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Norwin v. Local 804 Welfare Trust Fund

United States District Court, E.D. New York

January 21, 2015

MITCHELL S. NORWIN, Plaintiff,
v.
LOCAL 804 WELFARE TRUST FUND, Defendant

MITCHELL S. NORWIN, Plaintiff, Pro se, Suffern, NY.

For Defendants: David R. Hock, Noelia E. Hurtado, COHEN, WEISS and SIMON LLP, New York, NY.

MEMORANDUM AND ORDER

John Gleeson, United States District Judge.

Mitchell S. Norwin commenced this action in New York Small Claims Civil Court, seeking to recover $350.70 for nonpayment of an insurance claim against Local 804 Welfare Trust Fund, an employee welfare benefit plan. On November 14, 2014, defendant Local 804 Welfare Trust Fund removed the case to this Court pursuant to 28 U.S.C. § 1441(a). Norwin now moves to remand the case to Small Claims Civil Court. For the reasons stated below, the motion to remand is denied.

BACKGROUND

Local 804 Welfare Trust Fund (" the Fund"), is a self-insured " employee welfare benefit plan" within the meaning of the Employment Retirement Income Security Act of 1974, as amended (" ERISA"), Section 3(1), 29 U.S.C. § 1002(1), and a multiemployer plan within the meaning of ERISA, Section 3(37), 29 U.S.C. § 1002(37), established in collective bargaining between Teamsters Local 804 and employers.[1] Declaration of Thomas Lamontanaro dated January 7, 2015 (" Lamontanaro Decl.") ¶ 7, ECF No. 10. The fund provides hospitalization, medical and certain other benefits to individuals covered by collective bargaining agreements requiring that contributions be made on their behalf to the Fund. Lamontanaro Decl. ¶ 9, ECF No. 10. The Fund's plans of benefits set forth the terms of these benefits. Id. Norwin is a retiree eligible for coverage in accordance with the Fund's applicable plan of benefits.

Norwin received medical treatment from an out-of-network service provider on September 18, 2014, November 20, 2013 and January 15, 2014. Ex. C, ECF No. 10-3 (New York Medical Management Letter dated Apr. 23, 2014). The total claimed for these charges was $1200. Lamontanaro Decl. ¶ 18, ECF No. 10. The Fund issued payment in the amount of $200.70 in accordance with the Fund's rules for services rendered by out-of-network providers. See id.

On March 15, 2014, Norwin filed an appeal of the Fund's determination to pay only $200.70, and the Fund responded by letter on March 21, 2014, detailing the criteria it used to make the determination. Lamontanaro Decl. ¶ ¶ 19-20, ECF No. 10. On April 18, 2014, Norwin sent the Fund a letter requesting that it consider his appeal in accordance with the Healthcare Bluebook, which he alleged should be used to determine the level of benefits awarded. Id. at ¶ 20. The Fund then sought review of Norwin's appeal by New York Medical Management, a review service organization, which concluded that the payments made were consistent with the current payment policy. Id. at ¶ ¶ 22-23. On April 25, 2014, the Fund informed Norwin that his appeal would be considered a second-level appeal and that it would be presented at the May 2014 Board of Trustees Meeting. Ex. D, ECF No. 10-3 (Fund Letter dated April 25, 2014). At the Trustees' meeting, the board denied the appeal, finding that Norwin was responsible for the deductible and the difference between the out-of-network service provider's charge and the plan's fixed fee schedule. Lamontanaro Decl. ¶ 25, ECF No. 10.

Norwin filed an action to recover $350.70 for nonpayment of his insurance claim in Small Claims Court in Queens County, New York, on October 16, 2014. Ex. A, ECF No. 1 (Notice of Claim). On November 14, 2014, the Fund removed the case to this Court pursuant to 28 U.S.C. § 1441(a). Norwin seeks remand to state court based on the state and district courts' " concurrent jurisdiction of actions under [29 U.S.C. § 1132(a)(1)(B)] and [ERISA Section 502(a)]." Plaintiff's Affirmation dated Dec. 17, 2014, ECF No. 6 (" Pl. Aff.").

DISCUSSION

A. Legal Standards

A defendant can remove an action filed in state court to a federal district court only if the federal court has original subject matter jurisdiction. 28 U.S.C. § 1441(a) (" Except as otherwise expressly provided by Act of Congress, any civil action brought in a State court of which the district courts of the United States have original jurisdiction, may be removed by the defendant . .., to the district court of the United States for the district . . . embracing the place where such action is pending."). In evaluating whether removal was proper, a district court must consider whether the case could have been originally filed in federal court based on a federal question, diversity of citizenship, or another statutory grant of jurisdiction. Estate of Gottesman v. Verizon New York, Inc., No. 09-CV-667 (JG)(RLM), 2009 WL 92831, at *3 (E.D.N.Y. Apr. 6, 2009) (citing Caterpillar, Inc. v. Williams, 482 U.S. 386, 393, 107 S.Ct. 2425, 96 L.Ed.2d 318 (1987)). Claims for benefits from an ERISA employee pension benefit plan may be brought in federal district court pursuant to Section 502(a)(1)(B) of ERISA, 29 U.S.C § 1132(a)(1)(B).

When opposing a motion to remand, it is the removing party's burden to show that it has met the requirements for removal. R.G. Barry Corp. v. Mushroom Makers, Inc., 612 F.2d 651, 655 (2d Cir. 1979), abrogated on other grounds by Hertz Corp. v. Friend, 559 U.S. 77, 130 S.Ct. 1181, 175 L.Ed.2d 1029 (2010); Farneti v. BethPage FCU, No. 13-CV-7218 (SJF), 2014 WL 1797478, at *2 (E.D.N.Y. May 1, 2014) (citations omitted). Additionally, " [i]n light of the congressional intent to restrict federal court jurisdiction, as well as the importance of preserving the independence of state governments, federal courts construe the removal ...


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