Ay

true and draw all reasonable inferences in the plaintiff's favor. See MCM Partners, Inc. v. Andrews-
Bartlett & Assoc., Inc., 62 F.3d 967, 972 (7th Cir. 1995), aff'd 161 F.3d 443 (7th Cir. 1998), cert. denied
528 U.S. 810 (1999). Therefore, a complaint should not be dismissed “unless it appears beyond all
doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to
relief.” Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 102, 2 L.Ed.2d 80 (1957).

B. Preemption: Counts I-V

UHC argues that ERISA preempts each count of the Clinic's complaint, which is based on state
law causes of action. Section 514(a) of ERISA Provides, in relevant part, that ERISA “shall supersede
any and all State laws insofar as they may . . . relate to any employee benefit plan.” 29 U.S.C. §1144(a).
As such, the determination of whether ERISA preempts a state law requires an analysis of the following
two issues: (1) whether the policy at issue is an employee welfare benefit plan, and (2) whether the state
law “relate[s] to” the employce benefit plan. Jd.; see also Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41,
47, 107 S.Ct. 1549, 1553, 95 L.Ed.2d 39 (1987). The Seventh Circuit has explained that a plan is an
employee welfare bencfit plan if it has the following five elements: “(1) a plan, fund or program, (2)
established or maintained, (3) by an employer... (4) for the purpose of providing medical, surgical,
hospital care. . . (5) to participants or their beneficiaries.” Ed Miniat, Inc. v. Globe Life Ins. Group, Inc.,
805 F.2d 732, 738 (7th Cir. 1986).

In this case, the complaint states that Maritza Hernandez was insured under a policy issued by
UHC. The complaint docs not indicate whether Hernandez's coverage arose from an employee welfare
benefit plan cstablished or maintained by her employer, UHC insists that Hernandez obtained insurance
coverage through an employee welfare bencfit plan established by her employer, Lesly Motors. Neither
party, however, provides this Court with a copy of ‘Hernandez! insurance policy or the plan. In the

context of this motion, we cannot find that the insurance policy UHC issued to Hernandez was part of



policy issucd »y UHC. ULC informed the Clinic that Hernandez had benefits for anesthesia, surgery,
and office visits.

On October 29, 1997, the Clinic requested and UHC provided pre-certification for Hernandez
to receive certain surgery and anesthesia benefits. UHC did not place a time limit on the validity of the
pre-certification or on the date by which surgical procedures had to be completed. UHC did not inform
the Clinic that the pre-certification was only valid for services rendered through November 2, 1997. The
Clinic relied on the pre-certification when it performed surgery on Hernandez and provided medical and
podiatric treatment to her on the following dates: 10/28/97, 11/15/97, 11/25/97, 11/29/97, 12/6/97,
12/20/97, and 1/6/98. The reasonable value of the surgery and treatment totaled $23,165.00.

Before March 30, 1998, Hernandez assigned her rights under the insurance policy to the Clinic,
which thercalicr submitted billing statements requesting payment of $23,165.00 to UHC. The Clinic
submitted the statements in proper form, consistent with generally accepted insurance claims practices.
On December 3, 1997, UHC paid the Clinic $89.96 of a $310.00 claim for treatment rendered on
October 28, 1997. UHC subscquently denied the Clinic's claims for all treatment rendered after the
termination o* the policy on November 2, 1997. UHC informed the Clinic of its decision to deny those
claims after April 6, 1998. On October 22, 2002, the Clinic commenced the action presently before this
Court seeking payment from UHC in the amount of $23,075.04 as well as costs and attorneys' fees.
UHC filed a motion to dismiss the Clinic's complaint on December 31, 2002.

IL. ANALYSIS -

A. Standard of Review

The purpose of a motion to dismiss under Rule 12(b)(6) is to decide the adequacy of the
complaint, not the merits of the case. See Gibson » City of Chicago, 910 F.2d 1510, 1520 (7th Cir.

1990). In considering a motion to dismiss, we must accept all well-pled allegations in the complaint as

3



an ERISA cmiployce benefit plan. Consequently, we cannot further analyze UHC's contention that the
Clinic's complaint is preempted by ERISA. This Court therefore denies UHC's motion to dismiss the
Clinic's complaint on the ground of ERISA preemption.’

c. Failure to State a Claim: Count III

UHC contends that Count III of the complaint fails to state a claim under § 143.16 of the Illinois
Insurance Cole. We agree. In Count III, the Clinic claims that UHC violated §143.16 by failing to
provide the Clinic with 60 days notice of the cancellation of Hernandez health insurance policy. Section
143.16 requires that “[a]l] notices of cancellation of insurance to which Section 143.11 applies... must
be mailed at Icast 60 days prior to the effective date of cancellation.” 215 ILCS 5/143.16. Section
143.11 applics to companics that provide insurance “except life, accident and health, fidelity and surety,
and ocean mine policies.” 215 ILCS 5/143.11. UHC provides health insurance and is therefore
exempt from the Illinois Insurance Code's notice requirement. See id. The Clinic can prove no set of
facts in support of this particular claim. Accordingly, we grant UHC's motion to dismiss the portion of

Count III alleging a violation of $143.16 of the Illinois Insurance Code.

3We are confident that, after minimal discovery, the parties will explicitly determine whether
the policy at issuc was part of an employee welfare benefit plan. If the Clinic subsequently fails to
provide evidence to support its allegations that its five state law claims are not governed by ERISA,
UHC may, of course, reassert its argument in a motion for summary judgment.

5



Minute Order Form (06/97)

United States District Court, Northern District of Illinois

Notified counsel by telephone.
Docketing to mail notices.
Mail AO 450 form.

