Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Omega Hospital, LLC v. Community Insurance Company

United States District Court, E.D. Louisiana

November 21, 2014

OMEGA HOSPITAL, LLC,
v.
COMMUNITY INSURANCE COMPANY, Section: J(4)

ORDER AND REASONS

CARL J. BARBIER, District Judge.

Before the Court is a Motion to Remand (Rec. Doc. 8) filed by Plaintiff, Omega Hospital, LLC ("Plaintiff"), as well as an Opposition (Rec. Doc. 11) by Defendant, Community Insurance Company, doing business as Anthem Blue Cross and Blue Shield ("Defendant") and Plaintiff's Reply (Rec. Doc. 16). Having considered the motion, the parties' submissions, the record, and the applicable law, the Court finds, for the reasons expressed below, that the motions should be DENIED.

PROCEDURAL AND FACTUAL BACKGROUND

This lawsuit was originally filed by Plaintiff in the 24th Judicial District Court for the Parish of Jefferson, State of Louisiana on September 2, 2014. Plaintiff alleges that it provided medical care and services to patient A.Y. during April 2012, for which it billed $81, 292, 91. A.Y is a dependent beneficiary of a health benefits plan issued or administered by Defendant. Plaintiff further alleges that prior to providing A.Y. with medical treatment, it contacted Defendant, who confirmed that the services and care to be provided were covered by the insurance plan. After rendering the treatment, Defendant failed to pay the amount sought, and instead reimbursed Plaintiff only the amount of $7, 012.96. Prior to filing the present lawsuit, on November 28, 2012, Plaintiff's attorney mailed a letter to Defendant self-described as "both an appeal and a legal demand, " in which Plaintiff demanded that Defendant pay it "a balance of $74, 297.95, less any applicable co-insurance and/or deductible." (Rec. Doc. 11-1). When Defendant failed to respond by paying the unpaid balance as requested, Plaintiff filed suit, asserting claims of breach of contract and/or detrimental reliance and negligent misrepresentation, contending that the insurance claims were either negligently quoted to Plaintiff or were incorrectly paid by Defendant. In its petition for damages Plaintiff requested damages in the "approximate amount of $74, 000... plus attorney's fees and court costs." (Rec. Doc. 1-1, p. 4).

The matter was subsequently removed by Defendant to this Court based on diversity jurisdiction pursuant to 28 U.S.C. § 1441(b). In its Notice of Removal, Defendant contends that it has met the requisite jurisdictional amount imposed by 28 U.S.C. § 1332(a), because it has proven that Plaintiff seeks damages in excess of $75, 000. Defendant first submits that Plaintiff's estimation of damages in the amount of $74, 000 was derived from a calculation of its billed charges in the amount of $81, 292.91 less the reimbursement tendered by Defendant in the amount of $7, 012.96. Defendant further contends that this amount in dispute of $74, 279.95 should be supplemented by Plaintiff's right to recover attorneys' fees. Because Defendant's alleged breach of contract may constitute a failure to pay on an open account and because attorney's fees are specifically requested in Plaintiff's petition, Defendant contends that Plaintiff retains the right pursuant to La. R.S. § 9:2781 to seek attorneys' fees, which must be included in the amount in controversy for purposes of removal. Plaintiff then filed the instant motion, requesting that this Court remand the matter back to the 24th Judicial District Court.

LEGAL STANDARD

Generally, a defendant may remove a civil action filed in state court if a federal court would have had original jurisdiction. See 28 U.S.C. § 1441(a). Original diversity jurisdiction is appropriate where the matter in controversy exceeds $75, 000 and is between citizens of different states. 28 U.S.C. § 1332(a)(1). A defendant bears the burden of proving by a preponderance of the evidence that jurisdiction exists. De Aguilar v. Boeing Co., 47 F.3d 1404, 1412 (5th Cir. 1995). The jurisdictional facts supporting removal are examined as of the time of removal. Gebbia v. Walmart Stores, Inc., 233 F.3d 880, 883 (5th Cir. 2000).

The Fifth Circuit has "established a clear analytical framework for resolving disputes concerning the amount in controversy for actions removed from Louisiana state courts pursuant to § 1332(a)(1)." Gebbia, 233 F.3d at 883 (citing Luckett v. Delta Airlines, Inc., 171 F.3d 295, 298 (5th Cir. 1999). Because Louisiana law prohibits a plaintiff from specifying the numerical value of their damages in its petition, the removing party must prove that the amount in controversy exceeds $75, 000 by a preponderance of the evidence. Manguno v. Prudential Prop. and Cas. Ins. Co., 276 F.3d 720, (5th Cir. 2002) (citing De Aguilar, 47 F.3d at 1412); Gebbia, 233 F.3d at 882; Allen v. R&R Oil & Gas Co., 63 F.3d 1326, 1335 (5th Cir. 1995). A defendant may satisfy this burden by either: (1) demonstrating that it is facially apparent that the claims are likely to exceed $75, 000 or (2) by relying on summary-judgment type evidence of facts in controversy that establish the jurisdictional amount. Luckett, 171 F.3d at 298. Once the removing party makes this showing, "removal is deemed proper unless the plaintiff[] show[s] to a legal certainty that [its] recovery will not exceed the jurisdictional amount." Fairchild v. State Farm Mut. Automobile Ins. Co., 907 F.Supp. 969, 970 (M.D. La. 1995) (citing De Aguilar, 47 F.3d at 1412).

