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Helmy v. Aetna Health of California, Inc.

United States District Court, C.D. California

November 9, 2017

Abol G. Helmy
Aetna Health of California, Inc.

          Present: The Honorable Fernando M. Olguin, United States District Judge


         Proceedings: (In Chambers) Order Re: Pending Motion

         Having reviewed and considered all the briefing filed in connection with plaintiff's Motion to Remand (Dkt. 21, “Motion”), the court finds that oral argument is not necessary to resolve the Motion, see Fed.R.Civ.P. 78; Local Rule7-15; Willis v. Pac. Mar. Ass'n, 244 F.3d 675, 684 n. 2 (9th Cir. 2001), and concludes as follows.


         On February 14, 2017, plaintiff Abol G. Helmy (“plaintiff” or “Helmy”) filed a state-court complaint against Aetna asserting a single claim for breach of the implied covenant of good faith and fair dealing (“implied covenant”). (See Dkt. 1-1, Complaint). On March 17, 2017, defendant removed the action on the basis of federal question jurisdiction, asserting that plaintiff's claim arises under the Medicare Act. (See Dkt. 1, Notice of Removal (“NOR”) at 2-4); see also 42 U.S.C. §§ 1395, et seq. Plaintiff seeks remand of the action to state court.


         Plaintiff alleges that in June 23, 2015, he was hospitalized due to a major stroke. (See Dkt. 1-1, Complaint at ¶ 12). On July 23, 2015, he was transferred to The Rehabilitation Centre of Beverly Hills (“Rehabilitation Centre”) for skilled nursing facility (“SNF”) care and services, including physical therapy, occupational therapy, and speech therapy. (Id. at ¶ 13). The Rehabilitation Centre determined that plaintiff's “rehabilitation potential was good” and that he “would benefit greatly from a fairly rigorous therapy plan that would include physical, occupational and speech related therapies conducted five times a week[.]” (Id. at ¶ 16).

         Plaintiff alleges that “it was critical that he receive SNF care and services immediately and continuously after the occurrence of his stroke because it is generally and popularly understood within the medical community that stroke victims have the best chances for meaningful rehabilitation . . . when they undergo rehabilitation therapies immediately after the occurrence of a stroke. Therefore, any delay in the receipt of [such] therapies . . . would be damaging to him.” (Dkt. 1-1, Complaint at ¶ 17); (see id. at ¶ 25) (alleging that “rates of recovery after a stroke are greatest when therapeutic rehabilitation activities occur during the acute and post-acute periods of a stroke” and that “prematurely discontinuing” services would have a “damaging impact on Plaintiff's health and recovery”). On August 26, 2015, defendant advised “unexpectedly and without reason” that it was unlikely to continue coverage for plaintiff's SNF care and therapies beyond September 2, 2015. (See id. at ¶ 22).

         Ultimately, as a result of Aetna's “wrongful” terminations of SNF coverage, plaintiff paid to have the Rehabilitation Centre provide the required therapy, “albeit on a less intensive, ‘part-time basis[.]'” (Dkt. 1-1, Complaint at ¶ 32). Plaintiff alleges that Aetna's conduct violated the implied covenant of good faith and fair dealing by denying and delaying coverage decisions “with full knowledge and/or reckless disregard for the consequences to be borne by Plaintiff for not immediately and consistently receiving” SNF care and services. (Id. at ¶¶ 47-50). According to plaintiff, he was forced to forgo certain SNF care and services “to his detriment.” (Id. at ¶ 54).


         “Federal courts are courts of limited jurisdiction. They possess only that power authorized by Constitution and statute[.]” Kokkonen v. Guardian Life Ins. Co. of Am., 511 U.S. 375, 377, 114 S.Ct. 1673, 1675 (1994). The courts are presumed to lack jurisdiction unless the contrary appears affirmatively from the record. See DaimlerChrysler Corp. v. Cuno, 547 U.S. 332, 342 n. 3, 126 S.Ct. 1854, 1861 (2006).

         “The right of removal is entirely a creature of statute and a suit commenced in a state court must remain there until cause is shown for its transfer under some act of Congress.” Syngenta Crop Protection, Inc. v. Henson, 537 U.S. 28, 32, 123 S.Ct. 366, 369 (2002) (internal quotation marks omitted). Where Congress has acted to create a right of removal, those statutes, unless otherwise stated, are strictly construed against removal jurisdiction.[1] See id. Unless otherwise expressly provided by Congress, “any civil action brought in a State court of which the district courts of the United States have original jurisdiction, may be removed by the defendant or the defendants, to the district court[.]” 28 U.S.C. § 1441(a); see Dennis v. H a r t, 724 F.3d 1249, 1252 (9th Cir. 2013) (same). A removing defendant bears the burden of establishing that removal is proper. See Abrego Abrego v. The Dow Chem. Co., 443 F.3d 676, 684 (9th Cir. 2006) (per curiam) (noting the “longstanding, near-canonical rule that the burden on removal rests with the removing defendant”); Gaus v. Miles, Inc., 980 F.2d 564, 566 (9th Cir. 1992) (“The strong presumption against removal jurisdiction means that the defendant always has the burden of establishing that removal is proper.”) (internal quotation marks omitted). Moreover, if there is any doubt regarding the existence of subject matter jurisdiction, the court must resolve those doubts in favor of remanding the action to state court. See Gaus, 980 F.2d at 566 (“Federal jurisdiction must be rejected if there is any doubt as to the right of removal in the first instance.”).

         District courts have original jurisdiction over “all civil actions arising under the Constitution, laws, or treaties of the United States.” 28 U.S.C. § 1331. For purposes of removal based on federal question jurisdiction, the well-pleaded complaint rule “provides that federal jurisdiction exists only when a federal question is presented on the face of the plaintiff's properly pleaded complaint.” Smallwood v. Allied Van Lines, Inc., 660 F.3d 1115, 1120 (9th Cir. 2011) (quoting Caterpillar Inc. v. Williams, 482 U.S. 386, 392, 107 S.Ct. 2425, 2429 (1987)). “As the master of the complaint, a plaintiff may defeat removal by choosing ...

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