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State Law Claims, Fiduciary Breach Claim, and Jury Demand Dismissed

State Law Claims, Fiduciary Breach Claim, and Jury Demand Dismissed

ERISA and Life Insurance News
(April 20, 2011)

Thompson v. Aetna Health, Inc.,
No. 1:10-cv-2245 (N.D. Ga. Jan. 21, 2011)

Thompson sued Aetna, alleging wrongful denial of his claim for medical expense benefits for gastric bypass surgery. The complaint consisted of six counts: (1) wrongful denial of benefits, (2) breach of contract, (3) breach of fiduciary duty, (4) breach of the implied covenant of good faith and fair dealing, (5) violation of the Georgia Unfair Claims Settlement Practices Act, and (6) a claim for attorney’s fees.

Aetna moved to dismiss the state law claims in their entirety. Although Thompson agreed that ERISA applied to some of the claims, he contended that he was entitled to more than he could recover under ERISA, including “remuneration for Defendant’s bad faith handling of his claim in addition to the wrongful denial of benefits.”

In considering the motion to dismiss, the court reviewed the purpose of ERISA, as a “comprehensive statute designed to promote the interests of employees and their beneficiaries in employee benefit plans.” Shaw v. Delta Air Lines, 463 U.S. 85, 90 (1983). The court observed that in order to maintain nationwide uniformity, ERISA contains broad provisions preempting state law.

The court first determined that the plan was governed by ERISA under the test developed in Donovan v. Dillingham, 688 F.2d 1367 (11th Cir. 1982). The court next considered whether Thompson’s state law claims “related to” the plan. The court stated that a state law claim relates to an ERISA plan whenever the alleged conduct at issue is intertwined with the refusal to pay benefits.

Although Thompson argued that his claims should survive because he was seeking remuneration for Aetna’s alleged bad faith, the court found that “the manner in which his claim was handled does not exempt the plaintiff’s state law causes of action from preemption where the conduct allegedly constituting bad faith was intertwined with the denial itself.”

The court found that Thompson’s claims under Counts II, IV, and V were preempted, because the allegations were necessarily intertwined with the refusal to pay benefits. Likewise, to the extent that Count III related to state law claims for breach of fiduciary duty, it was also preempted. The court dismissed each of those counts.

The court likewise granted Aetna’s motion to dismiss with respect to plaintiff’s simultaneous claims to recover benefits under § 1132(a)(3) and for breach of fiduciary duty under § 1132 (a)(1)(B). Citing Rosario v. King & Prince Seafood Corp., 2006 WL 2367130 (S.D. Ga. 2006), the court stated that if allegations of misconduct were sufficient to state a claim under § 1132(a)(1)(b), then Thompson was precluded from asserting the same allegations through a breach of fiduciary duty claim under § 1132(a)(3).

Thompson argued that he could maintain his (a)(3) claim because he alleged conduct that would constitute a breach of fiduciary duty outside of the ERISA framework. The court rejected this argument, stating “this allegation amounts to no more than factual filler to substantiate the plaintiff’s improper denial of benefits claim” under § 1132(a)(1)(B).

Finally, the court granted Aetna’s motion to strike Thompson’s jury demand. The court said that the Seventh Amendment, which ensures the right to a trial by jury in suits at common law, was inapplicable to ERISA cases, because a claim for benefits under 29 U.S.C. § 1132(a)(1)(B) is equitable in nature. Because the only remaining claim was an ERISA claim for improper denial of benefits, Thompson was not entitled to a trial by jury.

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