The opinion of the court was delivered by: MICHAEL BAYLSON, District Judge
Presently before the Court is Defendant MAMSI Life and Health Insurance
Company's ("Defendant") Motion to Dismiss the Complaint of Plaintiff's
William and Sally McConnell ("Plaintiff's"). For the reasons that
follow, Defendant's motion will be granted and Plaintiff's' Complaint
will be dismissed without prejudice and with leave to file an amended
Plaintiff's in this case are a husband and wife who secured health
insurance from Defendant through Plaintiff William McConnell's employment
at Country Butcher. Plaintiff's allege the following facts. As part of
Plaintiff William McConnell's compensation, Plaintiff's were eligible for
health insurance coverage from Defendant. When Plaintiff's were
considering enrolling in this health insurance plan, an account
representative of Defendant's came to Plaintiff's place of employment to
take their application and Plaintiff's were assured, both orally and in a
booklet provided by the account representative, that Plaintiff sally
McConnell would be covered for medical costs related to the fact that she
was pregnant at that time. In reliance on those representations,
Plaintiff obtained medical services related to her pregnancy costing $3,555.00. After obtaining these services, Plaintiff's were informed that
Plaintiff's pregnancy-related services would not be covered by
Plaintiff's subsequently filed this suit in Pennsylvania District Court
in Chester County, Pennsylvania on July 1, 2003 alleging that Defendant
was indebted to them for $3,555.00. Defendant removed this suit, premised
on federal question jurisdiction under the Employee Retirement Income
Security Act ("ERISA"), 29 U.S.C. § 1001 et seq. (2003). Defendant filed
a Motion to Dismiss on February 2, 2004. Briefing was completed on March
When deciding a motion to dismiss pursuant to Federal Rule of Civil
Procedure 12(b)(6), the court may look only to the facts alleged in the
complaint and its attachments. Jordan v. Fox. Rothschild. O'Brien &
Frankel, 20 F.3d 1251, 1261 (3d Cir. 1994). The court must accept as true
all well pleaded allegations in the complaint and view them in the light
most favorable to the plaintiff. Angelastro v. Prudential-Bache Sec.,
Inc., 764 F.2d 939, 944 (3d Cir. 1985). A Rule 12(b)(6) motion will be
granted only when it is certain that no relief could be granted under any
set of facts that could be proved by the plaintiff. Ransom v. Marrazzo,
848 F.2d 398, 401 (3d Cir. 1988).
Jurisdiction is premised upon federal question jurisdiction, pursuant
to 28 U.S.C. § 1441(a)-(b). Venue is proper as a substantial portion
of the acts giving rise to the claims occurred in this judicial district.
Defendant argues that Plaintiff's' claims are state law claims that are
preempted by ERISA. In addition, Defendant argues that Plaintiff's'
claims are based on the allegation that an oral modification to the Plan existed and that, because ERISA requires
all modifications to be in writing, Plaintiffs' claims, even if properly
pled under ERISA, must be dismissed. Plaintiff's appear to concede that
their claims are properly brought under ERISA,*fn1 but dispute that
their claims rest on an allegation of oral modification.
The issue presented is whether Plaintiff's state law claims filed in
this Court are preempted by ERISA. There is no dispute that Plaintiffs
health insurance plan is an employee benefit plan governed by ERISA. See
29U.S.C. § 1002(2) (2003). As detailed above, Plaintiff's claims are to
recover benefits due under this ERISA plan.
Except as provided in subsection (b) of this section,
the provisions of this subchapter and subchapter III
of this chapter shall supersede any and all State laws
insofar as they may now or hereafter relate to any
employee benefit plan . . .
§ 514(a), 29 U.S.C. § 1144(a) (2003). In Pilot Life Ins. Co. v. Dedeaux,
481 U.S. 1
, 107 S.Ct. 1549, 95 L.Ed.2d 39 (1987), the Court interpreted
the preemption provision broadly.
The phrase "relate to" [is] given its broadest
common-sense meaning, such that a state law "relate[s]
to" a benefit plan "in the normal sense of the
phrase, if it has a connection with or reference to
such a plan."
Pilot Life. 481 U.S. at 47 quoting Shaw v. Delta Air Lines. 463 U.S. 85
97 (1983). The Court found that defendant's tort and breach of contract
claims "each based on alleged improper processing of a claim for benefits
under an employee benefit plan, undoubtedly meet the criteria for
preemption under § 514(a)." Pilot Life, 481 U.S. at 48. The Third Circuit
in Pryzbowski v. U.S. Healthcare, clarified the holding in Pilot Life,
ruling that a decision regarding benefits "falls within the scope of the administrative responsibilities of the HMO or
insurance company, and therefore `relates to' the employee benefit plan."
Pryzbowski v. U.S. Healthcare, 245 F.3d 266
, 278 (2001). This Court has
also repeatedly ...