502(a)(3)

: : Plan Prevails On Participant’s Challenge to Recoupment By Administrative Offset Of Benefit Payments

The Court is obliged to dismiss this action because Plaintiff has ultimately pleaded himself out of court. . . . Notably, Defendant has not pleaded that Plaintiff, in seeking to recoup and recouping the overpayments, violated either ERISA or the Plan.Hesse v. Case New Holland Indus. (E.D. Wis. 2021) Recovering plan overpayments will frequently lead …

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: : Primer Provider Reimbursement Pleading To Avoid Motion To Dismiss

“Before the Court is Defendants Cigna Healthcare Inc., Cigna Health and Life Insurance Co., Connecticut General Life Insurance Co., and Cigna Healthcare of Arizona’s (collectively, “Cigna”) Motion to Dismiss. In October 2018, PSCC received a letter from Cigna that it had “conducted an internal audit and determined that PSCC had damaged Cigna in an amount …

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: : Plaintiff May Proceed On ERISA Claims Challenging Repricing of Provider Claims

Through this matter, Plaintiffs are attempting to stop Defendants allegedly improper practice of underbilling for chiropractic services that Plaintiffs provided to their patients. Presently before the Court are motions to dismiss the First Amended Complaint filed by the . . . Defendants. Plaintiffs allege that the Cigna and Aetna Defendants hired the Vendor Defendants to …

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: : Duke Energy Benefits Committee Sues Law Firm & Plan Member in ERISA Reimbursement Case

Defendants have refused, despite numerous requests, to reimburse the Plan forbenefits the Plan paid on Heafner’s behalf out of Settlement Funds he received in connection withthe Accident. Defendants’ actions violate the terms of the Plan. Heafner has been unjustly enriched by her refusal to reimburse the Plan for themedical benefits it paid on his behalf. …

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: : Employer Sues Stop Loss Carrier and Express Scripts Alleging Fiduciary and Contractual Breach

“Express Scripts moves for summary judgment on Henkel’s claim for breach of fiduciary duty. Henkel alleges that Express Scripts breached its fiduciary duty not only by failing to adhere to the coverage criteria in the prior authorization policies but also by approving the subsequent claims. . . . Here, a reasonable jury could conclude that, …

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: : Court Remands Insurer’s Recoupment Claims Against Provider to State Court Applying Davila Test

Here, plaintiff seeks damages in the amount of $226,562.62, which it contends make up the unpaid balance of overpayments to Dr. Gupta. BCBSLA’s complaint does not seek a constructive trust or an equitable lien on particular funds. Rather, it seeks to recover from Dr. Gupta’s assets generally. Thus, the Court finds that plaintiff’s claims are …

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: : Disability Insurer Policy Language Does Not Support ERISA Claim for Reimbursement of Overpayments

Provident offers a second theory of liability: equitable lien by agreement. Annual supplemental claims forms, signed and submitted by Messing between 2010 and 2017, contain the following language: “should my claim be overpaid for any reason, it is my obligation to repay any such overpayment.” (See, e.g., ECF No. 38-2, PageID.677 (2010 supplemental claim form).) …

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: : Ninth Circuit Panel Holds Against Insurer On Indemnification Claim

First Reliance cannot maintain a claim for contribution or indemnification against Armani. In Kim v. Fujikawa, the court concluded that 29 U.S.C. § 1109, as referenced in 29 U.S.C. § 1132(a)(2), “cannot be read as providing for an equitable remedy of contribution in favor of a breaching fiduciary.” 871 F.2d 1427, 1432 (9th Cir. 1989) …

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: : Discovery Permitted on Breach of Fiduciary Duty Claim Despite Overlap with Claim for Benefits

It is true that the claims overlap. But where they do, they operate as alternate theories of liability. Pleading multiple causes of action and alternative theories of liability is a standard practice of civil litigation. See F.R.C.P. Rule 8(a)(3). And it is permissible under ERISA. To further clarify, the Ninth Circuit has held that a …

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: : Fourth Circuit Reinstates Claims Against Claims Administrator and Vendor Based Upon Undisclosed Bundling of Fees

The district court erred in granting summary judgment to Aetna, as Peters produced sufficient evidence for a reasonable factfinder to conclude that Aetna was at least a functional fiduciary under ERISA and breached its corresponding fiduciary duties. Specifically, a reasonable factfinder could conclude that Aetna was unjustly enriched when avoiding payment of Optum’s administrative fee …

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