wal-Mart in the present
motion and instead relies solely on its claim that BCBSLA unlawfully recouped its
payments after receiving reimbursement from Wal-Mart.

3

that the Court has diversity jurisdiction to hear this matter.
Specifically, Defendant argues that BCBSLA was improperly named as
a defendant in this matter, because the Plan's Administrative
Committee had full discretion to interpret the Plan's terms and
determine whether payment of benefits was appropriate, whereas
BCBSLA acted in a "purely ministerial capacity" with no such
discretion. Defendant argues that as such, BCBSLA's citizenship may
be ignored for purposes of jurisdiction, and because Defendant is
a citizen of Arkansas while Plaintiff is a citizen of Louisiana,
diversity jurisdiction exists over this matter pursuant to 28
U.S.C.A. § 1332(a).
Plaintiff then filed the instant motion, requesting that the
Court remand the matter back to state court on the basis that it
lacks jurisdiction. Plaintiff specifically argues that because this
matter does not question Plaintiff's rights under the Plan or the
application of its terms, and rather only addresses BCBSLA's
conduct in accepting reimbursement for payments it then recouped,
the lawsuit is not preempted by ERISA. Additionally, Plaintiff
asserts that BCBSLA was properly named as a defendant and that
BCBSLA's

Louisiana

citizenship

effectively

defeats

diversity

jurisdiction.
LEGAL STANDARD AND DISCUSSION
A defendant may remove a civil action filed in state court if
a federal court would have had original jurisdiction over the

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action.

See 28 U.S.C. § 1441(a).

The removing party bears the

burden of establishing that federal jurisdiction exists at the time
of removal.
1995).

DeAguilar v. Boeing Co., 47 F.3d 1404, 1408 (5th Cir.

Ambiguities are construed against removal and in favor of

remand, because removal statutes are to be strictly construed.
Manguno v. Prudential Prop. & Cas. Ins., 276 F.3d 720, 723 (5th
Cir. 2002).
The parties first dispute whether the Court has jurisdiction
over the matter pursuant to ERISA. Federal courts have original
jurisdiction

over

cases

which

pose

a

"federal

question,"

by

"arising under the Constitution, laws, or treaties of the United
States." 28 U.S.C.A. § 1331 (1980). Courts consider whether a case
poses a federal question pursuant to the "well-pleaded complaint
rule, which provides that federal jurisdiction exists only when a
federal question is presented on the face of the plaintiff's
properly pleaded complaint." Caterpillar Inc. v. Williams, 482 U.S.
386, 393 (1987) (citing Gully v. First Nat'l Bank, 299 U.S. 109,
112-113 (1936)). However, a significant exception

exists to the

"well pleaded complaint rule," known as the "complete pre-emption
doctrine," which provides that "once an area of state law has been
completely pre-empted, any claim purportedly based on that preempted state law is considered, from its inception, a federal
claim, and therefore arises under federal law." Caterpillar, 482
U.S. at 393 (citing Franchise Tax Bd. of State of Cal. v. Constr.

5

Laborers Vacation Trust Fund for So. Cal., 463 U.S. 1, 23-24
(1983)).
Because the stated purpose of ERISA is to "provide a uniform
regulatory

regime

over

employee

benefit

plans,"

it

includes

substantial preemption provisions to "ensure that employee benefit
plan regulation would be exclusively a federal concern." Aetna
Health Inc. v. Davila, 542 U.S. 200, 208 (2004) (citing Alessi v.
Raybestos-Manhattan, Inc., 451 U.S. 504, 523 (1981) (internal
quotations omitted)). Specifically, § 502(a) of ERISA is intended
to completely preempt any state law which supplements, duplicates,
or contradicts provisions of ERISA governing civil enforcement
remedies.

Davila,

542

U.S.

at

209.

As

such,

ERISA's

civil

enforcement provision "completely preempts any state cause of
action seeking the same relief, regardless of how artfully pled as
a state action." Copling v. Container Store, Inc., 174 F.3d 590,
594 (5th Cir. 1999), overruled on other grounds by Arana v. Ochsner
Health Plan, 338 F.3d 433 (5th Cir. 2003). It logically follows
that if a party removes a matter to federal district court on the
basis of ERISA's preemption provisions, and the plaintiff moves to
remand, "all the defendant has to do is demonstrate a substantial
federal claim, e.g., one completely preempted by ERISA, and the
court may not remand." Copling, 174 F.3d at 594.
In determining whether ERISA preempts a Plaintiff's state law
claim, this Court has previously recognized that "if an individual,

6

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 § 1132(a)(1)(B)."
Yong Ok Sankey v. Metro. Life Ins. Co., No. 12-1135, 2012 WL
2338964, at *3 (E.D. La. June 19, 2012) (Barbier, J.) (quoting
Davila, 542 U.S. at 210). Therefore, in order to determine whether
Plaintiff's claims are completely preempted by ERISA and properly
before this Court, the Court must determine whether the claims fall
within the scope of ERISA § 502(a)(1).

