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UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF FLORIDA 

MIAMI DIVISION 

PALMETTO EKG & ECHO READERS, 

PROFESSIONAL ASSOCIATION, a 

Florida Corporation (o/b/o Member # 

U6552876401), 

Plaintiff, 

vs. 

CIGNA HEALTHCARE OF FLORIDA, 

INC., a Florida corporation, 

Defendant 

/

CASE NO.: ___________ 

County Court Case No.: 

2022025501 SP 23 

DEFENDANT CIGNA HEALTHCARE OF FLORIDA, INC.’S 

NOTICE OF REMOVAL 

Defendant, Cigna Healthcare of Florida, Inc. a Florida Corporation (“Cigna”), 

pursuant to 28 U.S.C. §§ 1331, 1441 and 1446, files this Notice of Removal and 

alleges as follows: 

I. INTRODUCTION 

 1. Plaintiff commenced this action in the county Court of the Eleventh 

Judicial Circuit in and for Miami-Dade County, Florida, Case No. 2022025501-SP23 (“State Court Action”). 

 2. Cigna was served with the Complaint on September 14, 2022. In 

accordance with U.S.C. § 1446(a), copies of the process, pleadings, and all other 

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papers served on Cigna in the State Court Action are attached hereto as Composite 

Exhibit “A.” 

 3. Cigna removes this case pursuant to 28 U.S.C. § 1441(a) as an action 

over which this Court has federal question jurisdiction under 28 U.S.C. § 1331. The 

state law claims in Plaintiff’s Complaint are completely preempted by the Employee 

Retirement Income Security Act of 1974, 29 U.S.C. § 1001, et seq. (“ERISA”). 

II. NATURE OF THE CASE

4. Plaintiff Palmetto EKG & Echo Readers, Professional Association, 

(“Palmetto”) is a healthcare provider and Florida for-profit corporation doing 

business in Miami-Dade County with its principal place of business in Miami-Dade 

County, Florida. Complaint at ¶¶ 2, 3. 

5. According to the allegations, Member received medical services by 

Plaintiff and was a covered member of Cigna’s Florida-licensed health maintenance 

organization (“HMO”). Complaint at ¶¶ 10, 19, 20. 

6. Palmetto is an “out-of-network” provider that, at all times material, had 

no direct agreement with Cigna to be reimbursed for its services provided to Cigna’s 

subscribing members at discounted rates. Complaint at ¶ 18. 

7. According to the allegations, the medical services provided by Palmetto 

to Member are covered services under the Policy. Complaint at ¶ 23. 

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8. Palmetto’s claims against Cigna are “solely for breach of the Provider 

Agreements” and Palmetto expressly disclaims any claims for violations of ERISA. 

Complaint at ¶¶ 37, 52. Palmetto claims that Cigna is “in breach of its Policy with 

Member to which Plaintiff is a third-party beneficiary.” Complaint at ¶ 73. 

III. NATURE OF THE UNDERLYING HMO FURNISHING BENEFITS 

 9. The Complaint identifies one individual patient whose medical claim 

and health benefit plan are at issue. Complaint at ¶ 10. At the time of the date of 

service framed by the Complaint, that patient was enrolled in an “employee welfare 

benefit plan” within the meaning of the ERISA. See Declaration of Rhonda 

Anderson (“Anderson Declaration”)at ¶¶ 5,6, attached hereto as Composite Exhibit 

“B,” together with the attached pertinent ERISA plan document, the “Summary Plan 

Description”. 

 10. An “employee welfare benefit plan” is statutorily defined in 29 U.S.C. 

§ 1002(1) as follows: 

 Any plan, fund, or program which was heretofore or is hereafter 

established or maintained by an employer or by an employee organization, 

or by both, to the extent that such plan, fund, or program was established or 

is maintained for the purpose of providing for its participants or their 

beneficiaries, through the purchase of insurance or otherwise, (A) medical, 

surgical, or hospital care or benefits, or benefits in the event of sickness, 

accident, disability, death or unemployment, or vacation benefits, 

apprenticeship or other training programs, or day care centers, scholarship 

funds, or prepaid legal services... 

