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University of Wisconsin Hospitals & Clinics Authority v. Aetna Health & Life Ins. Co.

United States District Court, W.D. Wisconsin

November 3, 2015

UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY, Plaintiff,
v.
AETNA HEALTH & LIFE INSURANCE COMPANY and AETNA HEALTH INSURANCE COMPANY, Defendants

         Decided November 2, 2015

          For University of Wisconsin Hospitals and Clinics Authority, Plaintiff: Mark S. Sweet, LEAD ATTORNEY, Neuberger, Wakeman, Lorenz, Griggs & Sweet, Watertown, WI.

         For Aetna Health and Life Insurance Company, Defendant: Brett Wortman Barnett, Jeffrey C. Clark, LEAD ATTORNEYS, McGuireWoods LLP, Chicago, IL; Todd G. Smith, LEAD ATTORNEY, Godfrey & Kahn, S.C., Madison, WI.

         For Aetna Health Insurance Company, Defendant: Brett Wortman Barnett, Jeffrey C. Clark, LEAD ATTORNEYS, McGuireWoods LLP, Chicago, IL; Todd G. Smith, Godfrey & Kahn, S.C., Madison, WI.

Page 1049

          OPINION & ORDER

         WILLIAM M. CONLEY, District Judge.

         In this civil action, plaintiff University of Wisconsin Hospitals and Clinics Authority (" UWHCA" ) asserts breach of contract and related claims against defendants Aetna Health & Life Insurance Company and Aetna Health Insurance Company for denying a claim to payment for medical services provided to defendants' insured. Defendants properly removed this action from state court on the basis of exclusive federal question jurisdiction, 28 U.S.C. § 1331, asserting that plaintiff's state law claims are completely preempted by the Employee Retirement Income Security Act (" ERISA" ), 29 U.S.C. § 1001 et seq. (Not. of Removal (dkt. #1) ¶ ¶ 6, 11-14.)[1] Before the court is defendants' subsequent motion to dismiss on the grounds that plaintiff's claims fail as a matter of law because of an anti-assignment provision in the ERISA plan at issue. (Dkt. #4.) The court agrees with defendants and, therefore, will grant defendants' motion.

         ALLEGATIONS OF FACT[2]

         A. The Parties

         Plaintiff University of Wisconsin Hospitals and Clinics Authority is a public entity created by the State of Wisconsin. UWHCA operates a hospital in Dane County where Chandra Aschenbrener received medical treatment.

         Defendants Aetna Health & Life Insurance Company and Aetna Health Insurance Company (collectively " Aetna" ) are corporations that provide health insurance coverage and engage in other insurance-related business.

Page 1050

          B. The Policy[3]

         Chandra Aschenbrener is a policy holder of a contract for health insurance with Aetna under an ERISA plan issued by Safelite Group. This policy contains an anti-assignment clause in the General Provisions section of the Benefit Plan documents, which states in material part that: " coverage and your rights under this Aetna medical benefits plan may not be assigned. A direction to pay a provider is not an assignment of any right under this plan or of any legal or equitable right to institute any court proceeding" . (Defs.' Reply, Ex. 1 (dkt. #9-1) p.70 (emphasis added).) The plan also states that " Aetna has the right to pay any health benefits to the service ...


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