The opinion of the court was delivered by: Lowell A. Reed, Jr., Senior District Judge.
Now before the Court are the motions of defendants Cigna
HealthCare of Pennsylvania ("Cigna") (Document No. 9) and
defendant Retired Persons Services, Inc. ("RPS") (Document No.
10), to dismiss pursuant to Rule 12(b)(6) of the Federal Rules of
Civil Procedure, and the motion of plaintiff Charmaine Quarles to
remand (Document No. 8) to the Court of Common Pleas of
Philadelphia County, Pennsylvania, pursuant to
28 U.S.C. § 1447(c). Upon consideration of the motions, the responses, and
the pleadings, the motion to remand will be granted and the
motions to dismiss will be referred to the state court for
According to her complaint, on July 8, 1999, plaintiff sliced
her hand on broken glass while washing dishes and sought
treatment at the emergency room of defendant Germantown Hospital.
Plaintiff alleges that she suffered major, permanent injuries to
her hand and arm as a result of the negligence of the treating
physician, Dr. Lisa Wenger, and Germantown Hospital. Plaintiff
also asserts claims of negligence and breach of contract, against
her employer, Retired Persons Services, Inc., alleging that RPS
failed to activate her insurance coverage within the appropriate
time period and thus caused her to be
denied treatment by health care providers. Finally, plaintiff
alleges that Cigna was negligent, breached its contract with
plaintiff, and acted in bad faith in denying coverage to
Plaintiff filed this action in the Court of Common Pleas of
Philadelphia County, Pennsylvania on June 28, 2000. Cigna removed
the case to the United States District Court for the Eastern
District of Pennsylvania on July 26, 2000 (Document No. 1). Cigna
and RPS have filed motions to dismiss for failure to state a
claim, and plaintiff seeks remand on the ground that no federal
question is presented.*fn1 Defendants argue that Plaintiffs
claims are preempted by the Employee Retired Income Security Act
of 1974 ("ERISA"), 29 U.S.C. § 1001-1461 (1988), that remand is
improper, and that the case should be dismissed.
Rule 12(b) of the Federal Rules of Civil Procedure provides
that "the following defenses may at the option of the pleader be
made by motion: . . . (6) failure to state a claim upon which
relief can be granted." In deciding a motion to dismiss under
Rule 12(b)(6), a court must take all well pleaded facts in the
complaint as true and view them in the light most favorable to
the plaintiff. See Jenkins v. McKeithen, 395 U.S. 411, 421, 89
S.Ct. 1843, 23 L.Ed.2d 404 (1969). Because the Federal Rules of
Civil Procedure require only notice pleading, the complaint need
only contain "a short and plain statement of the claim showing
that the pleader is entitled to relief." Fed.R.Civ.P. 8(a). A
motion to dismiss should be granted if "it is clear that no
relief could be granted under any set of facts that could be
proved consistent with the allegations." Hishon v. King &
Spalding, 467 U.S. 69, 73, 104 S.Ct. 2229, 81 L.Ed.2d 59 (1984).
On a motion to remand, the defendant bears the burden of
proving by a preponderance of the evidence that removal was
proper and that the district court has subject matter
jurisdiction. See Irving v. Allstate Indem. Co., 97 F. Supp.2d 653,
654 (E.D.Pa. 2000) (citing Meritcare Inc. v. St. Paul
Mercury Ins. Co., 166 F.3d 214, 222 (3d Cir. 1999)).
Both the motions to dismiss and the motion to remand hinge on
the same question: whether plaintiff's claim is preempted under
the terms of ERISA. Therefore, I turn to a consideration of the
circumstances under which ERISA preempts a cause of action
brought under state law. There are two types of preemption that
arise in the ERISA context: (1) "complete preemption" under
section 502(a); and (2) "express preemption" under section
The complete preemption question revolves around whether the
complaint states a federal cause of action that confers subject
matter jurisdiction on this Court. The venerable "well-pleaded
complaint" rule requires a federal question to appear on the face
of a complaint for a court to exercise subject matter
jurisdiction. See Franchise Tax Bd. of Cal. v. Construction
Laborers Vacation Trust for S. Cal., 463 U.S. 1, 9-12, 103 S.Ct.
2841, 77 L.Ed.2d 420 (1983). There is a narrow exception to this
rule, however, where "Congress . . . so completely pre-empt[s] a
particular area that any civil complaint raising this select
group of claims is necessarily federal in character."
Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58, 63-64, 107
S.Ct. 1542, 95 L.Ed.2d 55 (1987). The complete preemption
doctrine essentially confers federal subject matter jurisdiction
over state claims against employer-related insurance companies
and health maintenance organizations into federal actions arising
under ERISA. See Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41,
56, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987).
As plaintiff and defendants recognize, Dukes v. U.S.
