United States District Court, E.D. New York
MEMORANDUM DECISION AND ORDER
M. COGAN, U.S.D.J.
initially brought this action in state court. The claims in
the complaint are entirely based on state law. Defendant,
however, contended that plaintiff's state law claims are
completely preempted by the Employee Retirement Income
Security Act (“ERISA”), 29 U.S.C. § 1132,
and removed this case to this court. Defendant has moved to
dismiss the complaint, and plaintiff has moved to remand this
case back to state court. For the reasons stated below,
plaintiff's motion to remand is granted, and
defendant's motion to dismiss is denied as moot.
brought a complaint against defendant in the Supreme Court of
New York, Queens County. Plaintiff is a health care provider
that provided medical treatment to Jose Tineo, who
participates in a health benefits plan that defendant issued.
According to the complaint, the plan prohibits the assignment
of benefits “and/or” the transfer of rights.
Nonetheless, Tineo authorized defendant to pay benefits
directly to plaintiff.
then filed a claim for reimbursement to defendant.
Plaintiff's personnel filled out a form to submit the
claim and answered “Yes” to “Accept
Assignment?” Plaintiff claims that defendant knew or
should have known that, by answering “Yes” on
this form, plaintiff was instructing defendant to directly
pay plaintiff. Nonetheless, defendant never told plaintiff
that plaintiff failed to properly submit this claim.
then underpaid plaintiff. Plaintiff brought claims for
equitable estoppel, breach of an implied contract,
“promissory contract, ” and under the Prompt Pay
Law. Defendant removed this action to federal court and
claimed that ERISA completely preempts plaintiff's
federal court, defendant moved to dismiss this action and
plaintiff moved to remand this case back to state court. In
connection with its briefing in support of its motion to
dismiss, defendant provided the plan at issue here. The plan
includes the following anti-assignment provision:
Assignment. You cannot assign any benefits
under this Certificate or legal claims based on a denial of
benefits to any person, corporation, or other organization.
You cannot assign any monies due under this Certificate to
any person, corporation or other organization unless it is an
assignment to Your Provider for a surprise bill. See the How
Your Coverage Works section of this Certificate for more
information about surprise bills. Any assignment of benefits
or legal claims based on a denial of benefits by You other
than for monies due for a surprise bill will be void.
Assignment means the transfer to another person or to an
organization of Your right to the services provided under
this Certificate or Your right to collect money from Us for
those services. Nothing is this paragraph shall affect Your
right to appoint a designee or representative as otherwise
permitted by applicable law.
party asserting jurisdiction bears the burden of proving that
the case is properly in federal court … .”
United Food & Commercial Workers Union, Local 919,
AFL-CIO v. CenterMark Properties Meriden Square, Inc.,
30 F.3d 298, 301 (2d Cir. 1994). “All doubts about
jurisdiction should be resolved in favor of remand to state
court.” Macro v. Indep. Health Ass'n,
Inc., 180 F.Supp.2d 427, 431 (W.D.N.Y. 2001). “On
a motion to remand for lack of subject matter jurisdiction,
courts assume the truth of non-jurisdictional facts alleged
in the complaint, but may consider materials outside of the
complaint, such as documents attached to a notice of removal
or a motion to remand … .” Romero v. DHL
Express (U.S.A), Inc., 15-cv-4844, 2016 WL 6584484, at
*1 (S.D.N.Y. Nov. 7, 2016).
action that is completely preempted by ERISA is removable to
federal court as an action arising under federal law. See
Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 66 (1987);
Wurtz v. Rawlings Co., LLC, 761 F.3d 232, 238 (2d
Cir. 2014). “Specifically, claims are completely
preempted by ERISA if they are brought (i) by ‘an
individual [who] at some point in time, could have brought
his claim under ERISA § 502(a)(1)(B),' and (ii)
under circumstances in which ‘there is no other
independent legal duty that is implicated by a
defendant's actions.'” Montefiore Med. Ctr.
v. Teamsters Local 272, 642 F.3d 321, 328 (2d Cir. 2011)
(quoting Aetna Health Inc. v. Davila, 542 U.S. 200,
test is conjunctive; a state-law cause of action is preempted
only if both prongs of the test are satisfied.”
Montefiore Med. Ctr., 642 F.3d at 328. A plaintiff
without standing fails the first prong of this test.
Id. at 329.
“absent a valid assignment of a claim, non-enumerated
parties lack statutory standing to bring suit under ERISA
even if they have a direct stake in the outcome of the
litigation.” McCulloch Orthopaedic Surgical Servs.,
PLLC v. Aetna Inc., 857 F.3d 141, 148 (2d Cir. 2017)
(internal quotation marks and alterations omitted). An
“assignment is ineffectual if the ERISA benefit plan
contains an unambiguous anti-assignment provision.”
Id. (internal quotation mark and alterations
omitted). Thus, a plaintiff lacks standing under ERISA if the
plaintiff's claims arise from the assignment of benefits
under a plan that prohibits the assignment of benefits.
basis for removing this case to federal court is that ERISA
preempts plaintiff's claims. But to the extent plaintiff
has any ERISA claims, they would arise from an assignment of
benefits under a plan that contains an anti-assignment
provision that prohibits this assignment. Thus, plaintiff
lacks standing to bring ERISA claims, and ERISA does not
preempt plaintiff's ...