Search
We use cookies to better understand how you use our site and to improve your experience by personalizing content. Please review our updated Privacy Policy and Terms of Use. If you accept the use of cookies, please click the "I accept" button.I acceptI declineX
 
Skip navigational links
 
 

U.S. District Court In Illinois Denies Motion To Dismiss Complaint

 
 

HLD, v. 31, n. 6 (June 2003)

U.S. District Court In Illinois Denies Motion To Dismiss Complaint

In August 1997, Maritza Hernandez became insured under a policy issued by United Health Care Insurance Co. of Illinois (UHC). On October 28, 1997, Hernandez sought treatment from the Chicago Foot Clinic (Clinic), which verified that she was covered by the UHC policy. The policy terminated on November 2, 1997, and on October 29, 1997, UHC precertified Hernandez for surgery and anesthesia benefits, and did not inform the Clinic that the benefits would expire on November 2. Hernandez was provided treatment on October 28 and on several dates after November 2. In March 1998, Hernandez assigned her rights under the UHC policy to the Clinic, which submitted claims for the treatment. UHC paid the October 28 claim, but denied the remaining claims for treatment after November 2. The Clinic sued UHC seeking payment of $23,075 for Hernandez's treatment. UHC removed the case to federal court on the ground that one of the claims was brought under the Employee Retirement Income Security Act of 1974 (ERISA), and the remaining claims came under the court's supplemental jurisdiction. UHC moved to dismiss the complaint on the ground of ERISA pre-emption. The Clinic moved to dismiss the ERISA count and remand the case to state court. The district court granted the motions, but later vacated the order on UHC's request for reconsideration based on the argument that the remaining claims arose under ERISA and were within the district court's jurisdiction under the "complete preemption" doctrine.

The U.S. District Court for the Northern District of Illinois denied UHC's motion to dismiss the complaint on the basis of pre-emption, and granted UHC's motion to dismiss Count III of the complaint, which alleged a violation of the Illinois Insurance Code. The court explained that in deciding whether ERISA pre-empts a state law a court must consider whether the policy is an employee welfare plan, and whether the state law "relates to" the employee benefit plan. The court found that the complaint stated that Hernandez was insured by an employee welfare benefit plan, but there was no copy of the policy provided by either side. Thus, the court held that it could not analyze UHC's argument that the complaint was pre-empted by ERISA.

UHC also argued that Count III, which alleged that UHC did not provide notice of the cancellation of Hernandez's policy, failed to state a claim under the Illinois Insurance Code. The court agreed because health insurers are not required to provide notice under the Code. Accordingly, the court denied UHC's motion to dismiss the complaint on the basis of pre-emption, and granted UHC's motion to dismiss Count III of the complaint.

Chicago Foot Clinic v. United Health Care Ins. Co. of Ill., No. 02C9115, 2003 WL 1888732 (N.D. Ill. Apr. 15, 2003) (3 pages). i31

© 2018 American Health Lawyers Association. All rights reserved. 1620 Eye Street NW, 6th Floor, Washington, DC 20006-4010 P. 202-833-1100 F. 202-833-1105