`
`TROUTMAN PEPPER HAMILTON SANDERS LLP
`Chad R. Fuller, Bar No. 190830
`chad.fuller@troutman.com
`11682 El Camino Real, Suite 400
`San Diego, CA 92130-2092
`Telephone: 858.509.6000
`Facsimile: 858.509.6040
`Jenna U. Nguyen, Bar No. 307929
`jenna.nguyen@troutman.com
`5 Park Plaza, Suite 1400
`Irvine, CA 92614-2545
`Telephone: 949.622.2700
`Facsimile: 949.622.2739
`Attorneys for Defendants
`Anthem Blue Cross Life and Health Insurance Company;
`Anthem, Inc., an Indiana corporation (erroneously sued
`as doing business in California as Anthem Health, Inc.);
`The Anthem Companies of California, Inc.; The Anthem
`Companies, Inc.; Anthem Insurance Companies, Inc.;
`Blue Cross of California
`UNITED STATES DISTRICT COURT
`CENTRAL DISTRICT OF CALIFORNIA
`
`THE DISCOVERY HOUSE, LLC, a
`California limited liability company;
`DISCOVERY TRANSITIONS
`OUTPATIENT, INC., a California
`corporation; DHP HEIGHTS, LLC,
`doing business as CIRCLE OF HOPE, a
`California limited liability company; MT
`GOLDEN CORPORATION, doing
`business as ADJUSTMENTS FAMILY
`SERVICES, a California corporation;
`MT PROCESS LLC, doing business as
`DIVINE DETOX, a California limited
`liability company,
`Plaintiffs,
`
`v.
`ANTHEM BLUE CROSS LIFE AND
`HEALTH INSURANCE COMPANY, a
`California corporation; ANTHEM INC.,
`an Indiana corporation doing business in
`
`113221880
`
`Case No.
`Removal from Orange County Superior
`Court Case No. 30-2021-01179856-CU-
`BC-CJC
`NOTICE OF REMOVAL OF CIVIL
`ACTION PURSUANT TO 28 U.S.C.
`§§ 1331 AND 1441
`[ERISA Federal Question
`Jurisdiction]
`[Filed concurrently with Civil Cover
`Sheet and Certificate of Interested
`Parties]
`Complaint Filed: January 19, 2021
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`Case 2:21-cv-02330 Document 1 Filed 03/16/21 Page 2 of 12 Page ID #:2
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`California as ANTHEM HEALTH,
`INC.; THE ANTHEM COMPANIES OF
`CALIFORNIA, a California corporation;
`THE ANTHEM COMPANIES, INC., an
`Indiana corporation; ANTHEM
`INSURANCE COMPANIES, INC., an
`Indiana corporation; BLUE CROSS OF
`CALIFORNIA, a California corporation;
`BLUE CROSS AND BLUE SHIELD
`ASSOCIATION, an Illinois corporation;
`VIANT, INC., a Nevada corporation;
`MULTIPLAN, INC., a New York
`corporation; and DOES 1 through 100,
`inclusive,
`
`Defendants.
`
`TO THE CLERK OF THE U.S. DISTRICT COURT AND TO ALL
`PARTIES:
`PLEASE TAKE NOTICE that Defendants Anthem Blue Cross Life and Health
`Insurance Company; Anthem Inc., an Indiana corporation (erroneously sued as doing
`business in California as Anthem Health, Inc.); The Anthem Companies of
`California, Inc.; The Anthem Companies, Inc.; Anthem Insurance Companies, Inc.,
`and Blue Cross of California (collectively “Anthem”), by and through its undersigned
`counsel, appearing specially so as to preserve any and all defenses including those
`available under Rule 12 of the Federal Rules of Civil Procedure, hereby invoke this
`Court’s jurisdiction under the provisions of 28 U.S.C. Sections 1331, 1367 and
`1441(a) and 29 U.S.C. 1132(e)(1). As grounds in support of this Notice of Removal,
`Anthem respectfully states as follows:
`I.
`BACKGROUND
`1.
