OPINION
This matter is before the Court on defendant Connecticut General Life Insurance Company’s (CGL’s) motion to dismiss the action and on its motion to strike plaintiff’s pleading captioned “Reply.” CGL bases its motion to dismiss on the assertion that plaintiff’s four state law claims are preempted by the Employee Retirement Income Security Act of 1974, 29 U.S.C. §§ 1001, et seq. (“ERISA”), and bases its motion to strike on the assertion that plaintiff’s pleading violates Local Rule 108. Upon consideration of the entire record, the Court denies defendant’s motion to strike, denies the motion to dismiss with regard to Counts II and IV of the complaint, and grants the motion to dismiss with regard to Counts I and III of the complaint. The Court’s dismissal of Counts I and III is without prejudice to plaintiff’s right to file an amended complaint within 30 days of the date of this Opinion.
BACKGROUND
Plaintiff, The Psychiatric Institute of Washington, D.C., Inc. (PIW), is a healthcare provider seeking compensation for services rendered to defendant Michael T. White. White was a participant in a group health insurance plan provided by defendant CGL through White’s employer, Corn-site. PIW treated defendant White as an inpatient between July 6,1988, and August
1, 1988, and between September 3, 1988, and September 9, 1988. Having received only partial compensation for those services, PIW filed this action in the Superior Court of the District of Columbia. Defendant CGL subsequently removed the case to this Court, based on 28 U.S.C. § 1331 and 29 U.S.C. § 1132(a)(1)(B).
See Metropolitan Life Ins. Co. v. Taylor,
PIW contends that, at the outset of each period of treatment, it obtained oral verification of defendant White’s coverage from defendant CGL. PIW also alleges that, prior to each admission, White entered into a written agreement with PIW, authorizing PIW to file insurance claims on his behalf and assigning his insurance benefits to PIW. At the time of White’s second admission to PIW, plaintiff mailed CGL an insurance benefits questionnaire requesting written confirmation of the health insurance coverage available to White. However, plaintiff did not receive the completed questionnaire from CGL until after the conclusion of White’s second period of treatment. The document stated that White’s health insurance coverage had been canceled as of July 5, 1988, one day prior to White’s first admission to PIW. Although CGL paid PIW $4,385.60 on August 26, 1988, it subsequently refused to pay the remaining $14,388.15 in charges for White’s treatment at PIW.
On its face, PIW’s complaint is grounded entirely on state law. The complaint consists of two contract claims against CGL, Count I and Count III, a claim of promissory estoppel against CGL, Count IV, and a contract claim against White, Count II. PIW seeks damages from defendants CGL and White in the amount of $14,388.15, prejudgment interest at the statutory rate from September 9, 1988, and attorneys’ fees of $2,158.22.
DISCUSSION
1. CGL’s Motion To Strike.
Defendant CGL moved to strike plaintiff’s pleading captioned “Reply,” based on Local Rule 108 and Fed.R.Civ.P. 12(f). De
2. CGL’s Motion To Dismiss.
A. The Existence of an ERISA “Plan.” Plaintiff PIW contends that CGL’s Motion To Dismiss is “premature,” because plaintiff has not alleged that the contract of insurance between White and CGL was part of an ERISA “plan,” and because the evidence in the record does not conclusively demonstrate that the health insurance benefits in this case were governed by ERISA. Section 1003 of ERISA provides that with limited exceptions, ERISA “shall apply to any employee benefit plan if it is established or maintained — (1) by any employer engaged in commerce or in any industry or activity affecting commerce.” 29 U.S.C. § 1003(a)(1). Although PIW’s complaint does not explicitly allege the existence of an ERISA plan, plaintiff does allege the existence of a plan of the kind ERISA covers. PIW’s complaint alleges that “[defendant [CGL] was the health benefits insurer for employees of Comsite, a corporation which is located in Beltsville, Maryland, pursuant to a contract of insurance,” and that White was “an employee of Corn-site and a participant in the health insurance plan of his employer.” Furthermore, the insurance benefits questionnaire completed by CGL and attached to PIW’s complaint lists “Comsite” as the “Group Name” for the policy covering White until July 5,1988, the date on which CGL alleges White’s benefits were canceled. In light of PIW’s pleadings, the Court concludes that defendant’s motion to dismiss is not premature. 1
B. Claims Against CGL Based on Breach of Insurance Contract.
Counts I and III set forth state law claims alleging that CGL breached its contract of insurance with White. The complaint asserts that CGL is contractually obligated to pay PIW the remaining charges for services rendered to White, due to PIW’s status as an assignee of White’s healthcare benefits (Count I) or as a third-party beneficiary to White’s contract of insurance with CGL (Count III). CGL contends that ERISA preempts these contractual claims arising from state common law, because they “relate to” an employee benefit plan. The Court agrees.