Copy to judge/magistrate judge.

courtroom
deputy’s
initials

GL

ash

Lyng) 1.5te |S
We

Name of Assigned Judge Marvin Aspen Sitting Judge if Other
or Magistrate Judge than Assigned Judge
CASE NUMBER 02 C9115 DATE 4/14/2003
CASE Chicago Foot Clinic vs. United Health Care Insurance, et al
TITLE
[In the following box (a) indicate the party filing the motion, e.g., plaintiff, defendant, 3rd party plaintiff, and (b) state briefly the nature
MOTION: of the motion being presented.]
DOCKET ENTRY:
(1) Oo Filed motion of [ use listing in “Motion” box above.]
(2) oO Brief in support of motion due
@) (a) Answer brief to motion due. . Reply to answer brief due__
(4) o Ruling/Hearing on set for at
(5) a Status hearing[held/continued to] [set for/re-set for] on set for at
(6) Oo Pretrial conference[held/continued to] [set for/re-set for] on set for at
(7) oO Trial[set for/re-set for] on at
(8) o [Bench/Jury trial] [Hearing] held/continued to at
0 a This case is dismissed [with/without] prejudice and without costs{by/agreement/pursuant to]
OOFRCP4(m) OLocal Rule 41.1 OFRCP41(a\(1) OO FRCP41(a)(2).
(10) Ml [Otherdocketentry) Enter Memorandum Opjnion and Order: UHC’s motion to dismiss the Clinic’s
complaint is granted in part and denied in part.

a1) ff [For further detail see order attached to the original minute order.]

No notices required, advised in open court. Document

. A Number
No notices required. umber of novices
Y | Notices mailed by judge’s staff. APR 15 2003

date docketed

ding Ud,

aniz/2003

date mailed notice

GL

Date/time received in

railing deputy initials

central Clerk’s Office

hil



Iii, CONCLUSION

For the foregoing reasons, UHC's motion to dismiss the Clinic's complaint on the basis of
preemption is denicd. UHC's motion to dismiss Count III of the Clinic's complaint alleging a violation
of §143.16 of the Illinois Insurance Code is granted. ItisS¢’ordered.

J

MARVIN E. ASPEN
United States District Judge

Dated y¥ ! uf 8 3



UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

CHICAGO FOOT CLINIC, )
an Illinois corporation )
)

Plaintiff, )

)

v. ) Case No. 02 C 9115

)

)

UNITED HEALTH CARE INSURANCE, )
COMPANY OF ILLINOIS, a corporation, )
UNITED HEALTH CARE INSURANCE )
COMPANY, a corporation, and LESLY )
MOTORS, INC., formerly known as )
CELEBRITY FORD, INC., a corporation. )
)

Defendants. )

APR 15 2003

MEMORANDUM OPINION AND ORDER

MARVIN E. ASPEN, District Judge:

Presently before us is the motion of Defendants United HealthCare Insurance Company of
Ulinois and United HealthCare Insurance Company (“UHC” or “UHC Defendants”), to dismiss the
complaint of Plaintiff Chicago Foot Clinic, Ltd. (“Clinic” or “Chicago Foot Clinic”). For the reasons
set forth below, this Court grants UHC’s motion in part and denies it in part.

L BACKGROUND

A. Procedural History

Plaintiff filed a six count complaint in the Circuit Court of Cook County, Illinois against UHC
Defendants and Lesly Motors, Inc. (“Lesly Motors” or “Dealership”) alleging breach of contract (Counts

I and ID!, violations of the Ilinois Insurance Code (Count II), misrepresentation and fraudulent

‘Chicago Foot Clinic labels Count I “Breach of Contract” and Count II “Third Party
Beneficiary.”


concealment (Count IV), estoppel (Count V), and violation of an unspecified provision of the
Consolidated Omnibus Budget Reconciliation Act (“COBRA”) (Count V1). Defendants removed the
case to this Court based on our federal question jurisdiction under 28 U.S.C. §1331 over Count VI of
the complaint which the Clinic brought under the Employee Retirement Income Security Act of 1974
(“ERISA”), 29 U.S.C. §1001 et seg. Defendants removed the remaining counts of the complaint based
on this Court's supplemental jurisdiction under 28 U.S.C. §1367(a).

UHC Defendants subsequently moved to dismiss on the ground that ERISA preempts each count
of the Plaintiff's complaint. Lesly Motors joined the motion as to Count VI of the complaint, the only
claim the Plaintiff brought against the Dealership. Plaintiff then moved to voluntarily dismiss Count VI
ofits complaint and moved to remand the case to the Circuit Court of Cook County, Illinois. We granted
both of the Plaintiff's motions on February 5, 2003. UHC Defendants petitioned this Court to reconsider
our order of February 5, 2003 remanding the case. On February 12, 2003, we vacated the order based
on UHC's argument that the remaining counts arise under ERISA and are therefore within our
jurisdiction under the doctrine of “complete preemption.” See Metro. Life Ins. Co. v. Taylor, 481 U.S.
58, 67, 107 S.Ct. 1542, 1548, 95 L.Ed.2d 55 (1987) (well-pleaded complaint rule does not prohibit
removal when action arises under ERISA).

B. Facts

The following factual allegations are taken from the Plaintiffs complaint and are deemed true
for the purpose of UHC Defendants' motion. On or about August 1, 1997, Maritza Hernandez became
insured under a policy issued by UHC. The policy terminated on November 2, 1997. On October 28,
1997, Hernandez came under the care of the podiatrist employees and independent contractors of the

Chicago Foot Clinic. On that date, the Clinic verified that Hernandez was covered by an insurance

?The Clinic labeled Count VI “ERISA”.