Opinion ID: 150123
Heading Depth: 3
Heading Rank: 2

Heading: Whether the Conduct Implicates a Legal Duty Independent of ERISA

Text: The test in Davila is conjunctive both conditions must be satisfied for a claim to be completely preempted. After United has demonstrated that Appellants' claims could have been brought under ERISA, it next must show that the claims asserted did not implicate legal duties independent of those imposed by ERISA or an ERISA plan's terms. Davila, 542 U.S. at 210, 124 S.Ct. at 2496. Because the Appellants pled claims based on coverage determinations under ERISA plans in addition to claims based on their provider contracts, the legal duty implicated is dependent upon an ERISA plan. As both Davila factors are met, the coverage claims are completely preempted. This gives a federal court federal question jurisdiction over those claims and supplemental jurisdiction over the remaining claims. In Connecticut State Dental, we concluded that certain claims in the dentists' complaints were not predicated on a legal duty independent of ERISA. Connecticut State Dental, 591 F.3d at 1353. We reasoned that claims involving only the amount owed based on the rate of payment might not implicate ERISA, but the claims that challenged coverage determinations under ERISA plans clearly implicated ERISA. Id. We held that subject matter jurisdiction existed over all of the claims in the complaint because jurisdiction existed over the completely preempted claims and those joined with them. Id. Appellants contend that their state law claims, based predominantly on their contracts with United, implicate legal duties independent of ERISA because state law, not ERISA, defines the contractual obligations of the parties. Though this is true in the abstract, the Supreme Court has indicated that we must evaluate each claim by its actual content. See Davila, 542 U.S. at 212-213, 124 S.Ct. at 2497-98 (concluding that Texas law imposing standard of care on managed care entities did not impose a duty independent of ERISA because interpretation of the terms of [ERISA] benefit plans forms an essential part of [the state law] claim). Here, the content of the claims necessarily requires the court to inquire into aspects of the ERISA plans because of the invocation of terms defined under the plans. Consistent with Connecticut State Dental, at least some of the claims pursued by the Appellants implicate legal duties dependent on the interpretation of an ERISA plan. These claimsabout wrongfully denied benefits based on determinations of medical necessityrelate directly to the coverage afforded by the ERISA plans. Many of the other allegations in the complaint, for practices like downcoding and bundling, are based on independent provider-insurer contracts and do not implicate ERISA. But, because at least some of the allegations are dependent on ERISA, those claims are completely preempted and federal question jurisdiction exists. Because Appellants' claims are completely preempted by ERISA, a federal court has subject matter jurisdiction over Appellants' suit.