Opinion ID: 796029
Heading Depth: 1
Heading Rank: 2

Heading: Subject Matter Jurisdiction Claim: Preemption Under Section 502(a)

Text: 8 Wirth argues that the removal of his lawsuit to federal court, and the reclassification of his state law claim as an ERISA action, was error. Because the question is one of jurisdiction, we exercise plenary review over Wirth's challenge. Pryzbowski v. U.S. Healthcare Inc., 245 F.3d 266, 268 (3d Cir.2001). In our Interim Opinion, we held that the District Court did not err in exercising jurisdiction over Wirth's claim. Wirth, 137 Fed.Appx. at 457-59. We reiterate that decision, and repeat our analysis here. 4 9 Under § 502(a), a participant in an ERISA-covered plan may bring a civil action 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. 29 U.S.C. § 1132(a)(1)(B). Wirth contends that because his claims are neither for benefits due nor to enforce rights under the Aetna plan, ERISA does not provide a civil enforcement mechanism for Wirth to challenge or defend against Aetna's liens and, therefore, that the District Court erred in granting removal of the case from state to federal court. 10 In our Interim Opinion, we found this argument foreclosed by our decision in Levine. The force of Levine's reasoning has not diminished. The plaintiffs in Levine were injured in an auto accident, received medical benefits from their respective insurers and subsequently recovered damages from the responsible tortfeasors. Following the plaintiffs' monetary recovery, their respective insurers sought reimbursement for the benefits paid pursuant to then-valid subrogation provisions of their relevant healthcare plans. The plaintiffs settled with their insurers by paying over a portion of their tort recovery but then sued the insurance companies for, inter alia, unjust enrichment in New Jersey state court. 5 11 On appeal in Levine, we considered, inter alia, whether plaintiffs' unjust enrichment claims for monies taken pursuant to subrogation and reimbursement provisions in their ERISA health plans are claims for `benefits due' within the meaning of ERISA section 502(a). In determining that they were, we noted that such a holding comported with similar rulings in the Fourth and Fifth Circuits, see Singh v. Prudential Health Care Plan Inc., 335 F.3d 278 (4th Cir.2003); Arana v. Ochsner, 338 F.3d 433, 437 (5th Cir.2003) (en banc), and would be consistent with the framework we previously laid out for evaluating complete preemption in Pryzbowski v. U.S. Healthcare Inc., 245 F.3d 266, 268 (3d Cir.2001) (designating two categories of ERISA cases: 1) where the claim challenges the administration of, or eligibility for, benefits, which are preempted, and 2) those challenging the quality of medical treatment, which are not preempted). Levine, 402 F.3d at 163. While recognizing that the facts of Levine neither overlapped perfectly with those in Arana or Singh, nor fell squarely within either Pryzbowski category, we nonetheless held that where plaintiffs claim that their ERISA plan wrongfully sought reimbursement of previously paid health benefits, the claim is for `benefits due' and federal jurisdiction under section 502(a) of ERISA is appropriate. Such a rule comports with our earlier jurisprudence because, although not directly analogous, such claims are more like challenges to the `administration of benefits' than challenges to the `quality of benefits received.' Id. (quoting Pryzbowski, 245 F.3d at 273). 12 As we noted in our Interim Opinion, our holding in Levine applies squarely to the present facts and precludes Wirth's argument that seeking recovery of the $2,066.90 paid to extinguish Aetna's lien is not tantamount to seeking recovery of benefits due to him. Here, as in Levine, the actions undertaken by the insurer resulted in diminished benefits provided to the plaintiff insureds. That the bills and coins used to extinguish Aetna's lien are not literally the same as those used to satisfy its obligation to cover Wirth's injuries is of no import—the benefits are under something of a cloud. Arana, 338 F.3d at 438. For these reasons, we reiterate the holding of our Interim Opinion: Wirth's claims against Aetna are completely preempted by ERISA and there was no error in the District Court's conclusion that it had jurisdiction over this matter.