: : 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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: : 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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: : Practical Guidelines On Privilege Objections To Discovery Requests

“The description for each of these emails is either “Redacted portion reflecting confidential attorney-client communications with BCBSM Legal Department regarding MLR issues” or “Email reflecting confidential attorney-client communications with BCBSM Legal Department regarding MLR issues.” (ECF No. 145-3). While not a model of detailed description, the description contains information similar to the description in Carhartt, …

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: : Nationwide Class Action Discovery Permitted Against LTD Carrier In Recoupment Dispute

“[T]he only issue before the Court is whether discovery regarding potential class members outside of the state of Pennsylvania is relevant to Plaintiff’s claims under ERISA. Aetna argues that this discovery is irrelevant because Plaintiff’s asserts claims only under state law.  But Aetna misconstrues the allegations in the second amended complaint, which clearly assert 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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: : Plaintiff FailsTo Show Breach of Fiduciary Duty By Misrepresentation or Omission

The Court now turns to the heart of the present controversy: whether either party is entitled to summary judgment on Ms. Staropoli’s claims that the Benefits Executive breached its fiduciary duties. A fiduciary may breach its duties by “either a misrepresentation or an omission.” In re Unisys Corp. Retiree Med. Benefits ERISA Litig., 579 F.3d …

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: : Assurances of Payment of Surgeon At R & C Rates By CIGNA Prove Unreliable

A surgeon at California Spine performed three surgical procedures on J.R., and then “billed Defendants for these services . . . using his standard rates for such services.” California Spine’s “charges for the surgery totaled $37, 000, ” which, the complaint alleges, “reflected the reasonable and customary value of the services at issue.” Neither Cigna …

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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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