Federal District Court in Chicago Rejects Pre-emption Defense in ERISA Claim

This lawsuit was originally filed in Kane County, Ill., in the wrongful death and survival act claims by Lee Anne Wigdahl for the death of her husband, Eric Wigdahl. The case was challenged by the defendant, who claimed that it should have been removed to the federal court because the case posed a federal question.

The complaint that Wigdahl filed made UnitedHealthcare (UHC) as a party defendant for allegedly choosing not to tell her now- deceased husband to immediately go to the emergency room rather than steering him to a less expensive urgent care center when he called the health insurer, UHC from California. He was in serious distress while seeking help in locating an in-network referral under his group health plan.

UHC argued that federal question jurisdiction applied here requiring removal to federal court because: (1) Section 502(a) of ERISA authorizes a beneficiary to sue the administrator of a group plan if its employees withhold or misrepresent the plan’s benefits; and (2) Section 514 says ERISA “shall supersede any and all state laws insofar as they may now or hereafter relate to any employee benefit plan.”

In granting Wigdahl’s request for a remand back to the state court, U.S. District Court Judge Sara L. Ellis explained that, although ERISA preempts state law claims involving “eligibility and coverage decisions, such as whether a plan breached its agreement to provide benefits or a plan representative misrepresented coverage under a plan,” lawsuits “involving treatment and quality of care decisions” are not preempted.

Because Wigdahl alleged UHC misdiagnosed her husband’s condition and gave him “faulty medical advice” – and her “claims against UHC do not rest upon the terms of Eric’s plan or required interpretation of that plan” – “ERISA does not completely pre-empt her claims.”

Eric Wigdahl had health insurance through a policy issued by his employer and administered by UHC. On March 29, 2016, he traveled from his home in Illinois to Burlingame, Calif., for his job.

When he arrived in California, he began experiencing shortness of breath, palpitations and weakness. He called the number on the back of his insurance card “to find a nearby medical facility within network to address” his medical issues.

When he first called UHC, he spoke to an individual who put him on hold for eight minutes and later connected him to a nurse who was an employee of UHC. He again relayed his medical symptoms to the nurse who suggested that he visit an urgent care facility instead of an emergency room.

On April 3, 2016, he suffered a pulmonary embolism and died. His wife, Lee Anne Wigdahl, filed this lawsuit on behalf of her husband’s estate in Kane County. She claimed that UHC, through the individual on the telephone and then later the UHC nurse, acted negligently in choosing not to have an automated recording instructing its members to call 911 if they were having an emergency such as her husband was having.

In addition, the lawsuit alleged that UHC gave unauthorized medical advice (by the person who first answered the phone for UHC) and significantly lowered Eric Wigdahl’s level of concern for his life-threatening medical symptoms. The lawsuit was brought under the Illinois Wrongful Death Act and Survival Act.

Ordinarily, under the court’s federal question jurisdiction, a defendant may only remove a case to federal court if the plaintiff’s complaint establishes that the plaintiff’s claims arise under federal law. But an exception to the well-pleaded complaint rule exists where a federal statute completely preempts state law claims, allowing those cases to be removed to federal court. Beneficial Bank v. Anderson, 539 U.S. 1 (2003).

UHC had removed this case to federal court contending that ERISA completely preempted Lee Anne Wigdahl’s state law claims against UHC. The ERISA’s preemption clause provides that ERISA “shall supersede any and all state laws insofar as they may now or hereafter relate to any employee benefit plan.”

The 7th Circuit Court of Appeals in Chicago considers three factors in determining whether a claim falls within Section 502(a)’s preemptive scope: (1) whether the plaintiff can bring a claim under Section 502; (2) whether the plaintiff’s claim can be enforced through Section 502; and (3) whether the plaintiff’s claim cannot be resolved without interpreting the plan. Jass v. Prudential Health Care Plan, 88 F.3d 1482 (7th Cir. 1996).

In this case, the court pointed out that “when a complaint alleges that a welfare-benefit plan has committed a tort – for example when a physician employed by an HMO that has been offered as a benefit to employees commits medical malpractice – the claim must arise under state law because ERISA does not attempt to specify standards of medical care.” Dukes v. U.S. Healthcare, 57 F.3d 350 (3d Cir. 1995).

UHC argued that the claims against it involved determinations under Eric’s insurance plan as to the necessity to certain medical care, thus bringing them within ERISA’s scope.

As the court pointed out, Lee Anne Wigdahl’s claims against UHC did not involve coverage or eligibility decisions. She never claimed that UHC failed to provide medically necessary treatment or other benefits to which her husband was entitled under the plan.

Instead she alleged UHC committed medical malpractice and acted negligently based on the actions or lack of actions that were taken toward her husband over the telephone by both the intake person and the nurse. The obvious medical malpractice error occurred when medical personnel directed Eric Wigdahl to an urgent care center rather than an emergency room, which was necessary given his symptoms.

In other words, these lay persons were giving medical advice to a man who had a serious medical condition that ultimately killed him. Accordingly, Lee Anne Wigdahl’s claims against UHC did not rest upon the terms of her husband’s plan or required interpretation of that plan, and ERISA does not completely pre-empt her claims. The federal district court lacked subject-matter jurisdiction over this case and thus remanded it back to the state court for further disposition.

Wigdahl v. Fox Valley Family Physicians, No. 18C 3513 (Sept. 21, 2018).

Kreisman Law Offices has been handling medical malpractice lawsuits, wrongful death cases, traumatic brain injury lawsuits, nursing home negligent lawsuits and hospital negligence cases for individuals, families and loved ones who have been injured, harmed or killed by the carelessness or negligence of a medical provider for more than 40 years in and around Chicago, Cook County and its surrounding areas, including University Park, Country Club Hills, Matteson, Oak Forest, Oak Lawn, Park Forest, Forest Park, Crestwood, Chicago (The Loop, DePaul University Area, UIC, Wrigleyville, Hyde Park, South Shore, East Side, Hegewisch, Lake Calumet), Waukegan, Joliet, Bolingbrook, Blue Island and Lemont, Ill.

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