The Supreme Court of Alabama decided this week to reaffirm its liberal policy of allowing amendments to pleadings in the context of a wrongful death action surrounded by questions of ERISA preemption.
The case involved a wrongful death claim against an insurance company administrating a deceased employee’s health benefit plan which he had received through work. The employee had been experiencing stomach pain, and presented at a hospital for treatment. After examination, the treating physician determined the employee had a blockage that required a colectomy, and scheduled the employee for surgery. On the day surgery was to be performed, the employee found out that the insurance company managing his health benefit plan did not want him to get surgery, but wanted him to have other, less drastic remedies. Over the next weeks, the employee would repeatedly return to the hospital, pleading with agents of the insurance company to clear him for surgery. Each time, he was turned away. The employee would succumb to complications related to the blockage.
The employee’s estate filed a state claim against the plan administrator for wrongful death. The circuit court dismissed the claim for being related to the ERISA plan, which supersedes state law insofar as it relates to an ERISA plan. The posture became slightly complex from there, but the matter got bounced around between courts before ending up back before the state circuit court, and was dismissed for being preempted by ERISA again. The employee’s estate asked the court to let it amend its complaint to cure its issue with ERISA preemption, which the court denied.
The Supreme Court ruled that the employee’s estate ought to have been permitted to amend its complaint. The Court reasoned that plaintiffs who have a potentially meritorious complaint should be permitted to test that claim on the merits. The employee’s estate claimed it could fix its preemption issue by making the allegations therein unrelated to coverage decisions, and instead based on how the plan administrator had acted negligently as a health care provider. The Court determined that the employee’s estate should have been permitted to make such an amendment, and the denial of such amendment was an abuse of discretion under ARCP 15.