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Cave v. Delta Dental of California

United States District Court, N.D. California

May 30, 2018





         Plaintiff Norine Sylvia Cave brings this action against defendant Delta Dental of California (“Delta Dental”), alleging claims of bad faith and a violation of Cave's civil rights under the Health Insurance Portability and Accountability Act (HIPAA). Delta Dental moves to dismiss all claims against it. Because I find that Cave's alleged claims fail as a matter of law, I DISMISS WITH PREJUDICE Cave's bad faith and HIPAA claims. But given Rule 15's liberal amendment standard, I GRANT Cave's request to amend her complaint to add claims under section 502 of the Employee Retirement Income Security Act (ERISA).


         Cave obtained dental benefits through the Entertainment Industry Flex Plan, group number 07578-00001. Complaint (Compl.), Ex. G at 1 (Dkt. No. 1). On October 21, 2013, Cave consulted with Dr. Suvidha Sachdeva of Coast Dental of Georgia for dental services. Id. ¶ 4. As a part of that consultation, Cave received a comprehensive exam and Dr. Sachdeva recommended crown replacements of allegedly fractured veneers on teeth #8 and #9, indicating that the teeth could no longer support veneers due to decay. Id. Approximately three months later, Dr. Sachdeva initiated the procedure to replace the crowns on teeth #8 and #9. Id. The next day Dr. Sachdeva submitted a benefits claim to Delta Dental for the crowns. Id.

         On April 30, 2014, Cave filed a grievance with Delta Dental, indicating that she suspected that Dr. Sachdeva had committed fraud in recommending crown replacements. Id. Specifically, upon review of Cave's x-rays and documentation, other doctors suggested that teeth #8 and #9 did not require replacement of the veneers. Id. Cave believes that Dr. Sachdeva diagnosed otherwise in order to receive payment for the unnecessary dental treatment. Id. She alleges that once she filed this grievance, Delta Dental should have examined all records and x-rays to determine whether she actually needed her veneers replaced rather than approved the claim by Dr. Sachdeva. Id. ¶ 11.

         Delta Dental (a California corporation) responded to Cave's grievance, informing her that California Health and Safety Code section 1371.5, provides that Delta Dental and Dr. Sachdeva are responsible for their own acts or omissions and not liable for the acts and omissions of each other. Id. ¶ 5, Ex. B. It also advised her that “the diagnosis for crowns for [her] teeth numbers 8 and 9 were one of the appropriate treatments of choice due to Dr. Sachdeva's documentation that the existing veneers 8 and 9 were chipped.” Id., Ex. B. But it further told her that it was “unable to confirm or deny the acceptability of [] crown numbers 8 and 9” because Dr. Sachdeva did not submit x-rays of diagnostic quality, meaning that Delta Dental's dental consultant could not have determined whether she needed new crowns prior to Dr. Sachdeva's decision to replace her veneers. Id. Cave alleges that a proper review of the x-rays should have resulted in Delta Dental not paying the claim because the x-rays did not reveal any condition that would justify crown treatments. Id.¶ 6.

         In May 2014, Cave requested copies of the treatment plan and x-rays submitted to Delta Dental by Dr. Sachdeva for her review. Id. ¶ 7. Delta Dental denied the request, stating that California Health and Safety Code section 1370 protects the documents that Cave requested from discovery. Id., Ex. C. It advised her that she could request copies of treatment notes from the dentist directly under section 123110 of California's Health and Safety Code, requiring that a dentist provide copies of x-rays and records upon written request. Id. It also noted that Georgia may have a similar law. Id.

         On September 10, 2014, Cave responded to Delta Dental's letter with “viable and sufficient” x-rays in addition to photographs of teeth #8 and #9, taken both before and after the new crowns. Id. ¶ 9. According to Cave, these documents demonstrate that her healthy tooth structure made Dr. Sachdeva's crown placements unnecessary. Id. Delta Dental responded to this new information in a letter dated October 4, 2014, standing by its prior determination that it was Dr. Sachdeva's responsibility-and not Delta Dental's-to choose the appropriate treatment plan. Id., Ex. D at 2.

         A month later, Cave served Delta Dental with a request for “production of documents to a non-party” in connection with litigation she had commenced against Dr. Sachdeva in Fulton County, Georgia. Id. ¶ 14. Delta Dental objected to the request for production based on California Evidence Code section 1157 and Health and Safety Code section 1370. Id.

         On January 24, 2018, Cave filed this action in the Superior Court of California, County of San Francisco. She asserts two causes of action: bad faith and violation of her civil rights under HIPAA. Delta Dental removed the case to the Northern District of California and now moves to dismiss. After it filed its motion to dismiss, Cave filed a motion for continuance, requesting that the hearing on Delta Dental's motion to dismiss be postponed until the Department of Health and Human Services Office of Civil Rights finished its investigation of a complaint Cave filed. Dkt. No. 18.

         For the reasons explained below, I DENY Cave's request to postpone consideration of Delta Dental's motion to dismiss or otherwise stay this case pending the resolution of the DHR OCR investigation. I GRANT Delta Dental's motion to dismiss Cave's claims for bad faith because it is preempted by ERISA and her HIPAA claim because there is no private right of action under HIPAA. Those claims are DISMISSED WITH PREJUDICE. However, I am granting Cave leave to amend to assert a breach of fiduciary duty claim under ERISA.[1]


         Under Federal Rule of Civil Procedure 12(b)(6), a district court must dismiss a complaint if it fails to state a claim upon which relief can be granted. To survive a Rule 12(b)(6) motion to dismiss, the plaintiff must allege “enough facts to state a claim to relief that is plausible on its face.” See Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007). A claim is facially plausible when the plaintiff pleads facts that “allow the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.” See Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (citation omitted). There must be “more than a sheer possibility that a defendant has acted unlawfully.” Id. While courts do not ...

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