Kuthy v. Mansheim , 124 F. App'x 756 ( 2004 )

UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 04-1290
JAMES KUTHY, individually and as Personal
Representative of the Estate of Debra K.
Kuthy, deceased,
Plaintiff - Appellant,
versus
BERNARD J. MANSHEIM; SCOTT L. SPRADLIN;
COVENTRY HEALTH CARE, INC.; CARELINK HEALTH
PLANS, INC.,
Defendants - Appellees.
Appeal from the United States District Court for the Northern
District of West Virginia, at Wheeling. Frederick P. Stamp, Jr.,
District Judge. (CA-03-108-5)
Submitted: October 8, 2004 Decided: December 3, 2004
Before WILKINS, Chief Judge, NIEMEYER, Circuit Judge, and Glen E.
CONRAD, United States District Judge for the Western District of
Virginia, sitting by designation.
Affirmed by unpublished per curiam opinion.
Patrick S. Cassidy, Wray V. Voegelin, Bradley H. Thompson, CASSIDY,
MYERS, COGAN, VOEGELIN & TENNANT, L.C., Wheeling, West Virginia,
for Appellant. Eric W. Iskra, Samuel M. Brock, III, Grant P. H.
Shuman, SPILMAN, THOMAS & BATTLE, P.L.L.C., Charleston, West
Virginia, for Appellees.
Unpublished opinions are not binding precedent in this circuit.
See Local Rule 36(c).
PER CURIAM:
James Kuthy appeals a decision of the district court
denying his motion to remand and granting summary judgment against
him on grounds of preemption. Finding that the issues raised are
controlled by Aetna Health Inc. v. Davila, 124 S. Ct. 2488 (2004),
we affirm.
I.
After a long struggle with non-Hodgkin’s lymphoma,
Kuthy’s wife, Debra, died in May 2003. Kuthy filed this medical
malpractice and wrongful death action in West Virginia state court
alleging state law claims against his wife’s HMO, Carelink Health
Plans, Inc. (Carelink); Coventry Health Care, Inc. (Coventry),
which owns Carelink; and two doctors who worked for Carelink and
Coventry, Bernard J. Mansheim and Scott L. Spradlin.1 Kuthy
alleged that the physicians breached their standard of care by
denying coverage for an experimental bone marrow transplant that
had been recommended by Ms. Kuthy’s treating physician. Appellees
removed the case to federal court and moved to dismiss on the
ground that Kuthy’s claims were completely preempted by the
Employee Retirement Income Security Act of 1974 (ERISA), see 29
U.S.C.A. §§ 1001-1461 (West 1999 & Supp. 2004). The district court
1
We refer to Carelink, Coventry, Mansheim, and Spradlin
collectively as “Appellees.”
2
denied Kuthy’s motion to remand. Then, treating Appellees’ motion
to dismiss as a motion for summary judgment, the district court
granted summary judgment in favor of Appellees.2 Kuthy now
appeals.
II.
“Congress clearly expressed an intent that the civil
enforcement provisions of ERISA § 502(a) be the exclusive vehicle
for actions by ERISA-plan participants and beneficiaries asserting
improper processing of a claim for benefits.” Pilot Life Ins. Co.
v. Dedeaux, 481 U.S. 41, 52 (1987). For a claim to be completely
preempted by ERISA, three requirements must be met: “(1) the
plaintiff must have standing under § 502(a) to pursue its claim;
(2) its claim must fall within the scope of an ERISA provision that
it can enforce via § 502(a); and (3) the claim must not be capable
of resolution without an interpretation of the contract governed by
federal law, i.e., an ERISA-governed employee benefit plan.”
Sonoco Prods. Co. v. Physicians Health Plan, Inc., 338 F.3d 366,
372 (4th Cir. 2003) (internal quotation marks & alterations
omitted). Kuthy’s claims meet each of these requirements.
First, Kuthy has standing to pursue an ERISA claim
because he, acting individually and as personal representative of
2
Prior to entering judgment, the district court granted
Kuthy twenty days in which to amend his complaint to assert a claim
under ERISA. Kuthy declined to do so.
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his wife’s estate, is “a participant or beneficiary” of the
Carelink/Coventry plan. 29 U.S.C.A. § 1132(a)(1)(B) (West 1999).
Second, Kuthy’s claims fall within the scope of an ERISA
provision. Claims that challenge an insurance company’s
interpretation of an ERISA-regulated plan fall within the scope of
ERISA. See Davila, 124 S. Ct. at 2496:
[I]f an individual brings suit complaining of
a denial of coverage for medical care, where
the individual is entitled to such coverage
only because of the terms of an
ERISA-regulated employee benefit plan, and
where no legal duty (state or federal)
independent of ERISA or the plan terms is
violated, then the suit falls “within the
scope of” ERISA § 502(a)(1)(B).
In Davila, the plaintiffs brought malpractice claims for “injuries
allegedly arising from [their insurance companies’] decisions not
to provide coverage for certain treatment and services recommended
by [plaintiffs’] treating physicians.” Id. at 2493. Because the
plaintiffs’ claims stemmed from their insurance companies’
interpretations of ERISA-regulated plans, the Court ruled that
their malpractice claims implicated the same duties contained in
ERISA and were therefore completely preempted. See id. at 2498.
The same is true here. Kuthy alleges that Appellees committed
malpractice by failing to authorize an experimental bone marrow
transplant recommended by his wife’s treating physician.
Appellees’ decision to deny coverage was based upon their
interpretation of a provision in the insurance plan that excluded
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experimental treatments. Kuthy’s claim therefore falls within the
scope of ERISA.
Finally, it is unquestioned that Kuthy’s insurance plan
is an ERISA-governed plan. As all of the requirements set forth in
Sonoco Prods. Co. are met, we hold that Kuthy’s claims are
completely preempted by ERISA. Kuthy’s motion to remand the case
was properly denied, see Davila, 124 S. Ct. at 2495, and summary
judgment in favor of Appellees was appropriate.
III.
For the reasons stated above, we affirm the judgment of
the district court.
AFFIRMED
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