The Ninth Circuit affirmed two district court decisions that concluded medical providers were not “beneficiaries” under Section 502(a) of ERISA and therefore lacked standing to bring an ERISA claim. The Court explained that, in one case, the provider had an assignment from the participants, but the assignment was invalid because the plan contained a non-assignment
Steven A. Sutro
Sixth Circuit: ERISA Exhaustion Not Required in Plan Amendment Suit
By Steven A. Sutro on
The Sixth Circuit held that retirement plan participants were not required to exhaust their administrative remedies prior to bringing a claim alleging that a plan amendment violated ERISA. In so holding, the Court agreed with the opinions of the Third, Fourth, Fifth, Ninth, Tenth, and D.C. Circuits and disagreed with the opinions of the Seventh…
Class Certified in Claims for Autism Treatment Coverage
By Steven A. Sutro on
A federal district court in the Western District of Kentucky certified a class of participants and beneficiaries in plans sponsored by Anthem Health Plans of Kentucky, Inc. who had been denied coverage or reimbursement for Applied Behavior Analysis (ABA) for Autism Spectrum Disorder (ASD). Plaintiff claimed that the time and dollar limitations violated ERISA and…
ERISA Section 510 Interference Claim Time Barred
By Steven A. Sutro on
A federal magistrate judge in Pennsylvania recommended that a class action complaint claiming that AlliedBarton terminated certain employees to prevent them from reaching eligibility for vacation benefits be dismissed as untimely. Observing that ERISA section 510 does not provide a specific statute of limitations, the court determined that the most analogous state-law cause of action…