Legal Memorandum: ERISA Claim for Health Benefits

Issue: When can a plaintiff submit an ERISA claim for health benefits under the federal complaint rule?

           Although the Supreme Court held that a state common law cause of action asserting improper processing of a claim for benefits under an ERISA plan relates to the plan and is preempted by the Act, Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 56 (1987), the court observed in a contemporaneous decision that as a general rule a federal preemption defense does not appear on the face of a well-pleaded complaint and does not authorize removal to federal court, Metropolitan Life Ins. Co. v. Tayor, 481 U.S. 58, 63 (1987).  According to the court, the well-pleaded complaint rule remains in effect when faced with an ERISA preemption defense.  Id.

In Metropolitan Life, the Supreme Court recognized that an exception to the well-pleaded complaint rule is found where Congress has so completely preempted a particular area that "any civil complaint raising this select group of claims is necessarily federal in character."  Id. at 63, 64.  Thus, the determination to be made is whether the claim asserted falls within "the select group of claims" which Congress intended to fall within ERISA’s civil enforcement provisions as set forth at 29 U.S.C. § 1132(a)(1)(B).

Complete preemption will support removal jurisdiction only when two circumstances are present: (1) the enforcement provisions of the federal statute create a federal cause of action vindicating the same interests that plaintiff’s state cause of actions seeks to vindicate; and (2) where there is affirmative evidence of a congressional intent to permit removal […]