Violet Hogan v. Jo Ellen Jacobson
823 F.3d 872
| 6th Cir. | 2016Background
- Hogan, covered by an ERISA-regulated disability policy through her employer, was denied short- and long-term disability benefits after medical reviews by two unlicensed insurance-company nurses, Jo Ellen Jacobson and Kem Alan Lockhart.
- Hogan previously sued the insurer for wrongful denial of benefits in federal court (Hogan I); the district court and this Court rejected her short-term claim on the merits and held her long-term claim unexhausted.
- While that appeal was pending, Hogan sued the two nurses in Kentucky state court for negligence per se, alleging they practiced medicine/psychology without Kentucky licenses by issuing opinions that led to denial of benefits.
- Defendants removed under ERISA complete-preemption; the district court denied remand, allowed an amended complaint (adding a § 1140 claim), then dismissed the case for failure to state a claim and other grounds.
- On appeal, the Sixth Circuit affirmed: Hogan’s state-law claim was completely preempted (so removal was proper); the recast § 1132 benefits claim failed (improper defendants, failure to exhaust, res judicata); the § 1140 claim failed for conclusory allegations; sanctions on appeal were denied.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Hogan's state-law negligence-per-se claim is completely preempted by ERISA § 1132(a) | Hogan argued her claim enforces an independent state-law licensing duty and thus is not an ERISA claim | Defendants argued the claim in essence challenges denial of ERISA benefits and arises solely from the ERISA plan relationship, so § 1132 completely preempts it | Court held claim is artful pleading of an ERISA-benefits dispute and is completely preempted; remand denied |
| Whether any duty Hogan alleges is independent of ERISA | Hogan contended Kentucky licensing statutes create an independent duty separate from the plan | Defendants contended any duty arises only from the plan-based review and denial process, so not independent | Court held the alleged duty derives from the ERISA plan and is not independent (Davila test satisfied) |
| Whether Hogan stated a § 1132(a)(1)(B) claim after amendment | Hogan sought benefits/relief under § 1132 recasting her state claim | Defendants argued improper defendants (nurses, not plan administrator), failure to exhaust long-term claim, and res judicata from Hogan I | Court dismissed § 1132 claim: wrong defendants, unexhausted long-term claim, and res judicata barred relitigation |
| Whether Hogan stated an ERISA § 1140 interference claim | Hogan alleged defendants intentionally issued adverse opinions to interfere with her rights under the plan | Defendants argued allegations merely restate denial-of-benefits and lack particularized facts showing independent interference beyond claim denial | Court held § 1140 claim deficient—allegations conclusory and show only defendants' role in denying the claim; dismissal affirmed |
Key Cases Cited
- Aetna Health Inc. v. Davila, 542 U.S. 200 (state-law claims that duplicate ERISA remedies are completely preempted)
- Caterpillar Inc. v. Williams, 482 U.S. 386 (well-pleaded complaint rule and preemption defenses)
- Metro. Life Ins. Co. v. Taylor, 481 U.S. 58 (complete preemption converts state claims into federal ones)
- Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41 (ERISA’s comprehensive enforcement scheme preempts state remedies)
- Ingersoll-Rand Co. v. McClendon, 498 U.S. 133 (preemption hinges on congressional intent)
- Gardner v. Heartland Indus. Partners, LP, 715 F.3d 609 (Davila two-part test applied)
- Peters v. Lincoln Elec. Co., 285 F.3d 456 (focus on substance over label for preemption analysis)
- Berera v. Mesa Med. Grp., PLLC, 779 F.3d 352 (piercing artful pleading to determine federal implication)
- Jass v. Prudential Health Care Plan, Inc., 88 F.3d 1482 (claims arising from benefits determinations are preempted)
- Gibson v. Prudential Ins. Co. of Am., 915 F.2d 414 (state duties created by plan administration are preempted)
- Danca v. Private Health Care Sys., Inc., 185 F.3d 1 (negligent decisionmaking in benefits process is preempted)
- Thurman v. Pfizer, Inc., 484 F.3d 855 (example of an independent state claim not preempted when it arises outside plan relationship)