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Gatti v. Western Pennsylvania Teamsters & Employers Welfare Fund

October 19, 2007


The opinion of the court was delivered by: Ambrose, Chief District Judge.



This action asserting claims for breach of contract and declaratory judgment was filed originally in the Court of Common Pleas of Allegheny County. On August 28, 2007, Defendant filed a Notice of Removal to this Court on the grounds that the Complaint states claims subject to preemption under ERISA section 502(a). Plaintiff now moves to remand the case to state court, arguing that the Complaint asserts only state law claims, or alternatively, that he is entitled by contract and federal law to the forum of his choice. Plaintiff also seeks attorneys' fees in connection with this Motion. For the reasons set forth below, I deny Plaintiff's Motion in its entirety.


"It is well settled that a civil action filed in state court may be removed if the district court would have had 'original jurisdiction founded on a claim or right arising under the Constitution, treaties or laws of the United States.'" Knochel v. HealthAssurance PA, Inc., 2006 WL 3040847, at *2 (W.D. Pa. Oct. 22, 2006) (quoting 28 U.S.C. § 1441). "Under the 'well-pleaded complaint rule,' removal is generally proper only if a federal question is presented on the face of the plaintiff's complaint." Sopak v. Highmark, Inc., 2002 WL 1271366, at *3 (W.D. Pa. Feb. 19, 2002). The removing party bears the burden of proving subject matter jurisdiction. Wirth v. Aetna U.S. Healthcare, 2004 WL 253525, at *1 (E.D. Pa. Feb. 10, 2004), aff'd, 137 Fed.Appx. 455 (3d Cir. 2005).

"However, the complete preemption doctrine is an exception to the well-pleaded complaint rule." Id. "This is so because when [a] federal statute completely pre-empts the state-law cause of action, a claim which comes within the scope of that cause of action, even if pleaded in terms of state law, is in reality based on federal law." Aetna Health Inc. V. Davila, 542 U.S. 200, 207-08 (2004). "ERISA is one of these statutes." Id. at 208. "Hence, causes of action within the scope of the civil enforcement provisions of § 502(a) are removable to federal court." Id. at 209; see also, Levine v. United Healthcare Corp., 402 F.3d 156, 162 (3d Cir.) ("Certain federal laws. . ., including ERISA, so sweepingly occupy a field of regulatory interest that any claim brought within that field, however stated in the complaint, is in essence a federal claim. In such cases, the doctrine of complete preemption provides federal jurisdiction and allows removal to federal court."), cert. denied, 546 U.S. 1054 (2005); Sopak, 2002 WL 1271366, at *3 ("Complete preemption creates removal jurisdiction even though no federal question appears on the face of the plaintiff's complaint.")


Defendant Western Pennsylvania Teamsters & Employers Welfare Fund (the "Fund") provides for the payment of health and welfare benefits to eligible members of participating companies signatory to collective bargaining agreements entered into with local unions. The Fund is subject to the provisions of ERISA. At all relevant times, Plaintiff was an eligible participant under the Fund's Benefit Program Plan A (the "Plan"), a copy of which is annexed to the Complaint as Exhibit A.

Plaintiff was injured in a motor vehicle collision on May 15, 2007. As a result of the injuries he sustained, Plaintiff was unable to work for a period of nine weeks from May 15 through July 16, 2007. Plaintiff sought non-occupational accident benefits under the terms of the Plan in the amount of $200 per week for the nine-week period. While Plaintiff submitted all the necessary documentation of his eligibility, he refused to execute a Subrogation Acknowledgment form. On this basis, the Fund refused to pay the requested benefits.

In a section entitled "General Information, Rights and Protections Under ERISA," the Plan states that "[i]f you are improperly denied a benefit in full or in part, you have a right to file suit in a federal or a state court." (Complaint, Ex. A at 12.) In accordance with this provision, which Plaintiff refers to as a forum selection clause, Plaintiff brought suit in the Court of Common Pleas for Allegheny County.

Plaintiff's claim for breach of contract alleges that the Plan only provides for subrogation of medical benefits, not accident benefits, or at best is ambiguous on the issue. In the alternative, Plaintiff claims that the anti-subrogation provision of §1720 of the MVFRL bars application of contractual subrogation provisions to sick and accident benefits if Defendant is a self-funded ERISA plan. Plaintiff seeks to recover the denied benefits, amounting to $1800, as well as attorneys fees. Plaintiff also asserts a claim for declaratory judgment that the Plan does not provide Defendant with a contractual right of subrogation for accident benefits paid.


Plaintiff's Motion to Remand is premised on three bases: (1) that the claims are ordinary state law claims that do not fall within the scope of ERISA section 502(a); (2) that the Plan contains a forum selection clause expressly providing for suit in state court; and (3) that ERISA itself, in section 502(e), provides for suit in state court. Plaintiff is wrong on all counts.

ERISA section 502(a) provides: "A civil action may be brought - (1) by a participant or beneficiary-. . .(B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan." Aetna Health Inc., 542 U.S. at 209 (quoting 29 U.S.C. §1132(a)(1)(B)). "Likewise, Section 502(a)(1)(B) preempts a state law cause of action when interpretation of the terms of plaintiff's benefit plan forms an essential part of plaintiff's state law claims." Alloca v. Wachovia, 2005 WL 2972845, at *3 (D. N.J. Nov. 4, 2005). If Plaintiff's claims fall within the scope of section 502(a), they are completely preempted, and removal was proper. Levine, 402 F.3d at 162 ("Thus, if the claim is one that falls within section 502(a) of ERISA, removal to federal court is proper."); Pryzbowski v. U.S. Healthcare, Inc., 245 ...

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