DISCUSSION

Plaintiff's motion presents two issues. First, the parties dispute the actual amount in controversy. Additionally, regardless of the actual amount of damages sought, the parties dispute whether the amount in controversy includes attorney's fees to which Plaintiff may potentially be entitled.

A. Amount at Issue

The parties first dispute the actual amount in controversy, exclusive of a potential award of attorney's fees. In its petition for damages, Plaintiff seeks damages "in the approximate amount of $74, 000.00." (Rec. Doc. 1-1, p. 5). In determining the precise amount of damages at issue, both parties have reached substantially different conclusions. Defendant's calculations reflect an amount in controversy of $74, 279.95.[1] In contrast, Plaintiff contends that the actual amount at issue is calculated at $69, 324.79.[2] Essentially the dispute regarding the calculations revolves around the starting amount used in the calculations. Plaintiff contends that this starting point should reflect the "reasonable and customary" amount charged for the services provided by A.Y., less the amount of benefits provided by the insurance policy as represented by Defendant, whereas Defendant takes the position that this starting point should reflect only the amount charged by Plaintiff.

The Court has great discretion in determining whether the jurisdictional amount has been satisfied. Foret v. S. Farm Bureau Life Ins. Co., 918 F.2d 534, 537 (5th Cir. 1990) (quoting Opelika Nursing Home, Inc. v. Richardson, 448 F.2d 658, 667 (5th Cir. 1971) ("[T]he trial court is not required to follow any set procedure in determining whether the jurisdictional amount has been satisfied [and]... the method of determining the length and breadth of the amount in controversy is entirely within the discretion of the trial court.") (internal quotations omitted). Here, the Court disagrees with Plaintiff that the estimate of $74, 000 plead in Plaintiff's petition refers to an amount in controversy of $69, 324.79. Generally, despite the fact that Louisiana law precludes plaintiffs from pleading specific amounts for damages in their petitions, if a plaintiff wishes to establish that diversity jurisdiction does not exist over the matter, it is required to explicitly declare in its state court petition that its damages do not exceed $75, 000. Wornner v. Christian Home Health Care, Inc., No. 13-6416, 2014 WL 130331, at *3 (E.D. La. 1/14/14) (Barbier, J). Here, because Plaintiff did not do so, there exists a "strong presumption" in favor of federal jurisdiction. Id. (quoting Raggio v. Hartford Steam Boiler Inspection and Ins. Co., No. 06-1981, 2006 WL 4059093, at *1 (W.D. La. Dec. 29, 2006)). Additionally, while Plaintiff has provided the Court with extensive e-mail exchanges between counsel for both parties regarding the proper calculations of the damages amount, it has failed to provide any concrete evidence of why its particular calculation is appropriate. Despite Plaintiff's allegations that this method of calculation reflects how Defendant orally represented the procedure for processing the claim, it fails to provide any specific evidence to support this contention, and fails to even reference the terms regarding co-insurance contained in A.Y.'s insurance policy.

Weight should also be given to Plaintiff's original estimate of the amount of damages included in its petition for damages. Plaintiff provides no reason for why it would include as the amount of damages sought in its petition "the approximate amount of $74, 000.00" rather than $69, 000 or $68, 000, if it actually believed the proper estimate to be closer to the latter numbers. In opposition to Plaintiff's motion to remand, Defendant asserts that Plaintiff's calculation of damages in the amount of $69, 324.79, which was not provided to either the Court or to Defendant until after the filing of Plaintiff's complaint, is merely an invalid post-removal attempt to reduce its demand in an effort to remove the case. It has been widely held within the Fifth Circuit that an attempt to reduce the amount of damages sought below the jurisdictional requirement does not justify a remand or otherwise affect a federal district court's jurisdiction. See Marcel v. Pool Co., 5 F.3d 81, 85 (5th Cir. 1993) (quoting St. Paul Mercury Indem. Co. v. Red Cab Co., 303 U.S. 283, 292 (1938)). Plaintiff, in response, maintains that its introduction of this new calculation reflecting a total damage request of $69, 324.79 is merely an attempt to "clarify" the amount of damages sought. (Rec. Doc. 16, p. 5). Considering Plaintiff's failure to provide the Court with adequate evidence to support a calculation of $69, 324.79, as well as Plaintiff's initial estimate of $74, ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.