The gravamen of plaintiff's complaint is that the defendant represented to plaintiff that it would "pay all charges for all services rendered [to Ms. Vucetic] at the Medical Center" but later refused to do so. Plaintiff's Complaint, para. 17. The claim is pleaded under Pennsylvania common law on a theory of estoppel.
Defendant contends that its employee benefit plan ("Action Manufacturing Company Group Health and Accident and Sickness Plan") provided for a lifetime maximum medical benefit of $ 250,000, and that it is not liable to the Medical Center for charges in excess of its beneficiary's coverage.
Defendant removed this case to federal court on the basis that plaintiff's estoppel action was preempted by the Employee Retirement Income Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. In its petition to remand, plaintiff contends that its claim is only tenuously related to ERISA because it focuses not on the terms of the benefit plan but on the promises made by the plan's agents to personnel at the Medical Center. Plaintiff also seeks to have this action consolidated with plaintiff's suit in Philadelphia Common Pleas Court against Ms. Vucetic's husband, Mr. Peter Vucetic, in which plaintiff seeks collection on Ms. Vucetic's medical bill.
Plaintiff's petition to remand to state court raises two issues: whether ERISA preempts the plaintiff's state common law claim against the defendant and, if so, whether the defendant can remove plaintiff's claim to federal court on the basis of its federal preemption defense.
ERISA's preemption clause, § 514, 29 U.S.C. § 1144, states in part that ERISA's provisions "shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan" described in the statute. The Supreme Court has construed ERISA's preemption provision broadly, holding that § 514 preempts both state statutory and common law causes of action that "relate to" employee benefit plans. See Pilot Life Insurance Co. v. Dedeaux, 481 U.S. 41, 107 S. Ct. 1549, 1553, 95 L. Ed. 2d 39 (1987); see also Shiffler v. Equitable Life Assurance Society, 838 F.2d 78, 81 (3d Cir. 1988).
Despite the breadth of ERISA's preemption provision, and the scope given that provision by the Supreme Court, the claim asserted in this case does not "relate to" an employee benefit plan within the meaning of § 514. The plaintiff in this action is not an aggrieved participant or beneficiary of defendant's plan. Nor is the plaintiff suing as a third-party beneficiary of the plan, claiming that the terms of the plan require payment for the services it rendered. In fact, the plaintiff's cause of action does not in any sense turn on an interpretation of the rights of a beneficiary under the plan. Rather, the complaint alleges that the agents of defendant's employee benefit plan misrepresented that the plan would cover the expenses of one of its beneficiaries. The estoppel claim is thus independent of the defendant's actual obligations under the benefit plan. Cf. Friends Hospital v. Shaw, 1987 U.S. Dist. LEXIS 5374, Civil No. 87-1593, slip op. at 7 (E.D. Pa. June 17, 1987) (finding "unrelated to the benefit plan" suit by medical facility to collect charges in excess of coverage from plan beneficiary).
Both of the cases cited by defendant in support of its preemption claim involved state common law actions brought by actual beneficiaries -- employees who claimed rights to benefits pursuant to the terms of their benefit plans. See Defendant's Memorandum at 7-9 (citing Holland v. Burlington Industries, 772 F.2d 1140 (4th Cir. 1985); Blau v. Del Monte Corporation, 748 F.2d 1348 (9th Cir. 1984)). The case for preemption is much weaker in this context, in which the claim is not based on a right related to plaintiff's statutory protections under ERISA. In addition, the congressional purpose underlying the breadth of ERISA's preemption provision -- to secure uniform federal laws regulating employee benefit plans
-- is not advanced by preemption of state common law claims which are not premised on a violation of duties imposed by ERISA.
Since plaintiff's claim is not preempted by ERISA, there is no basis for characterizing plaintiff's suit as one arising under federal law and hence removable.
Because plaintiff's petition to remand will be granted, defendant's motion to dismiss is not properly before this court. These rulings are reflected in the accompanying order.
For the reasons stated in the accompanying Memorandum, plaintiff's Petition to Remand to State Court is GRANTED and defendant's Motion to Dismiss is denied as MOOT.