Hall v. Aetna Life Ins. Co., Case No. 3:09cv222/MCR/MD.

• Decision Date: 29 September 2010
• Docket Number: Case No. 3:09cv222/MCR/MD.
• Parties: Linda S. HALL, Diana L. Luke, Justin M. Paiva, on behalf of themselves and all others similarly situated, Plaintiffs,v.AETNA LIFE INSURANCE COMPANY, Defendant.
• Court: U.S. District Court — Northern District of Florida

759 F.Supp.2d 1321

Linda S. HALL, Diana L. Luke, Justin M. Paiva, on behalf of themselves and all others similarly situated, Plaintiffs,

v.AETNA LIFE INSURANCE COMPANY, Defendant.

Case No. 3:09cv222/MCR/MD.

United States District Court, N.D. Florida,Pensacola Division.

Sept. 29, 2010.

Jack Enrique de la Piedra, McKenzie Taylor & Zarzaur PA, Pensacola, FL, for Plaintiffs.Shari Gerson, Law Offices of Steven M. Ziegler PA, Hollywood, FL, for Defendant.

ORDER

M. CASEY RODGERS, District Judge.

This action is brought under the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001, et seq. (“ERISA”), for breach of fiduciary duty and declaratory and injunctive relief (doc. 13). On February 16, 2010, the plaintiffs filed a Motion to Certify a Class of Cancer Patients Who Were Denied Radiology Benefits Known as Diagnostic CT and Supporting Memorandum of Law (doc. 82). The defendant, Aetna Life Insurance Company (“Aetna”), responded on April 8, 2010, opposing plaintiffs' motion (doc. 93).¹ Having considered the plaintiffs' motion and the defendant's response, the court finds the plaintiffs lack standing to assert the claims in their Second Amended Complaint (“Complaint”) and their motion thus should be denied.

BACKGROUND

The named plaintiffs, all of whom claim to be Aetna insureds, were diagnosed with cancer and underwent fusion PET/CT scans at Angel Williams Imaging Center (“AWIC”) in Pensacola, Florida, for additional diagnostic purposes. According to the Complaint, a fusion PET/CT scan is performed by a single machine that combines images obtained through positron emission tomography (“PET”), which depicts the body's metabolic or chemical activity, and computed tomography (“CT”), which depicts the body's anatomical structures, allowing the interpreting physician to detect “metabolic changes in the proper anatomical context of the patient's body.” See doc. 23 at ¶¶ 33, 34, 36. Dr. Angel Williamson, a radiologist at AWIC, explained in her deposition that, although fusion PET/CT consists of one scan, it produces three different images—one through PET, one through CT, and one that is a combination or overlap of the two.² The plaintiffs urge that fusion PET/CT is the most effective tool to distinguish benign from malignant disease, determine the extent of disease, detect residual and recurrent tumors, and monitor therapy, providing increased accuracy over the former approach of performing PET and CT scans separately and subjecting patients to less radiation. See doc. 23 at ¶¶ 6, 8. The plaintiffs also contend that the CT portion of the scan must be interpreted separately from the fused PET/CT to avoid false interpretations and thus incorrect diagnoses. See doc. 23 at ¶ 49. Although Aetna did not deny coverage for any of the named plaintiffs' PET/CT scans, it refused to reimburse AWIC separately for the CT scan, finding that it was incidental to the fusion PET/CT scan. The plaintiffs claim that Aetna's refusal in that regard constituted a breach of fiduciary duty. Even though none of the named plaintiffs paid out-of-pocket for any portion of the fusion PET/CT scan, they seek to recover the amount billed by AWIC for the CT scan under 29 U.S.C. § 1132(a)(1)(B).³ They also seek declaratory and injunctive relief under 29 U.S.C. § 1132(a)(3) ⁴ and to certify the following class action:

All individuals insured under an ERISA-governed health insurance policy with Aetna Life Insurance Company who (from as far back as the applicable statute of limitations permits) received denials of provider-requested diagnostic CT (CPT codes 71250, 74150, 70450, 70490, 72192) when fusion PET/CT (CPT codes 78815, 78816) was concomitantly requested and approved.⁵

In response to plaintiff's motion to certify, Aetna asserts, among other things, that the named plaintiffs do not fit within the proposed class and, even if they did, they lack standing to bring the causes of action alleged in their Complaint. The court agrees.