`On February 16, 2021, Anthem accepted service of the summons and
`complaint in this action, executing its Notice of Acknowledgment and Receipt, a true
`and correct copy of which is attached hereto as Exhibit A. A true and correct copy
`of the other contents of the Orange County Superior Court case file is attached hereto
`as Exhibit B. The action was filed on January 19, 2021, by Plaintiffs the Discovery
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`House, LLC; Discovery Transitions Outpatient, Inc.; DHP Heights, LLC; Mt Golden
`Corporation; and Mt Process LLC (“Plaintiffs”) in the Superior Court for the State
`of California, County of Orange, styled and captioned exactly as above, and assigned
`Case No. 30-2021-01179856-CU-BC-CJC (the “State Court Action”).
`2.
`The Complaint identified the Anthem entities as named defendants,
`along with three other entities, Viant, Inc., MultiPlan, Inc., Blue Cross and Blue
`Shield Association, and “Doe” defendants. Anthem is informed and believes that
`none of the unidentified Doe defendants have been served in this matter. No other
`pleadings or papers have been filed in the action.
`II. GROUNDS FOR REMOVAL
`Federal Question Jurisdiction
`Federal courts have original jurisdiction of all cases that arise under
`3.
`federal law, 28 U.S.C. § 1331, and such cases are explicitly within this Court’s
`removal jurisdiction. 28 U.S.C. § 1441(b) (providing that the courts have removal
`jurisdiction for any action in which the district courts have original jurisdiction
`founded on a claim or right arising under the Constitution, treaties, or laws of the
`United States).
`4.
`In Count I of the Complaint, Plaintiffs assert “Claims for Plan Benefits
`Under ERISA, 29 U.S.C. § 1332(a)(1)(B).” (Compl. ¶¶ 125-139.) Plaintiffs allege
`that Defendants have violated the Employee Retirement Income Security Act
`(“ERISA”) in a variety of ways. (E.g., id. ¶135(a)-(p).) Because Plaintiffs assert
`claims explicitly arising under federal law, this Court has jurisdiction pursuant to 28
`U.S.C. § 1331 which provides that the district court has original jurisdiction of “all
`civil actions arising under the Constitution, laws, or treaties of the United States.”
`See 29 U.S.C. § 1132(a). This alone provides ample grounds for removal.
`5.
`However, this Court also has additional grounds for removal based on
`Plaintiffs’ Counts III-V. Under the doctrine of complete preemption, the district
`court has original jurisdiction of “all civil actions arising under the Constitution,
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`laws, or treaties of the United States” pursuant to 28 U.S.C. § 1331. See 29 U.S.C. §
`1132(a); Aetna Health Inc. v. Davila, 542 U.S. 200, 207–08 (2004) (“[W]hen the
`federal statute completely preempts the state-law cause of action, a claim which
`comes within the scope of that same cause of action, even if pleaded in terms of state
`law, is in reality based on federal law: ERISA is one of these statutes.”) (internal
`quotations and citations omitted). Under this doctrine, multiple of Plaintiffs’ state-
`law causes of action are entirely encompassed by Section 502(a) of ERISA, 29 U.S.C.
`Section 1132(a) and those claims in the Complaint are converted into federal claims
`for purposes of the well-pleaded complaint rule. Id.
`6.
`Here, on information or belief, at least some of the state law claims
`asserted relate to patients who are covered by ERISA-governed employee benefit
`plans. (Compl. ¶¶ 125-139.)
`7.
`Plaintiffs assert claims, and seeks relief, regarding services allegedly
`provided to patients with health insurance that was sold, insured and/or administered
`by Defendants. (Compl. ¶ 20.) Plaintiffs’ Complaint does not identify the patients
`and it has not yet provided a list of those patients to Anthem. (See Id.). However,
`Plaintiffs’ Complaint on its face makes clear that at least some of those patients are
`beneficiaries or participants in ERISA health plans. (Id. ¶¶ 125-139.) Specifically,
`Plaintiffs allege that “Traditionally, insurers and employers have covered treatment
`for mental health conditions, including substance use disorders, less favorably than
`treatment for physical health conditions, including higher cost-sharing obligations
`for patients, more restrictive limits on the number of inpatient days and outpatient
`visits, and more onerous prior authorization requirements. To address this unequal
`treatment, Congress first passed a mental health parity law in 1996, and many states
`followed suit in the following decade by passing laws of their own. Among other
`limitations, however, the 1996 act did not address the treatment of substance use
`disorders. Congress addressed this gap in passing the historic Paul Wellstone and
`Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA),
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`42 U.S.C. § 300gg-26, which, among other things, prohibits most plans governed by
`the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§
`1001 et seq., from imposing different treatment limits, cost sharing and in-network
`and out-of-network coverage on mental health and substance use disorder treatment
`than are imposed on other medical and surgical services. Furthermore, ERISA
`requires fiduciaries to act solely in the interests of plan participants and beneficiaries,
`and to decide claims for health care benefits in accordance with plan documents and
`under a full and fair procedure.” (Id. ¶ 38.)
