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WASHINGTON v. HUMANA HEALTH PLAN

April 20, 1995

VALERIE WASHINGTON, Plaintiff, -vs- HUMANA HEALTH PLAN, INC., a foreign corporation, MICHAEL REESE HEALTH PLAN, INC., an Illinois health service plan corporation, HEALTH COST CONTROLS OF ILLINOIS, INC., an Illinois corporation, and HEALTH COST CONTROLS OF AMERICA, INC., an Illinois corporation, Defendants.


The opinion of the court was delivered by: GEORGE W. LINDBERG

 Following an automobile collision with an uninsured motorist, a panel of arbitrators awarded plaintiff Valerie Washington $ 60,000 for her injuries from Allstate Insurance Company based on her uninsured motorist coverage benefits. Washington received treatment costing $ 10,500.15 under a health benefit plan (the "Plan") sponsored by the University of Chicago. Defendants (hereinafter collectively referred to as "Humana") are alleged to be current or former owner-operators or administrators of the Plan. Humana claims a right under the terms of the Plan to reimbursement for the cost of Washington's treatment. Washington brought this action in the Circuit Court of Cook County seeking a declaratory judgment that she is not required under the terms of the Plan to reimburse Humana for the cost of the treatment she received. Humana removed this case to federal district court. In the notice of removal, Humana asserted that the Plan is an employee welfare benefit plan as defined in section 3(1) of the Employee Income Retirement Security Act of 1974, as amended ("ERISA") Humana argued that Washington's state law claims are preempted by section 514 of ERISA, 29 U.S.C. § 1144, and that her pleaded claims, to the extent they are legally cognizable, exclusively arise under ERISA, specifically 29 U.S.C. § 1132(a)(1). Washington has now moved to have this case remanded to state court.

 
Under the federal removal statute,
 
any civil action brought in a State court of which the district courts of the United States have original jurisdiction, may be removed by the defendant or the defendants, to the district court of the United States for the district and division embracing the place where such action is pending.

 28 U.S.C. § 1441(a). The district courts "shall have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States." 28 U.S.C. § 1331. A case "arises under" the laws of the United States only if the plaintiff's well--pleaded complaint raises issues of federal law. Metropolitan Life Ins. Co. v Taylor, 481 U.S. 58, 63, 95 L. Ed. 2d 55, 107 S. Ct. 1542 (1987). In other words,

 
"Whether a case is one arising under the Constitution or a law or treaty of the United States, in the sense of the jurisdictional statute, . . . must be determined from what necessarily appears in the plaintiff's statement of his own claim in the bill or declaration, unaided by anything alleged in anticipation of avoidance of defenses which it is thought the defendant may interpose."

 Franchise Tax Board v Construction Laborers Vacation Trust, 463 U.S. 1, 10, 77 L. Ed. 2d 420, 103 S. Ct. 2841 (1983) (quoting Taylor v Anderson, 234 U.S. 74, 75-76, 58 L. Ed. 1218, 34 S. Ct. 724 (1914)). Thus, for example, under this doctrine, which is known as the "well-pleaded complaint" rule, a complaint that raises only state law causes of action could not be removed to federal court on the basis of an answer that pleaded the defense of federal preemption. Franchise Tax Board, 463 U.S. at 13-14.

 Section 502(a) of ERISA (codified at 29 U.S.C. § 1132(a)) provides:

 
A civil action may be brought--
 
(1) by a participant or beneficiary--
 
. . . .
 
(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 right to future benefits under the terms of the plan.

 Humana argues that Washington's claim falls within the scope of § 1132(a)(1)(B). *fn1" Washington disagrees. She argues that, because she has already received benefits under the Plan, her cause of action is neither one to "recover benefits due to [her] under the terms of [her] plan," nor one to "clarify [her] right to future benefits under the terms of the plan." She also argues that she is not trying to "enforce [her] rights ...


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