Carter v. Blue Cross and Blue Shield of Florida, 5:98CV105-SPM.

• Court: United States District Courts. 11th Circuit. United States District Courts. 11th Circuit. Northern District of Florida
• Citation: 61 F.Supp.2d 1241
• Docket Number: No. 5:98CV105-SPM.,5:98CV105-SPM.
• Parties: Denise CARTER, Plaintiff, v. BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC., Defendant.
• Decision Date: 12 March 1999

61 F.Supp.2d 1241 Denise CARTER, Plaintiff,
v.
BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC., Defendant. No. 5:98CV105-SPM. United States District Court, N.D. Florida, Panama City Division. March 12, 1999.

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Frank Alfred Baker, Marianna, FL, for Plaintiff Denise Carter.

W. Edward McIntyre, Bunnell Woulfe Kirschbaum Keller, Cohen & McIntyre, P.A., Ft. Lauderdale, FL (Adam Feinberg, Miller & Chevalier, Chartered, Washington, DC, of counsel), for Defendant Blue Cross Blue Shield of Florida, Inc.

ORDER

MICKLE, District Judge.

THIS CAUSE comes for consideration upon Defendant's motion and memorandum of law for judgment on the pleadings brought pursuant to Fed.R.Civ.Pro. 12(c) and 12(h)(2) (doc. 11). Plaintiff has filed a response (doc. 18). Defendant also filed a motion for leave to file a reply to Plaintiff's response (doc. 24) to which Plaintiff filed a response (doc. 25). Defendant has filed a notice of new statutory authority and supplemental memorandum on the issue of preemption (doc. 32) as well as a subsequent notice of additional authority, both in support of the motion (doc. 37).

Standard of Review

Judgment on the pleadings is appropriate when there are no material facts in dispute, and judgment may be rendered by considering the substance of the pleadings and any judicially noticed facts. See Hawthorne v. Mac Adjustment, Inc., 140 F.3d 1367, 1370 (11th Cir.1998). A complaint may not be dismissed on a motion for judgment on the pleadings "unless it appears beyond doubt that the plaintiff can prove no set of facts in support of his claim which would entitle him to relief." Id. The Court accepts as true the facts alleged in the complaint and draws all inferences in Plaintiff's favor. See Bankers Ins. Co. v. Florida Residential Property and Casualty Joint Underwriting Assoc., 137 F.3d 1293, 1295 (11th Cir.1998). Having resolved Plaintiff's motion to remand (doc. 17) and determined that removal in this case was proper (doc. 38), the Court has jurisdiction to entertain this motion.

Background

It is undisputed that this case arose out of Defendant's denial of Plaintiff's claim for health benefits under the Service Benefit Plan ("the Plan"). The Plan is a federal health insurance plan created by a federal procurement contract pursuant to the Federal Employees Health Benefits Act ("FEHBA"), 5 U.S.C. § 8901-8914. The purpose of the FEHBA, enacted by Congress in 1954, is to provide health insurance coverage to federal employees and retirees. Kobleur v. Group Hospitalization & Medical Services, Inc., 954 F.2d 705, 709 (11th Cir.1992). The statute authorizes the Office of Personnel Management

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("OPM") to contract with carriers to provide health insurance to federal employees and to police those administering FEHBA plans. See Id. at 710; 5 U.S.C. §§ 8902, 8907, 8913, 8902(j). Defendant is just one carrier contracting with OPM to provide comprehensive health care coverage to federal employees like Plaintiff.

While the parties disagree about how long he was hospitalized, it is undisputed that Plaintiff's son was hospitalized from January 1, 1995 through April 14, 1995.¹ Thereafter, Plaintiff sought benefits for her son's hospitalization from Defendant but was denied upon a determination by Defendant that the hospital stay was not covered under the Plan. Pursuant to OPM regulations, Plaintiff appealed the denial to OPM. OPM affirmed the denial. Rather than seek judicial review of OPM's decision, Plaintiff filed this lawsuit against Defendant.

The Amended Complaint alleges that Defendant's denial of benefits constituted a breach of the Plan. The Complaint also appears to raise an estoppel argument. In her response to the motion, Plaintiff concedes that her breach of contract claim is preempted by FEHBA. In fact, such claims are preempted by the Act. See e.g. Tackitt v. Prudential Ins. Co., 595 F.Supp. 887 (N.D.Ga.1984), aff'd 758 F.2d 1572, 1575 (11th Cir.1985) (the interpretation of FEHB plans is controlled by federal, not state, law); Negron v. Patel, 6 F.Supp.2d 366, 370 (E.D.Pa.1998) (breach of contract claim a "relatively easy case for preemption" because interpreting FEHB plans under state law and differing state contract doctrines could lead to differing outcomes with regard to benefits).

However, Plaintiff requests the opportunity to amend her complaint to assert a fraudulent inducement claim; she apparently waives the estoppel argument. See, doc. 18. Defendant seeks to file a reply to Plaintiff's response, arguing that any fraudulent inducement claim brought by Plaintiff is also preempted by FEHBA (doc. 24). While Rule 15(a) mandates that leave to amend be freely given, leave need not be given where the amendment would be futile. Fed.R.Civ.Pro. 15(a); Florida Power & Light Co. v. Allis Chalmers Corp., 85 F.3d 1514, 1520 (11th Cir.1996). If the Act preempts fraud claims relating to FEHB plans, then allowing amendment to assert the claim would be futile. Defendant having shown good cause to file a reply as required under N.D.Fla.Loc.R. 7.1(C), the motion for leave to file a reply (doc. 24) is due to...