`8.
`For “each” of the patients whose claims give rise to this lawsuit,
`including the patients identified above, Plaintiffs “obtained a written assignment of
`benefits” to assert “all rights and causes of action” against Anthem. (Compl. ¶ 47.)
`Thus, Plaintiffs could have brought suit as assignees under ERISA for the portion of
`their patients whose claims for benefits are covered under ERISA plans.
`9.
`Under the complete preemption doctrine, the legal claims that Plaintiffs
`seek to adjudicate with respect to these ERISA plans are properly characterized as
`claims under ERISA Section 502(a), even though they are pled as state law claims.
`After Davila, the Ninth Circuit has held that a state-law cause of action is completely
`preempted if “(1) an individual, at some point in time, could have brought the claim
`under ERISA § 502(a)(1)(B), and (2) where there is no other independent legal duty
`that is implicated by a defendant's actions.” Fossen v. Blue Cross & Blue Shield of
`Mont., 660 F.3d 1102, 1107-08 (9th Cir. 2011) (citations omitted). As explained
`further below, each of Plaintiffs’ claims satisfies that test.
`10. Upon information and belief, Plaintiffs’ claims for breach of written
`contract, breach of implied covenant of good faith and fair dealing, breach of implied
`contract, breach of oral contract, promissory estoppel, and unfair competition relate
`to the enforcement of rights and the payment of benefits under ERISA-governed
`health benefits plans. 29 U.S.C. § 1132(a). For each of these causes of action,
`Plaintiffs make clear that it is asking the Court to adjudicate claims for benefits under
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`ERISA Section 502(a)(1)(B), and to award damages pursuant to ERISA where
`ERISA plans are at issue. (Compl., passim).
`11. Although couched in state law causes of action, the Complaint attempts
`to adjudicate rights that are properly characterized as claims under ERISA. Because
`Plaintiffs’ claims for breach of written contract, breach of implied covenant of good
`faith and fair dealing, breach of implied contract, breach of oral contract, promissory
`estoppel, and unfair competition attempt to adjudicate rights that arise under federal
`law, this Court has federal question jurisdiction over these claims, which are
`inherently federal in nature. Likewise, each of Plaintiffs’ state law claims (unless
`expressly stated that they are directed to non-ERISA health benefits plans as in the
`Second Cause of action) requires interpretation of the ERISA plan terms and seeks
`to enforce obligations imposed by ERISA, not any independent duties. Therefore,
`Plaintiffs’ claims for breach of written contract, breach of implied covenant of good
`faith and fair dealing, breach of implied contract, breach of oral contract, promissory
`estoppel, and unfair competition are preempted and removal is proper. See Melamed,
`M.D. v. Blue Cross of California, 557 Fed. Appx. 659, 661 (9th Cir. 2014) (complete
`preemption of an individual claim is sufficient for removal to be proper). Courts
`uniformly recognize that such claims seeking ERISA plan benefits are completely
`preempted; Cleghorn v. Blue Shield, 408 F.3d 1222, 1226 (9th Cir. 2005) (ERISA
`preempted claim that insurer refused to reimburse [patient] for the emergency
`medical care he received); Lodi Mem. Hosp. Ass’n v. Tiger Lines, LLC, 2015 U.S.
`Dist. LEXIS 110495, at *16 (E.D. Cal. Aug. 20, 2015) (ERISA preempted claims
`where “Plaintiffs identify no independent contract, agreement or obligation apart
`from obligations under the plan agreement itself”).
`12.
