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United States District Court, E.D. Pennsylvania

April 5, 2004.

JONATHAN WIRTH, individually and on behalf of all others similarly situated

The opinion of the court was delivered by: HARVEY BARTLE, III, District Judge


Defendant Aetna Health, Inc. ("Aetna") (improperly denominated by plaintiff as Aetna U.S. Healthcare) moves to dismiss the first amended class action complaint ("complaint")*fn1 for failure to state a claim upon which relief can be granted under Rule 12(b)(6) of the Federal Rules of Civil Procedure.

Plaintiff Jonathan Wirth alleges various state law claims against Aetna in connection with a health care agreement under which he is a beneficiary. This action was originally filed in the Court of Common Pleas of Bucks County, Pennsylvania and then removed to this court. We denied plaintiff's motion to remand on the ground that this court has subject matter jurisdiction under the doctrine of complete preemption. We determined that plaintiff's claims relate to an employee benefit plan within the scope of § 502(a)(1)(B) of the Employee Retirement Income Security Act ("ERISA") even though we may still apply state insurance law due to the savings clause of § 514(b)(2)(A) of ERISA. 29 U.S.C. § 1132(a)(1)(B) and 1144(b)(2)(A); Wirth v. Aetna U.S. Healthcare, Civ.A. No. 03-5406 (E.D. Pa. Feb. 9, 2004).

  For present purposes we accept as true all well-pleaded facts. In re Rockefeller Ctr. Props. Secs. Litig., 311 F.3d 198, 215 (2002). We may also consider "an undisputedly authentic document that a defendant attaches as an exhibit to a motion to dismiss if the plaintiff's claims are based on the document." Pension Benefit Guar. Corp. v. White Consol. Indus., Inc., 998 F.2d 1192, 1196 (3d Cir. 1993), cert. denied, 510 U.S. 1042 (1994).

  According to the complaint, Plaintiff sustained injuries as a result of an automobile accident. Aetna, a health maintenance organization ("HMO"), paid part of the medical benefits for his injuries under the provisions of a health care agreement with his father's employer. After plaintiff obtained a settlement from the tortfeasor, Aetna asserted a lien against the proceeds in order to obtain reimbursement for its expenditures on his behalf. He subsequently paid Aetna $2,066.90 to release the lien. He now seeks declaratory, injunctive, and monetary relief against Aetna for its allegedly wrongful conduct.

  No one disputes that the terms of Aetna's health care agreement authorize the lien in question. Rather, plaintiff maintains that such liens violate Pennsylvania's Motor Vehicle Financial Responsibility Law ("MVFRL"), which reads in pertinent part:

In actions arising out of the maintenance or use of a motor vehicle, there shall be no right of subrogation or reimbursement from a claimant's tort recovery with respect to workers' compensation benefits, benefits available under section 1711 (relating to required benefits), 1712 (relating to availability of benefits) or 1715 (relating to availability of adequate limits) or benefits paid or payable by a program, group contract or other arrangement whether primary or excess under section 1719 (relating to coordination of benefits).
75 Pa. Cons. Stat. Ann. § 1720.

  Aetna moves to dismiss the complaint on the ground that HMOs are exempt from the anti-subrogation provisions of § 1720 under a provision of the Pennsylvania Health Maintenance Organization Act ("HMO Act"). This Act provides:

a health maintenance organization operating under the provisions of this act shall not be subject to the laws of this State now in force relating to insurance corporations engaged in the business of insurance nor to any law hereafter enacted relating to the business of insurance unless such law specifically and in exact terms applies to such health maintenance organization. For a health maintenance organization established, operated, and maintained by a corporation, this exemption shall apply only to the operations and subscribers of the health maintenance organization.
Pa. Stat. Ann. tit. 40, § 1560(a) (emphasis added).

  Section 1720 of the MVFRL is "a law hereafter enacted" since it was adopted later in time than § 1560(a) of the HMO Act. It is also a law "relating to the business of insurance." No less an authority than the United States Supreme Court has ruled in FMC Corp. v. Holliday, 498 U.S. 54, 61 (1990), that "Section 1720 directly controls the terms of insurance contracts by invalidating any subrogation provisions that they contain. . . . It does not merely have an impact on the insurance industry; it is aimed at it." Moreover, there is nothing in § 1720 which "specifically and in exact terms applies" to HMOs. Consequently, as a result of § 1560(a), § 1720 does not abrogate the subrogation provisions of the Aetna healthcare agreement. The lien against plaintiff for reimbursement of his medical benefits was valid, and he is not entitled to the return of the $2,066.90.

  Whether or not, as plaintiff contends, HMOs like Aetna have an unfair competitive advantage under Pennsylvania law is a matter properly addressed by the Commonwealth's General Assembly, not this court. See DiGreqorio v. Keystone Health Plan East, 840 A.2d 361, 370 n.3 (Pa. Super. 2003).

  Plaintiff's claims for breach of contract, unjust enrichment, bad faith insurance practices, and for declaratory, injunctive, and monetary relief are all dependent on his argument that § 1720 invalidated Aetna's lien against his motor vehicle tort recovery. Since his premise is without merit, his claims fail as a matter of law.

  The motion of defendant to dismiss plaintiff's first amended class action complaint will be granted.


  AND NOW, this day of April, 2004, for the reasons set forth in the accompanying Memorandum, it is hereby ORDERED that the motion of defendant Aetna Health, Inc. (improperly denominated by plaintiff as Aetna U.S. Healthcare) to dismiss plaintiff's first amended class action complaint is GRANTED.

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