Geweke Ford v. St. Joseph's Omni Preferred Care Inc.

Plaintiff filed suit in state court alleging that the third party administrator and the excess liability insurer of its health benefit plan failed to perform their contractual duties to repay it for expenses arising from a payment under the plan. The defendants presented an ERISA-based defense and removed to federal court. The district court dismissed the complaint under Rule 12(b)(6), holding that ERISA preempted the state claims, yet provided no remedy itself. This court has jurisdiction under 28 U.S.C. § 1291 . We AFFIRM-IN-PART and REVERSE-IN-PART.

BACKGROUND

Geweke Ford (“Geweke”) is a private California employer which established and sponsored the Geweke Ford Employee Health Care Plan (“Plan”), a self-funded employee benefit plan subject to ERISA. Geweke contracted with St. Joseph’s Omni Preferred Care, Inc. (“Omni”) to provide administrative services for the Plan. Geweke remained the ultimate Plan Administrator, but Omni was to manage the day-to-day operations of the Plan, including claims processing. Geweke contracted for excess loss coverage from John Alden Life Insurance Company and Alden Risk Management Services (collectively, “Alden”). The excess loss policy required…