§ 502(a) provides, in

pertinent part:
A civil action may be brought by a participant or
beneficiary . . . to recover benefits due to him
under the terms of his plan, to enforce his rights
under the terms of the plan, or to clarify his
rights to future benefits under the terms of the
plan.
29 U.S.C.A. § 1132 (2014). The parties do not dispute that the Plan
is an employee benefits plan governed by ERISA. However, Plaintiff
contends that its claims pursuant to Louisiana law, namely its
claim that BCBSLA violated La. R.S. 23:1205(c), are not preempted
by § 502(a). Plaintiff maintains that this claim solely addresses
BCBSLA's act in accepting reimbursement money for payments it
failed to make, and does not require an analysis of the terms of
the Plan or Plaintiff's rights under the Plan. Because the sole
issue at hand is BCBSLA's conduct, rather than the terms or
provisions of the plan, Plaintiff argues that a finding that its
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claims

are

completed

preempted

by

§

502

would

be

improper.

Defendant, in response, disagrees with Plaintiff's contention that
its claim does not implicate the terms of the Plan. Instead,
Defendant submits that despite the fact that Plaintiff labeled his
claim as a state-law issue, he is seeking only to recover benefits
and enforce his rights under the Plan. Defendant further contends
that the duties imposed by La. R.S. 23:1205(c) are derived entirely
from the rights and obligations imposed by the Plan's terms.
Because Plaintiff's claim is directly intertwined with the terms
and rights provided by the Plan, Defendant asserts that removal is
proper on the basis of § 502(a).
Neither this Court nor the Fifth Circuit have previously
addressed the issue of whether a claim brought pursuant to

La.

R.S. 23:1205(c) may be preempted by ERISA for purposes of federal
jurisdiction. However, the Fifth Circuit has recognized that a
claim regarding reimbursement of payments made from an ERISA plan
brought pursuant to a Louisiana statute is completely preempted by
§ 502. See Arana, 338 F.3d at 437-39. In Arana, similarly to the
present factual circumstances, the plaintiff's employee benefits
health insurance plan governed by ERISA originally made payments to
cover medical expenses incurred by the plaintiff. Id. at 435.
However, upon determining that the plaintiff had not satisfied the
requisite procedures to earn these payments, the plan sought
reimbursement by the plaintiff for those benefits it had already

8

paid. Id. The plaintiff then filed a lawsuit against the plan
seeking declaratory judgment pursuant to La. R.S. § 22:663 holding
that the Plan was barred from seeking reimbursement from the
plaintiff for payments already made.3 Id. at 435-36. Despite the
plaintiff's argument that federal jurisdiction did not exist over
the matter because he sought relief under Louisiana law, as opposed
to under the terms of his ERISA plan, the Court found that
Plaintiff's claim was effectively a claim seeking benefits pursuant
to the terms of his plan and was completely preempted by § 502(a).
Id. at 438. Additionally, the Court recognized that preemption was
proper even though the plaintiff's ERISA claim was required to be
read in conjunction with state law. Id. (citing Plumb v. Fluid Pump
Serv., Inc., 124 F.3d 849, 860-62 (7th Cir. 1997)).
Here, like the plaintiff in Arana, Plaintiff asserts that
preemption is not appropriate as his "claim stems from Louisiana
state law statutory duties and not from ERISA." (Rec. Doc. 15-1, p.
9). While Plaintiff alleges that he is merely seeking to have

3

La. R.S. § 22:994, formerly La. R.S. § 22:663, provides in pertinent

part:
[N]o group policy of accident, health or hospitalization
insurance, or of any group combination fo these coverages, shall
be issued by any insurer doing business in this state which by
the terms of such policy group contract excludes or reduces the
payments to or on behalf of an insured by reason of the fact that
benefits have been paid under any other individually underwritten
contract or plan of insurance for the same claim determination
period.
LA. REV. STAT. ANN. § 22:994 (2009).

9

BCBSLA return the money it has allegedly recouped, the Court finds
that what Plaintiff is actually requesting is payment of the
benefits to which he claims to be entitled pursuant to the Plan.
This claim is analogous to the plaintiff's claim in Arana, in which
the Court found that "although the benefits have already been paid
[to plaintiff by the ERISA plan], Arana has not fully 'recovered'
them because he has not obtained the benefits free and clear of
OHP's claims." Arana, 338 F.3d at 438. Here, while Plaintiff
originally received benefit payments from the Plan, he also did not
receive these payments "free and clear," because the Plan allegedly
subsequently recouped these benefits, leaving Plaintiff to make the
payments for his medical services. In light of this, despite the
fact that Plaintiff "artfully pled" his claim as based solely on
Louisiana law, the Court concludes this claim is essentially a
claim "to recover benefits due to him under the terms of his plan"
within the scope of § 502(a). As such, Plaintiff's state law claim
is completely preempted by ERISA, granting the Court federal
question jurisdiction over the current matter, and making removal
at this stage in the proceedings proper.
Because the Court determines it has jurisdiction over the
present matter, on the basis that ERISA preempts Plaintiff's state
law claim for violation of La. R.S. 23:1205(c), it is unnecessary
to determine whether BCBSLA was properly named as a defendant for
purposes of diversity jurisdiction.

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CONCLUSION
Accordingly,
IT IS HEREBY ORDERED that the Motion to Remand (Rec. Doc. 15)
is DENIED.
New Orleans, Louisiana this 4th day of December, 2014.

________________________________
CARL J. BARBIER
UNITED STATES DISTRICT JUDGE

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