DISCUSSION

It is well-settled in the Eleventh Circuit that “ ‘any analysis of class certification must begin with the issue of standing.’ ” Prado–Steiman v. Bush, 221 F.3d 1266, 1280 (11th Cir.2000) (quoting Griffin v. Dugger, 823 F.2d 1476, 1482 (11th Cir.1987)). Indeed, “[f]ederal courts ... have only the power that is authorized by Article III of the Constitution and the statutes enacted by Congress pursuant thereto.” Bender v. Williamsport Area Sch. Dist., 475 U.S. 534, 541, 106 S.Ct. 1326, 89 L.Ed.2d 501 (1986). As a result, “prior to the certification of a class, and technically speaking before undertaking any formal typicality or commonality review, the district court must determine that at least one named class representative has Article III standing to raise each class subclaim.” Bush, 221 F.3d at 1279. “ ‘Only after the court determines the issues for which the named plaintiffs have standing should it address the question whether the named plaintiffs have representative capacity, as defined by Rule 23(a), to assert the rights of others.’ ” Id. (quoting Griffin, 823 F.2d at 1482). “At an ‘irreducible constitutional minimum’ Article III standing requires that the plaintiff ‘must have suffered an injury in fact—an invasion of a legally protected interest which is (a) concrete and particularized; and (b) actual or imminent, not conjectural or hypothetical.’ ” Connecticut v. Health Net, Inc., 383 F.3d 1258, 1261 (11th Cir.2004) (quoting Lujan v. Defenders of Wildlife, 504 U.S. 555, 560, 112 S.Ct. 2130, 119 L.Ed.2d 351 (1992)).⁶ In other words, in evaluating a plaintiff's standing, the court must determine whether he has “ ‘alleged ‘such a personal stake in the outcome of the controversy’ as to warrant his invocation of federal-court jurisdiction and to justify exercise of the court's remedial powers on his behalf.' ” Warth v. Seldin, 422 U.S. 490, 498–99, 95 S.Ct. 2197, 45 L.Ed.2d 343 (1975) (quoting Baker v. Carr, 369 U.S. 186, 204, 82 S.Ct. 691, 7 L.Ed.2d 663 (1962)). “Generally, a plaintiff ‘must assert his own legal rights and interests, and cannot rest his claim to relief on the legal rights or interests of third parties.’ ” Id. (quoting Warth v. Seldin, 422 U.S. 490, 499, 95 S.Ct. 2197, 45 L.Ed.2d 343 (1975)). Bringing suit in the form of a class action does not abrogate the individualized standing requirement. See Bowen v. First Family Fin. Servs., Inc., 233 F.3d 1331, 1339 fn. 6 (11th Cir.2000). “Without a plaintiff's satisfaction and demonstration of the requirements of Article III standing, a federal court has no subject matter jurisdiction to hear the merits of a plaintiff's—or, in this case, the class plaintiffs'—claim.” Central States Southeast and Southwest Areas Health and Welfare Fund v. Merck–Medco Managed Care, L.L.C., 433 F.3d 181, 198 (2d Cir.2005). And when the court lacks jurisdiction, its only function is to announce that fact and dismiss the case. See Steel Co. v. Citizens for a Better Env't, 523 U.S. 83, 94, 118 S.Ct. 1003, 140 L.Ed.2d 210 (1998).

The plaintiffs' motion for class certification is woefully inadequate for a number of reasons, only two of which need to be addressed here. First, as Aetna observes, none of the named plaintiffs fit the definition of the proposed class. Indeed, none of the named plaintiffs were Aetna insureds when they received the fusion PET/CT scan from AWIC; instead, each of the named plaintiffs was insured under a separate employer-sponsored health benefit plan administered by Aetna.⁷ And none of the named plaintiffs were refused a CT scan; rather, as set forth in the Complaint, each of the named plaintiffs received a fusion PET/CT scan which included a separately interpreted diagnostic CT scan. Because none of the named plaintiffs fit the definition of the proposed class, the plaintiffs' motion for class certification must be denied. See Sosna v. Iowa, 419 U.S. 393, 402, 95 S.Ct. 553, 42 L.Ed.2d 532 (1975) (holding that, in order to satisfy Article III's standing requirement, there must be a named plaintiff who has a case or controversy at the time the class action complaint is filed and at the time the class action is certified); Cooper v. Southern Co., 390 F.3d 695, 714 (11th Cir.2004), overruled on other grounds, Ash v. Tyson Foods, Inc., 546 U.S. 454, 457, 126 S.Ct. 1195, 163 L.Ed.2d 1053 (2006) (holding that “the named plaintiffs' claims must ... share the same essential characteristics as the claims of the class at large”) (internal quotations omitted).

Even if the named plaintiffs were members of the proposed class, their motion for class certification must nevertheless be denied because none of the named plaintiffs suffered any injury as a result of the acts alleged in their Complaint. Not only did each of the named plaintiffs receive a provider-requested diagnostic CT scan in conjunction with a fusion PET/CT scan, but none of them were required to pay for the separately billed CT scan. In fact, under the Facility Agreement (“Agreement”) between Aetna and AWIC, ⁸ AWIC is precluded from billing the named plaintiffs for the CT scan.⁹ Although AWIC sent each of the named plaintiffs a bill after Aetna refused to reimburse it for the CT scan, it never collected payment from any of them, and it is clear from their depositions that none of the named plaintiffs consider themselves financially responsible for the CT scan. Having received the diagnostic CT scan and having no financial responsibility for it, the named plaintiffs have not been injured by Aetna's alleged actions and thus lack standing to assert the breach of fiduciary duty claim alleged in their Complaint.¹⁰ See Lanfear v. Home Depot, Inc., 536 F.3d 1217, 1222 (11th Cir.2008) (noting that “ERISA allows the recovery of benefits, but it does not allow suits for extracontractual damages”); see also Weaver v. Aetna Life Ins. Co., 370 Fed.Appx. 822, 823 (9th Cir.2010) (concluding that the plaintiff suffered no injury-in-fact, as required to support standing, where ...