The opinion of the court was delivered by: Yvette Kane, Chief Judge United States District Court Middle District of Pennsylvania
Before the Court is Defendant Connecticut General Life Insurance Company's ("Connecticut General") motion to dismiss Plaintiff Shatzer's complaint for failure to state a claim pursuant to Federal Rule of Civil Procedure 12(b)(6). (Doc. No. 6.) The motion has been briefed and is ripe for disposition. For the reasons that follow, the motion to dismiss will be granted.
On October 30, 2006, Shatzer filed a pro se civil complaint in the Magisterial District Court of Franklin County, Pennsylvania, seeking an $8,000 judgment against Connecticut General*fn1 for breach of contract. (Doc. No. 1-3.) Specifically, Plaintiff alleged the following:
The Plaintiff called Defendant in December 2005, to see if Gastric Bypass was a covered procedure under the policy contract. Plaintiff was told it was covered but six nutritional visits and a psychological visit was required prior to submitting a pre-authorization for consideration. The Plaintiff went to a covered nutritionist at a covered hospital as well as a covered psychologist. The Defendant denied medical visits that were covered under the policy contract. These visits were disputed by the Plaintiff over a course of several month[s]. A Department of Insurance complaint was made but this did not stop the Defendant from maliciously and viciously denying claims. The result from Cigna Insurance company was Breach of Contract.
In her brief in opposition to the motion to dismiss, Shatzer details more fully the events leading to this litigation. (See Doc. No. 11.) Specifically, she complains that Connecticut General initially denied, in whole or in part, coverage for four pre-operative appointments with her nutritionist, and improperly delayed paying for two other pre-operative appointments with her nutritionist and psychologist, respectively. (Id. at 1-2.) Shatzer explains that it was only after her repeated requests and complaints that Connecticut General reimbursed her for the amount to which she was entitled under the "policy contract." (Id.) Shatzer also explains that she submitted a seventh claim for a post-operative follow-up appointment with her nutritionist, only to have Connecticut General deny this claim as well. (Id. at 2.) She contends that Connecticut General has yet to reimburse her for this final appointment. (Id.); (see also Doc. No. 16, at 2.) In a letter addressed to the Court and docketed April 19, 2007, Shatzer states that yet another visit, this time with her gastric bypass surgeon, was improperly denied by Connecticut General and urges the Court to find the company liable for breach of contract. (Doc. No. 22.)
The Court notes that Plaintiff has not, in her complaint or with her other filings, provided the Court with a complete copy of the "policy contract" upon which she bases her claims. Connecticut General, however, has provided a summary plan description of the "policy contract" to which Shatzer refers. (Benefits Description, Doc. No. 6-3, Ex. A.) Plaintiff has not contested the authenticity of this document, and the Court accepts it as an accurate representation of the plan benefits effective January 1, 2006.*fn2
On November 28, 2006, Connecticut General timely filed a notice of removal in this Court pursuant to 28 U.S.C. § 1441, on the grounds that the complaint is completely preempted by the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. ("ERISA"). (Doc. No. 1.) On December 5, 2006, Connecticut General moved to dismiss Shatzer's complaint pursuant to Federal Rule of Civil Procedure 12(b)(6). (Doc. No. 6.) In response to the Court's order to show cause why the complaint should not be dismissed (Doc. No. 10), Plaintiff filed a letter brief in opposition to the motion to dismiss (Doc. No. 11). Defendants filed a reply. (Doc. No. 12.) A case management conference was held on January 30, 2007, during which the Court invited the parties to supplement their filings. Plaintiff timely filed a supplemental brief. (Doc. No. 16.)
Connecticut General advances several arguments as to why dismissal is appropriate, including: (1) complete ERISA preemption; (2) express ERISA preemption; (3) failure to exhaust the administrative-claims appeal process mandated by ERISA; (4) failure to state a basis for holding ...