`Specifically, Plaintiffs’ claim for “breach of written contract” (Count II)
`is properly characterized as a claim for ERISA benefits. Plaintiffs allege that
`“Plaintiffs obtained written assignments of benefits from each of the insureds at issue,
`by which Defendants’ insureds intended to, and did, assign to Plaintiffs not only
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`rights to payment of claims but to assert all rights and causes of action against
`Defendants in connection with such claims.” (Compl. ¶ 145.) Put otherwise,
`Plaintiffs’ breach of contract action seeks payment of claims under the terms of the
`policies themselves. Because at least some of those policies are governed by ERISA,
`Plaintiffs’ breach of contract claim is essentially a claim for ERISA plan benefits and
`will necessarily require interpretation of the ERISA plan terms at issue. Such claims
`are preempted. Heldt v. Guardian Life Ins. Co. of Am., 2017 U.S. Dist. LEXIS 36490,
`at *14 (S.D. Cal. Mar. 13, 2017) (holding ESISA preempted breach of contract claim
`based on “breach of the Policy that Defendant is responsible for administering” under
`ERISA); Smilow v. Anthem Life & Disability Ins. Co., 2015 U.S. Dist. LEXIS
`159643, at *57 (N.D. Cal. Nov. 24, 2015) (holding ERISA completely preempted
`breach of contract claim “premised on the insurance contract” itself).
`13.
`Furthermore, Plaintiffs’ “breach of written contract” claim is preempted
`for the independent reason that Plaintiffs claim to be entitled to relief as “an express
`and intended third-party beneficiary of the written contracts (the policies) between
`Defendants and the 513 patients treated by Plaintiffs . . . .” (Compl. ¶ 150.) That
`allegation alone supports removal, as ERISA completely preempts a provider’s claim
`that it “is owed money as a third-party beneficiary under the terms of [its] patient’s
`ERISA plan.” Melamed, 557 Fed. Appx. at 661 (affirming district court’s holding
`that removal was proper where provider claimed to be “third-party beneficiary” of
`patient’s ERISA plan benefits). For all of those reasons, Count I is preempted.
`14.
`Plaintiffs’ claim for breach of the implied covenant of good faith and
`fair dealing (Count III) is preempted because it is premised on Plaintiffs’ recovery of
`benefits as “an assignee and intended beneficiary of its patients’ health insurance
`plans issued, managed and/or administered by Defendants and the rights conferred
`thereunder.” (Compl. ¶ 162.) The alleged breaches include “withholding of proper
`claim payments”; “making unreasonable demands on Plaintiffs”; “not engaging in a
`prompt, full[,] and complete investigation of Plaintiffs’ claims”; and “interpreting the
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`policies in an unduly restrictive manner.” (Id. ¶ 165.) ERISA preempts good faith
`and fair dealing claims that seek to recover ERISA benefits. See Supel v. Northrop
`Grumman Corp., 2018 U.S. Dist. LEXIS 203536, at *12 (S.D. Cal. Nov. 30, 2018)
`(“Plaintiffs’ state-law claim for breach of the implied covenant falls squarely within
`the civil enforcement provisions of ERISA and is, therefore, completely
`preempted.”). Count III is therefore preempted.
`15.
`In addition, Plaintiffs’ claim for breach of implied contract (Count IV)
`and “oral contract” (Count V) are properly characterized as claims for ERISA
`benefits. Plaintiffs allege that an implied contract existed due to the parties’ “course
`of conduct.” (Compl. ¶ 175.) But that “course of conduct” consisted of Plaintiffs
`calling Anthem to obtain “authorization and verification of benefits,” i.e., Plaintiff’s
`patients’ ERISA benefits. (Id. ¶ 175.) Plaintiffs similarly allege that the same
`authorization and verification calls constituted an “oral contract” to pay “on the same
`terms as provided for in the policies.” (Id. ¶¶ 192.) Those alleged calls and
`communications are not only communications about the terms of ERISA plans, but
`also are undertaken pursuant to ERISA’s claims regulations and plan terms. Courts
`hold that such claims are completely preempted. Melamed, 557 Fed. Appx. at 661
`(holding implied contract claim is “completely preempted” because claim existed
`“only because of [the defendant's] administration of ERISA-regulated benefit plan)
`(citation omitted). For those patients with ERISA-governed health benefits plans,
`both Count IV and V seek benefits due under the terms of the ERISA plans in
`question and, as such, are preempted by ERISA.
