Filed March 6, 2017
The Court notes that, to the extent that Plaintiff seeks to pursue the limited issue of whether or not it is covered by the Managed Care Agreement negotiated between Aetna and Liberty, without seeking reimbursement as an ERISA assignee, such a dispute is purely a matter of contract law and is not governed by ERISA. See Pascack Valley Hosp., 388 F.3d at 401. End of Document © 2017 Thomson Reuters.
Filed January 26, 2018
Page 15 of 18 11 Hosp., Inc. v. Local 464 A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 404-05 (3d Cir. 2004) (Alito, J., concurring) (facts surrounding standard provider benefits claims “are more than sufficient to prove that the claims were implicitly assigned to the provider”). And even if the Court ultimately determines that individual class members are entitled to recovery only with individualized proof of a right to sue under ERISA, there are a myriad of ways to resolve this issue after certifying the class.
Filed July 12, 2017
The Court Should Not Grant Summary Adjudication as to American Express’s Assignments. VNB cites Pasack Valley Hosp., Inc. v. Local 464A UFCW Welfare Reimb. Plan, 388 F.3d 393 (3d Cir. 2004), for the proposition that American Express has the burden to provide proof to establish that the passengers assigned their claims to American Express. But VNB’s reliance on Pasack is misplaced.
Filed June 6, 2017
ERISA Section 502(a) provides that a “participant” or “beneficiary” may bring a civil action “to recover benefits due to him under the terms of his plan.” North Jersey Brain & Spine Center v. Aetna, Inc., 801 F.3d 369, 372 (3d Cir. 2015) (quoting Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plant, 388 F.3d 393, 400 (3d Cir. 2004)). While a healthcare provider does not have direct standing to bring a claim for benefits under ERISA, every Court of Appeals that has addressed the issue, including the Third Circuit, has recognized that a valid AOB confers upon a healthcare provider derivative standing under ERISA.
Filed May 26, 2017
”) (internal citations and footnotes omitted); Pa. Chiropractic Ass’n v. Indep. Hosp. Indem. Plan, Inc., 802 F.3d 926, 930 (7th Cir. 2015) (“We need not distort the word ‘beneficiary’ in order to enable medical providers to contract for and enforce procedural rules about how insurers pay for medical care. [Medical providers] are not ‘beneficiaries’ as ERISA uses that term . . .”); Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 400 (3d Cir. 2004) (“We conclude that the Hospital could not have brought its claims under § 502(a) because the Hospital does not have standing to sue under that statute.”); Hobbs v. Blue Cross Blue Shield of Ala., 276 F.3d 1236, 1241 (11th Cir. 2001) (“Healthcare providers such as physician assistants generally are not considered ‘beneficiaries’ or ‘participants’ under ERISA.”).
Filed May 1, 2017
[Medical Case 2:16-cv-09056-DMG-AGR Document 20-1 Filed 05/01/17 Page 10 of 22 Page ID #:88 5 MEMORANDUM OF LAW IN SUPPORT OF DEFENDANTS’ MOTION TO DISMISS (Case No. 2:16-cv-09056-DMG-AGR) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 providers] are not ‘beneficiaries’ as ERISA uses that term . . .”); Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 400 (3d Cir. 2004) (“We conclude that the Hospital could not have brought its claims under § 502(a) because the Hospital does not have standing to sue under that statute.”)
Filed February 11, 2010
See, e.g., Blue Cross of California v. Anesthesia Care Associates Med. Group, Inc., 187 F.3d 1045, 1051 (9th Cir. 1999) (ERISA does not preempt claims over in-network fee schedules because “[t]he dispute here is not over the right to payment, which might be said to depend on the patients’ assignments to the Providers, but the amount, or level, of payment, which depends on the terms of the provider agreements”); Pascack Valley Hosp., Inc. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 402 (3d Cir. 2004) (ERISA not involved because “[c]overage and eligibility . . . are not in dispute”). Where, unlike in Anesthesia Care and Pascack Valley, the dispute is over the right to payment, instead of the amount, ERISA governs even for an In-Network Provider.
Filed November 10, 2017
ERISA may preempt state law in two ways—either expressly or impliedly. See Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 44–56 (1987); see also Passack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 398 n.4 (3d Cir. 2004). Express preemption, which is rooted in Section 514 of ERISA, exists if a state-law claim “relates to” an ERISA plan.
Filed May 1, 2017
LEXIS 3076 (App. Div. Dec. 20, 2011) ........................................................................................ 52 Nolan v. Lee Ho, 120 N.J. 465 (1990) .................................................................................................. 29 North Jersey Brain & Spine Ctr. v. Aetna, Inc., 801 F.3d 369 (3d Cir. 2015) ............................................................................... 38, 39 Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plant, 388 F.3d 393 (3d Cir. 2004) ..................................................................................... 38 Pell v. E. I. DuPont De Nemours & Co., 539 F.3d 292 (3d Cir. 2008) ..................................................................................... 69
Filed August 30, 2016
A state law claim is completely preempted under § 502(a) of ERISA where “(1) the plaintiff could have brought the claim under § 502(a); and (2) no other independent legal duty supports the plaintiff's claim. Id. (citing Pascack Valley Hosp. Inc. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 400 (3d Cir.2004)). Here, the first prong of this test is clearly met because Plaintiff not only could have brought a claim for plan benefits under § 502(a), but, in fact, did bring such a claim.