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 11. The very terms of the health plan at issue demonstrates that an ERISA 

plan exists here. A review of the Summary Plan Description attached to the 

(“Anderson Declaration”) demonstrates that: (i) the plan was established by the 

employer PriceSmart, Inc.; (ii) the intended benefits are the medical expense benefits 

that are payable in accordance with the plan’s terms; (iii) the class of beneficiaries 

are the eligible employees (and dependents) of the employer who established the 

plan; and (iv) the procedures for submitting claims and receiving benefits are those 

which are spelled out in the plans. Fleming v. Metropolitan Life Ins. Co., No. 8:06-

cv-88-T-23TBM, 2006 U.S. Dist. LEXIS 15156 (M.D. Fla. March 16, 2006) (terms 

of group disability policy “persuasively demonstrate” that ERISA applies); see also 

(“Anderson Declaration”). 

IV. FEDERAL QUESTION JURISDICTION - COMPLETE PREEMPTION 

 12. This Court has jurisdiction under 28 U.S.C. § 1331 because Plaintiff’s 

state law causes of action are completely preempted by ERISA with respect to the 

ERISA governed benefit plan at issue. 

 13. Normally, removal may not be accomplished unless the face of the 

Complaint reveals a federal question. This general rule is known as the “wellpleaded complaint” rule. However, the United States Supreme Court recognized the 

doctrine of “complete preemption” as a corollary or an exception to the well-pleaded 

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complaint rule. Metropolitan Life Ins. Co. v. Taylor, 481 U.S. 58, 63-64 (1987). 

State court actions that come within the scope of § 502(a) of ERISA, 29 U.S.C. § 

1132(a), such as a claim for improper denial of benefits under state law, are 

“displaced” by ERISA’s civil enforcement mechanism and are therefore “removable 

to federal court” as actions that arise under the laws of the United States. 

Metropolitan Life, 481 U.S. 58 at 60; see also Ehlen Floor Covering v. Lamb, 660 

F.3d 1283, 1287 (11th Cir. 2011) ("Regardless of its characterization as a state law 

matter, a claim will be re-characterized as federal in nature if it seeks relief under 

ERISA.”). When a “federal statute [such as ERISA] completely preempts 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, 208 (2004). 

 14. In this case, Palmetto’s state law claims are “in reality based on federal 

law.” Davila 542 U.S. at 208. Despite Palmetto’s efforts to disavow the application 

of ERISA, the claims are completely preempted because they “duplicate, 

supplement, or supplant” the ERISA civil enforcement remedy that Congress 

intended to be exclusive. Id. at 209. In other words, Palmetto’s claims challenge 

the right to a benefit allegedly covered by an employee welfare benefit plan. 

Therefore, removal of this action that squarely implicates ERISA-plan benefits is 

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consistent with ERISA’s purpose “to provide a uniform regulatory regime over 

employee benefit plans.” Id. at 208. 

 15. The source of Palmetto’s claims is whether health plan benefits beyond 

what was already paid are owed for the services allegedly provided to the ERISA 

plan participant. 

/s/ Ruel W. Smith 

Ruel W. Smith 

Florida Bar No. 36548 

rsmith@hinshawlaw.com 

Steven D. Lehner 

Florida Bar No. 39373 

slehner@hinshawlaw.com 

HINSHAW & CULBERTSON LLP 

100 South Ashley Drive 

Suite 500 

Tampa, FL 33602 

Telephone: 813-276-1662 

Facsimile: 813-436-8738 

Attorneys for Defendant

CERTIFICATE OF SERVICE 

I hereby certify that on October 14, 2022, I electronically filed the foregoing 

with the Clerk of the Court by using the CM/ECF system. I also certify that the 

foregoing document was sent via email to: 

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Patrick R. Sullivan, Esq. 

Mark L. Rosen, Esq. 

George E. Dahdal, Esq. 

LUBELL ROSEN 

200 South Andrews Avenue 

Suite 900 

Fort Lauderdale, Florida 33301 

E-Mail: prs@lubellrosen.com; 

mlr@lubellrosen.com; 

ged@lubellrosen.com 

Attorneys for Plaintiff 

/s/ Ruel W. Smith

Ruel W. Smith 

Florida Bar No. 36548 

rsmith@hinshawlaw.com 

Steven D. Lehner 

Florida Bar No. 39373 

slehner@hinshawlaw.com 

HINSHAW & CULBERTSON LLP 

100 South Ashley Drive 

Suite 500 

Tampa, FL 33602 

Telephone: 813-276-1662 

Facsimile: 813-436-8738 

Attorneys for Defendant

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