`16.
`Plaintiffs’ remaining claims—for promissory estoppel (Count V),
`quantum meruit (Count VI), and statutory unfair competition (Count VII)—are all
`preempted for those patients with ERISA-governed health benefits plans for the same
`reason: any alleged obligation to pay arises from ERISA or the terms of ERISA plans.
`17.
`Plaintiffs’ promissory estoppel claim (Count V) is based on purported
`promises to pay claims for benefits “on the same terms as provided for the in policies
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`between Defendants and their insureds.” (Compl. ¶ 192, emphasis supplied.) ERISA
`completely preempts promissory estoppel claims that are nothing more than
`“claims[s] for accrued benefits under [an ERISA] Plan.” Yaralian v. Fastovsky, 2016
`U.S. Dist. LEXIS 17161, at *12 (C.D. Cal. Feb. 10, 2016); Montour v. Hartford Life
`& Accident Ins. Co., 2007 U.S. Dist. LEXIS 104431, at *12-13 (C.D. Cal. Oct. 1,
`2007) (“The complete preemption doctrine thus vests this Court with jurisdiction
`over Plaintiffs’ promissory estoppel claim.”). Count V seeks benefits pursuant to
`ERISA plan terms and is therefore preempted.
`18.
`Finally, Plaintiffs’ Unfair Competition Law, Cal. Bus. & Prof. Code
`Section 17200, et. seq. (Count VII) is also preempted for those patients with ERISA-
`governed health benefits plans. UCL claims for denials of ERISA benefits are
`preempted. Lodi Mem’l Hosp. Ass'n v. Tiger Lines, Ltd. Liab. Co., 2015 U.S. Dist.
`LEXIS 110495, at *19 (E.D. Cal. Aug. 20, 2015). Injuries that derive solely from
`ERISA, such as a failure to pay benefits, cannot be used as the injury in fact or
`economic loss for a UCL claim because those are derivative claims subject to
`ERISA’s exclusive remedies. Cleghorn v. Blue Shield of California, 408 F.3d 1222,
`1227 (9th Cir. 2005) (holding that a UCL claim could not be based upon liabilities
`created by ERISA); see also Leonard v. Metlife Ins. Co., 2013 U.S. Dist. LEXIS
`200342, at *16 (C.D. Cal. Feb. 25, 2013) (ERISA completely preempted UCL claim
`because any obligation that Defendant has to pay benefits . . . arises from its
`administration of the ERISA-regulated plan”). Here, the heart of Plaintiffs’ UCL
`claim are that Defendants “unjustifiably withh[eld] proper payment of claims,” i.e.,
`claims arising under the terms of ERISA benefit plans. (Compl. ¶ 200.) Count VII
`is therefore preempted.
`19. Alternatively, to the extent the UCL claim purports to raise claims under
`the federal Mental Health Parity Act, it is preempted because that Act is incorporated
`into ERISA under 29 U.S.C. Section 1185(a). Although Plaintiffs do not identify the
`“state or federal law” violations giving rise to its UCL claim (see Compl. ¶¶ 198-
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`201), Plaintiffs elsewhere allege that “Defendants’ practices were similarly unfair,
`fraudulent and unlawful under state and federal law in that they violate the Mental
`Health Parity and Addiction Equity Act (‘MHPAEA’).” (Id. ¶ 38.) If premised upon
`the MHPAEA, Plaintiffs’ UCL claim seeks to adjudicate claims that are both
`completely preempted by ERISA and also present federal questions under 28 U.S.C.
`Section 1331.
`20. Accordingly, multiple of Plaintiffs’ claims arises under the laws of the
`United States and could have been originally filed in this Court.
`21.
`Further, 28 U.S.C. § 1441(c) allows for the removal of an entire action
`even when removable claims are joined with non-removable claims. Thus, this Court
`has supplemental jurisdiction over any otherwise non-removable claims—or causes
`of action—and may determine all issues raised in the Complaint.
`III. COMPLIANCE WITH STATUTORY REQUIREMENTS
`22. Because Anthem accepted service of the Complaint on February 16,
`2021 and executed the Notice of Acknowledgment of Receipt, removal is timely
`because it is within thirty (30) days of service of the Complaint, as required by 28
`U.S.C. § 1446(b)(1).
