Opinion ID: 3012804
Heading Depth: 2
Heading Rank: 3

Heading: The Discharge from the Hospital

Text: Count I also includes a claim that Aetna improperly interfered with DiFelice’s medical treatment by “insisting on [his] discharge from the [hospital] . . . before his attending physician was planning on discharging [him].” The District Court did not address this aspect of the claim in its order dismissing the complaint. 4. Aetna argues that the Supreme Court’s decision in Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355 (2002), compels this result, but we find that case to be inapposite. The Court in Moran was faced with an Illinois statute that provided HMO participants “with a right to independent medical review of certain denials of benefits,” id. at 359, and required HMOs to provide any service that the independent reviewing physician deemed “medically necessary.” Id. at 361. The Court held that “it was beyond serious dispute” that the statute “related to” an ERISA plan and was therefore preempted under 29 U.S.C. § 1144(a), but went on to hold that the statute was saved from preemption under 29 U.S.C. § 1144(b)(2)(A) because it regulated insurance. Id. at 365-66. Thus, the Court was not faced with the question of whether a suit challenging an HMO’s medical necessity determinations would be preempted under ERISA absent a particular state statute that imposed additional burdens on the HMO, which is the issue before us here. 17 Unlike his claim regarding the tracheostomy tube, DiFelice does not allege that Aetna deemed the hospital stay to be “medically unnecessary” and therefore not covered by the Plan. The claim also does not appear to rely on a discharge policy in the Plan or any agreed benefit. Indeed, it is difficult to tell from DiFelice’s vague pleadings what precisely he is alleging that Aetna did or the form this “insistence” took. If Aetna in some way forced the hospital to discharge him, or imposed financial incentives like those in U.S. Healthcare and Lazorko that unduly affected his physician’s judgment, then DiFelice has pled a negligence cause of action that is not preempted by ERISA. At the dismissal stage, it was Aetna’s burden to prove federal jurisdiction by proving that this is an ERISA claim. See Spectacor Mgt. Group, 131 F.3d at 127. There is nothing apparent from the pleadings that would foreclose DiFelice from being able to prove that the discharge decision was not a plan benefit. Unlike his claim that the tube was erroneously determined to be “medically unnecessary” under the Plan, this claim on its face is not plan-related. Therefore, because DiFelice’s claim of “insistence” on the discharge could give rise to state law negligence liability, we hold that it is not completely preempted by section 502(a) of ERISA. Aetna argues that, even if DiFelice’s hospital discharge claim is cognizable as a state law cause of action, we should uphold the District Court’s dismissal of that claim on the alternative ground that it is nonetheless expressly preempted by virtue of section 514 of ERISA, 29 U.S.C. § 1144(a), which provides that ERISA “shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan” covered by the statute. However, “[u]nlike the scope of § 502(a)(1)(B), which is jurisdictional and creates a basis for removal to federal court, § 514(a) merely governs the law that will apply to state law claims, regardless of whether the case is brought in state or federal court.” Lazorko, 237 F.3d at 248. As we have determined that the hospital discharge claim is not preempted by section 502(a), we do not have jurisdiction over that claim. Rather, the question of whether the hospital discharge claim will be controlled by federal law 18 pursuant to section 514 must be decided by the District Court on remand, should it choose to exercise supplemental jurisdiction under 28 U.S.C. § 1367(a), or by the state court. See Pryzbowski, 245 F.3d at 276 (where District Court has jurisdiction over one claim by virtue of preemption under section 502(a), it has discretion to decide whether to exercise supplemental jurisdiction over claims arising from the same factual predicate or remand to state court).