ERISA preempts every state law that “relate[s] to ... employee benefit plan[s]” classified under § 1003(a), unless the state law “regulates insurance, banking, or securities.” 29 U.S.C. §§ 1144(a), 1144(b). “[A] law ‘relates to’ an employee benefit plan, in the normal sense of the phrase, if it has connection with or reference to such a plan.”
Shaw v. Delta Air Lines, Inc.,
Ultimately, “ ‘[t]he question whether a certain state action is pre-empted by federal law is one of congressional intent.’ ”
Pilot Life,
State law contract claims brought by plan participants and by health care providers that have rendered services to plan participants are preempted by ERISA because they “relate to” employee benefit plans and are not based on state laws “which regulate insurance.”
Thayer v. Group Hospitalization and Medical Servs., Inc.,
Nevertheless, plaintiff retains the right to amend Counts I and III of its original complaint. “It is common ground that Rule 15 embodies a generally favorable policy toward amendments.”
Davis v. Liberty Mut. Ins. Co.,
The facts alleged indicate that PIW would have standing to state a contract claim against CGL under ERISA. A healthcare provider designated as an as-signee of an employee’s health benefit contract has derivative standing to sue the employee’s insurer under ERISA,
Hermann Hosp.,
Granting standing to healthcare providers under ERISA is consistent with Congress’s intent to promote employee interests and to protect their “contractually defined benefits.”
Massachusetts Mut. Ufe,
C. Promissory Estoppel Claim Against CGL.
Count IV of PIW’s complaint asserts a claim of promissory estoppel against CGL. PIW argues that it provided services to White in reliance on statements by CGL employees confirming the availability of benefits covering the services proposed by PIW. PIW alleges that as a result of its reliance on the verification of coverage provided by CGL, PIW rendered $14,388.15 in services for which it has not been compensated. Although state law claims of equitable estoppel brought by healthcare providers against insurers of ERISA plans are preempted by ERISA, defendant’s motion to dismiss this claim of promissory estoppel is denied. Plaintiff states a claim for which relief can be granted under the federal common law governing actions preempted, but not specifically addressed, by ERISA.
Employees and healthcare providers have a federal common law cause of action against insurers who have provided an oral interpretation of ambiguous ERISA plan provisions.
See Kane v. Aetna Life Ins.,
A federal common law cause of action for promissory estoppel effectuates Congress’s intent “to promote the interest of employees and their beneficiaries in employee benefit plans.”
Shaw,
D. Claim Against White Based on Breach of Medical Services Contract.
Count II of PIW’s complaint is a breach of contract claim against the individual defendant White. This claim contends that White entered into a service contract with PIW and remains liable for the charges he incurred as a patient at PIW, despite his assignment of benefits to PIW.
18
This state law contract claim against White is not preempted by ERISA, because it is only “peripherally” related to an ERISA employee benefit plan.
Hartle,
State common law governing contracts between patients and healthcare providers is “a law of general application” which applies to all patients regardless of whether they are or ever have been participants in an ERISA welfare benefit plan and to all providers regardless of whether they are assignees of an ERISA plan beneficiary.
Sommers,
CONCLUSION
The Court denies defendant’s motion to strike plaintiffs “Reply” in the interest of permitting a more complete record in this case, although assuredly superfluous pleadings are discouraged. The Court grants defendant’s motion to dismiss with respect to Counts I and III, but denies defendant’s motion to dismiss with respect to Counts II and IV. Counts I and III are invalid state law contract claims preempted by ERISA, but plaintiff retains the right to amend the complaint to assert federal common law claims within 30 days. Count IV states a valid claim of equitable estoppel under the federal common law, and Count II asserts a valid state law contract claim which may be addressed by this Court as a pendent claim attached to Count IV.
Notes
. PIW’s reliance on
Weiner v. Blue Cross of Md., Inc.,
. Section 1132(a) of ERISA provides:
A civil action may be brought—
(1) by a participant or beneficiary—
(A) for the relief provided for in subsection (c) of this section, or
(B) to recover benefits due to him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan;
(2) by the Secretary, or by a participant, beneficiary or fiduciary for appropriate relief under section 1109 of this title;
(3) by a participant, beneficiary, or fiduciary (A) to enjoin any act or practice which violates any provision of this subchapter or the terms of the plan, or (B) to obtain other appropriate equitable relief (i) to redress such violations or (ii) to enforce any provisions of this subchapter or the terms of the plan;
(4) by the Secretary, or by a participant, or beneficiary for appropriate relief in the case of a violation of 1025(c) of this title;
(5) except as otherwise provided in subsection (b) of this section, by the Secretary (A) to enjoin any act or practice which violates any provision of this subchapter, or (B) to obtain other appropriate equitable relief (i) to redress such violation or (ii) to enforce any provision of this subchapter; or
(6)by the Secretary to collect any civil penalty under subsection (c)(2) or (i) or (/) of this section.