`23.
`In accordance with 28 U.S.C. § 1446(a), a true and correct copy of all
`process, pleadings, and orders from the State Court Action are collectively attached
`hereto as Exhibits A and B. Upon information and belief, no other related process,
`pleadings, or orders have been served upon Anthem.
`24. Venue of this removal is proper under 28 U.S.C. § 1441(a) because this
`Court is the United States District Court for the district corresponding to the place
`where the State Court Action is pending. Specifically, Plaintiffs filed this action in
`the Superior Court for the State of California, County of Orange (see Ex. A), which
`is located within the Central District of California. Therefore, this action may be
`removed to this Court.
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`V.
`
`is also
`
`In accordance with 28 U.S.C. § 1446(d), a copy of Anthem’s Notice of
`25.
`Filing of Notice of Removal is being filed contemporaneously with the Clerk of the
`Superior Court for the State of California, County of Orange.
`26.
`In accordance with 28 U.S.C. § 1446(d), Anthem
`contemporaneously serving this Notice of Removal on all adverse parties.
`IV. CONSENT OF CO-DEFENDANTS
`27. Counsel for Defendants Viant, Inc., MultiPlan, Inc., Blue Cross and
`Blue Shield Association have consented to removal.
`28. Accordingly, removal is proper pursuant to 28 U.S.C. § 1446(b)(2).
`RESERVATION OF RIGHTS
`29. Anthem denies the allegations contained in Plaintiffs’ Complaint and
`files this Notice of Removal without waiving any defenses, objections, exceptions,
`and/or obligations that may exist in its favor in either state or federal court, including
`any defense or affirmative matter under California law and/or Rule 12 of the Federal
`Rules of Civil Procedure, any state or federal statute, or otherwise.
`30.
`Further, in making the allegations in this Notice of Removal, including
`referencing allegations in the Complaint, Anthem does not concede in any way that
`(i) the allegations from the Complaint quoted, supra, by Anthem are Anthem’s, (ii)
`that Plaintiffs have asserted a claim upon which relief can be granted, and/or (iii) that
`recovery of any of the amounts sought is authorized or appropriate.
`31. Anthem also reserves the right to amend or supplement this Notice of
`Removal. And, in this regard, if any questions arise as to the propriety of the removal
`of the State Court Action, Anthem expressly requests the opportunity to present a
`brief, oral argument, and any further evidence necessary in support of its position that
`this action is removable.
`WHEREFORE, in accordance with the authorities set forth above, Defendants
`Anthem Blue Cross Life and Health Insurance Company; Anthem, Inc., an Indiana
`corporation (erroneously sued as doing business in California as Anthem Health,
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`113221880
`NOTICE OF REMOVAL OF CIVIL ACTION PURSUANT TO 28 U.S.C. §§ 1331 AND 1441
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`Case 2:21-cv-02330 Document 1 Filed 03/16/21 Page 12 of 12 Page ID #:12
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`Inc.); The Anthem Companies of California, Inc.; The Anthem Companies, Inc.; and
`Anthem Insurance Companies, Inc. request to remove this action from the Superior
`Court in and for Orange County, California, to the United States District Court for
`the Central District of California, Southern Division, and requests such other and
`further relief as the Court deems appropriate and just.
`
`Dated: March 16, 2021 TROUTMAN PEPPER HAMILTON SANDERS LLP
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`By: /s/ Chad Fuller
`Chad Fuller
`Jenna U. Nguyen
`
`Attorneys for Defendants
`Anthem Blue Cross Life and Health Insurance
`Company; Anthem, Inc., an Indiana corporation
`(erroneously sued as doing business in California as
`Anthem Health, Inc.); The Anthem Companies of
`California, Inc.; The Anthem Companies, Inc.; Anthem
`Insurance Companies, Inc.; Blue Cross of California
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`113221880
`NOTICE OF REMOVAL OF CIVIL ACTION PURSUANT TO 28 U.S.C. §§ 1331 AND 1441
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`SAN DIEGO,CA92130-2092
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`11682EL CAMINO REAL
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`TROUTMAN PEPPER HAMILTON SANDERS LLP
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