Opinion · Supreme Court of the United States

Aetna Health Inc. v. Davila

542 U.S. 200

Type
Opinion
Court
Supreme Court of the United States
Jurisdiction
Federal
Date
2004-06-21
Topic
general

How later courts describe this case

  • holding that the particular label affixed to a cause of action does not affect whether the claim is preempted
  • holding that a state-law wrongful discharge claim was preempted because it was premised on the existence of the ERISA plan
  • holding that ERISA so “completely pre-empted” state law cause of action such that action was “removable from state to federal court”
  • holding that a claim falls within ERISA’s scope where the plaintiff is only entitled to the benefit in question under the terms of a benefit plan
  • holding that whether a particular case arises under federal law generally turns on the well-pleaded complaint rule
  • recognizing that complete preemption only inures if the plaintiff “at some point in time, could have brought his claim under ERISA”
  • holding that ERISA preempted plaintiff’s state common law claims, including breach of contract and breach of the covenant of good faith and fair dealing
  • holding that wife’s claims were completely preempted where she alleged she was a beneficiary under husband’s ERISA-governed health insurance plan

Citator

UpLaw has not yet analyzed Aetna Health Inc. v. Davila. The absence of a flag is not a finding that it is good law.

Cited by
1601 opinions

Headnotes

  1. Civil Procedure — Removal A state-law cause of action may be removed to federal court when a federal statute wholly displaces the state-law cause of action through complete pre-emption, because a claim within the scope of that federal cause of action, even if pleaded in terms of state law, is in reality based on federal law. 542 U.S. 200, 207-208
  2. Employee Benefits & Exec Comp — Preemption — Exclusive Civil Enforcement Any state-law cause of action that duplicates, supplements, or supplants the civil enforcement remedy of ERISA § 502(a) conflicts with the clear congressional intent to make that remedy exclusive and is therefore pre-empted. 542 U.S. at 209
  3. Employee Benefits & Exec Comp — Preemption — Removal Because the pre-emptive force of ERISA § 502(a)(1)(B) mirrors that of § 301 of the Labor Management Relations Act, it converts an ordinary state common-law complaint into one stating a federal claim for purposes of the well-pleaded complaint rule, and causes of action within the scope of ERISA's civil enforcement provisions are removable to federal court. 542 U.S. at 209
  4. Employee Benefits & Exec Comp — Preemption — State-Law Benefits Claims If an individual at some point in time could have brought his claim under ERISA § 502(a)(1)(B), and no other independent legal duty is implicated by the defendant's actions, then the individual's cause of action is completely pre-empted by ERISA § 502(a)(1)(B). 542 U.S. at 210
  5. Employee Benefits & Exec Comp — Preemption — Independent Legal Duty A state-law cause of action alleging a duty of ordinary care is not independent of ERISA where interpretation of the terms of the ERISA-regulated benefit plan is an essential part of the claim, and liability would exist only because of the defendant's administration of the plan, so that the duty derives entirely from the particular rights and obligations established by the plan. 542 U.S. at 213
  6. Employee Benefits & Exec Comp — Preemption — Characterization of Claims Whether a state cause of action is pre-empted by ERISA § 502(a) is not determined by the label affixed to the claim, so distinguishing between pre-empted and non-pre-empted claims based on whether they sound in tort rather than contract, or on whether the plaintiff seeks tort damages rather than reimbursement of denied benefits, would elevate form over substance and allow parties to evade ERISA's pre-emptive scope. 542 U.S. at 214
  7. Employee Benefits & Exec Comp — Remedies The fact that a state cause of action attempts to authorize remedies beyond those authorized by ERISA § 502(a) does not put the cause of action outside the scope of ERISA's civil enforcement mechanism; Congress's intent to make the ERISA remedy exclusive would be undermined if state causes of action supplementing the § 502(a) remedies were permitted, even if the elements of the state cause of action did not precisely duplicate the elements of an ERISA claim. 542 U.S. at 214-215
  8. Employee Benefits & Exec Comp — Preemption — Savings Clause ERISA § 514(b)(2)(A) must be interpreted in light of the congressional intent to create an exclusive federal remedy in ERISA § 502(a); under ordinary principles of conflict pre-emption, even a state law that can arguably be characterized as regulating insurance will be pre-empted if it provides a separate vehicle to assert a claim for benefits outside of, or in addition to, ERISA's remedial scheme. 542 U.S. at 216-218
  9. Employee Benefits & Exec Comp — Fiduciary Duty A benefit determination under ERISA is generally a fiduciary act and is part and parcel of the ordinary fiduciary responsibilities connected to the administration of a plan; the fact that a benefits determination is infused with medical judgments does not alter this result. 542 U.S. at 218-219
  10. Employee Benefits & Exec Comp — Preemption — Mixed Eligibility and Treatment Decisions *Pegram v. Herdrich*'s holding that an HMO is not to be treated as a fiduciary to the extent it makes mixed eligibility and treatment decisions acting through its physicians applies only where the challenged decisions are medical necessity decisions made by a treating physician who also administers benefits; where the defendant is neither the treating physician nor the employer of the treating physician, its coverage decisions are pure eligibility decisions and *Pegram* is not implicated. 542 U.S. at 219-221