29 U.S.C. § 1132(a).
.
See also Memorial Hosp. Sys.
v.
Northbrook Life Ins. Co.,
.
Cf. Franchise Tax Bd. v. Construction Laborers Vacation Trust,
. The Hermann court summarized the evidence of Congress’s intention to allow the assignment of ERISA health benefits, stating:
[t]o deny standing to health care providers as assignees of beneficiaries of ERISA plans might undermine Congress’ goal of enhancing employees’ health and welfare benefit coverage. Many providers seek assignments of benefits to avoid billing the beneficiary directly and upsetting his finances and to reduce the risk of non-payment. If their status as assignees does not entitle them to federal standing against the plan, providers would either have to rely on the beneficiary to maintain an ERISA suit, or they would have to sue the beneficiary. Either alternative, indirect and uncertain as they are, would discourage providers from becoming assignees and possibly from helping beneficiaries who were unable to pay them ‘upfront.’ The providers are better situated and financed to pursue an action for benefits owed for their services. Allowing assignees of beneficiaries to sue under § 1132(a) comports with the principle of sub-rogation generally applied in the law.
Hermann Hosp.,
.The Court of Appeals for the District of Columbia Circuit has not yet addressed the standing of healthcare providers under ERISA. However, one District Court has stated “[fjrom Congress' silence ... it follows that assignments of health benefit claims are not barred [by ERISA].”
Washington Hosp. Center Corp. v. Group Hospitalization and Medical Servs., Inc.,
Other courts have also held that ERISA health and welfare benefits may be assigned to third parties.
See Belmont Community Hosp. v. Local Union No. 9, I.B.E.W. & Outside Contractors Health & Welfare Fund, Til
F.Supp. 1034, 1036 (N.D.Ill.1990) (citing
Hermann Hosp.,
. In
Pressroom,
the Second Circuit denied standing to a pension fund, holding that the lack of evidence on Congress's intention regarding the standing of non-enumerated parties under § 1132(a) should be construed to deny standing under ERISA to non-enumerated parties.
Press-room,
. This Court rejects the
Fentron
court’s holding that ERISA may implicitly authorize independent standing for parties not explicitly enumerated by the statute.
Fentron,
.
See abo United States Fidelity & Guar. Co. v. United States,
. In
Misic,
plaintiff, a healthcare provider, sued an employer-funded health and welfare benefit plan, alleging a contract claim under ERISA, state law tort claims, and unfair business practices in violation of the California Insurance Code. The court held that plaintiffs state law claims were preempted, but that as an assignee of plan beneficiaries, plaintiff had standing under ERISA to assert the breach of contract claim and other claims of his assignors. Mi
sic,
. Compare Nachwalter v. Christie,
. ERISA gives beneficiaries the right to recover contractual plan benefits under § 1132(a)(1)(B). The fiduciary obligations explicitly imposed by ERISA are “to the plan.”
Massachusetts Mut. Life,
. Like plaintiffs contract claims against CGL, plaintiffs state promissory estoppel claim is preempted by ERISA, because it ”relate[s] to” the employee benefit plan and is not exempt from ERISA preemption under the “savings clause.” 29 U.S.C. § 1144(b)(2)(A). Furthermore, classifying promissory estoppel claims against insurers as state claims, not preempted by ERISA, would undermine Congress's aim “to establish a uniform administrative scheme, which provides a set of standard procedures to guide processing of claims and disbursement of benefits” through federal law.
Ft. Halifax,
. The Court concludes that PIW’s state law equitable estoppel claim is preempted, but that as an assignee of an ERISA beneficiary, PIW has derivative standing to bring its equitable estoppel claim under ERISA.
See Kane,
. "The expectation that a federal common law of rights and obligations under ERISA-regulated plans would develop ... would make little sense, if the remedies available to ERISA participants and beneficiaries under § 502(a) could be supplemented or supplanted by various state laws.”
Pilot Life,
.
See Kane,
. See supra n. 10.
. Exhibit B of PIW’s complaint, a document entitled "Conditions of Admissions," which appears to be signed by White, supports plaintiff's allegations. The exhibit states that ”[t]he undersigned and/or the patient are responsible for any and all charges not covered by this assignment" of benefits to PIW.
