502(A)(1)(B) Claim for Benefits

: : 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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: : District Court Grants Over $200,000 In Attorneys’ Fees And Costs Against UNUM In Disability Case

In any action brought by a plan participant, beneficiary, or fiduciary under ERISA, “the court in its discretion may allow a reasonable attorney’s fee and costs of action to either party.”  29 U.S.C. § 1132(g) (1). In interpreting this statute, the Ninth Circuit has held that a prevailing plan participant, such as Dr. Connor, should …

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: : State Law Banning Discretionary Language Saved from ERISA Preemption

Research revealed no relevant case law addressing Oregon’s specific regulation. However, several circuits, including the Ninth, Seventh, and Sixth Circuit Courts of Appeals, have held that similar state bans on discretionary language in ERISA plans are not preempted. See Standard Ins. Co. v. Morrison, 584 F.3d 837, 846-47 (9th Cir. 2009)…Adams v. United of Omaha …

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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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: : Provider’s Claims Against CIGNA Dismissed For Failure to Allege Existence of Assignment of Benefits By Plan Participants

By the statute’s terms, only a “participant or beneficiary” may bring a claim. Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 400 (3d Cir. 2004). Nonetheless, a healthcare provider may bring claims if it has a valid assignment of benefits from a plan participant. CardioNet, Inc. v. Cigna Health Corp., …

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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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