Healthcare, 57 F.3d 350 (3d Cir. 1995), cert. denied,
516 U.S. 1009, 116 S.Ct. 564, 133 L.Ed.2d 489 (1995), lights
the way for our inquiry. There, the Court of Appeals for the
Third Circuit considered whether negligence claims against a
health maintenance organization (HMO) were covered by ERISA. In
analyzing whether the claim was preempted by ERISA, the court
drew a distinction between claims that allege a claim for benefit
due under insurance plan (and thus object to the quantity of the
care) and claims that attack the quality of the benefit received
by the plaintiff.*fn2 The court found that former claims are
completely preempted by ERISA and the latter are not. Id. at
355. The court then looked to plaintiffs' complaints and
determined that they did not allege the denial of a benefit and
instead challenged the quality of care under agency and
negligence principles. Id. at 359; see also Bauman v. U.S.
Healthcare, Inc. (In re: U.S. Healthcare, Inc.), 193 F.3d 151,
161-162 (3d Cir. 1999), cert. denied, U.S., ___ U.S. ___, 120
S.Ct. 2687, 147 L.Ed.2d 960 (2000).
As discussed in my decision in Spear v. Richard J. Caron
Found., No. 99-0706, 1999 WL 768299, 1999 U.S. Dist. LEXIS 14910
(E.D.Pa. Sept. 28, 1999), the Court must look to the language of
the complaint to answer the quality/quantity question posed by
Dukes. See id. at *2 ("I am much more comfortable reading the
language of a complaint than minds of the plaintiffs.") (citing
Bauman, 193 F.3d at 163 (holding that the state law claims were
not preempted because "[t]he counts are phrased in terms of the
quality of the medical care provided")). If a plaintiff makes a
claim to recover benefits, and a challenge to the quantum of
the benefits received by plaintiff is plain on the face of the
complaint, then plaintiff's claim is completely preempted by
ERISA. If, however, it is clear from the face of the complaint
that plaintiff is challenging the quality of the care received,
plaintiff's claim is not completely preempted.
The Court of Appeals for the Third Circuit acknowledged in
Bauman that "[t]here are some cases in which it may be
difficult to distinguish between claims challenging the quality
of benefits rather than their quantity." Bauman, 193 F.3d at
162. This is one of those cases. Plaintiff on one hand alleges
that she was denied coverage, and on the other hand avers that as
a result of the denial of coverage, the quality of the care she
received was deficient. While plaintiff's case falls in the
twilight between a quantity and a quality claim, I believe there
is a polestar that guides us to the answer: the gravamen of
plaintiff's claims. The interstitial nature of plaintiff's claim
demands that the Court focus on the central basis and gravamen of
the claims to discern where, along the quantity/quality
continuum, plaintiff's claims fall.
Upon a careful review of the complaint, I conclude that
plaintiff's claims are closer to a challenge to the quality of
medical care received. In each count against RPS and Cigna,
plaintiff's fundamental claim is that because of the acts or
omissions of RPS and Cigna, "plaintiff was denied timely,
adequate and appropriate medical treatment and suffered the
injuries and damages hereinbefore described." (Complaint, at ¶¶
19, 25, 32, 39.) While plaintiff alleges that Cigna and RPS
failed to provide health care coverage, the denial of coverage is
antecedent and ancillary to plaintiff's central complaint, which
is the deficient medical treatment she received. See Bauman,
193 F.3d at 164 ("The mere fact that the Baumans referred in
their complaint to a benefit promised by their health plan does
not automatically convert
their state-law negligence claim into a claim for benefits under
section 502."). The failure to provide coverage matters to
plaintiff's claims only insofar as it affected the quality of the
medical care plaintiff received.
Nowhere in the complaint does plaintiff seek the payment of
medical bills or the payment of benefits due under the health
care plan. See Bauman, 193 F.3d at 162. I do not believe this
to be a case of "artful pleading," carefully crafted to defeat
complete preemption. Rather, I believe plaintiff's allegations
and her claims for relief all center around the fact that she did
not receive adequate medical care. Thus, while plaintiff's
complaint includes allegations that benefits were denied to her,
I conclude that the gravamen of her claims is that defendants'
breaches of contract and negligence caused her to receive
substandard medical care.
While I conclude that no federal claim is apparent on the face
of the complaint and therefore the doctrine of complete
preemption does not apply here, I also believe that plaintiff's
state claim could be expressly preempted by § 514(a) because it
"relates to" an employee benefit plan. Nevertheless, under such
circumstances, this Court "cannot resolve the dispute regarding
express preemption," because it lacks removal jurisdiction.
Bauman, 193 F.3d at 165 (quoting Dukes, 57 F.3d at 355).
Therefore, this action ...