Medical provider claims against an employee health benefit plan; Employee Retirement Income Security Act (ERISA) preemption; State-law claims that “relate to” an ERISA plan; 29 USC § 1144(a); Cromwell v Equicor-Equitable HCA Corp; Negligent misrepresentation & promissory estoppel claims; A plan administrator’s misstatements about a plan’s coverage or reimbursement terms; The operative complaint; Denial of leave to file a second amended complaint; FedRCivP 15(a); Lack of a motion
[This appeal was from the ED-MI.] The court held that plaintiffs-medical providers’ state-law negligent misrepresentation and promissory estoppel claims based on defendant-plan administrator’s (Blue Cross) misstatements about the plan’s reimbursement terms were preempted by ERISA. Thus, it affirmed the district court’s dismissal of the case. Defendant-La-Z-Boy sponsors the employee health benefit plan at issue. Before providing a covered person treatment, plaintiffs contacted Blue Cross about the reimbursement terms under the plan. Relying on oral representations by Blue Cross employees, plaintiffs provided treatment. But when they sought reimbursement, “Blue Cross paid an amount far below the promised rate.” On appeal, the court first declined plaintiffs’ request to “apply ERISA to the new allegations and claims contained in their proposed second amended complaint, rather than limit [its] review to the operative first amended complaint.” The latter was the only one before the district court when it dismissed their claims. As to the merits, the court agreed with the district court that Cromwell dictated dismissal of plaintiffs’ claims. “Under Cromwell, ERISA preempts negligent-misrepresentation and promissory-estoppel claims that depend upon a plan administrator’s misstatements about the coverage or reimbursement terms of an employer’s ERISA plan.” While plaintiffs asserted their “claims neither make ‘reference to’ nor have a ‘connection with’ La-Z-Boy’s ERISA-governed plan[,]” the court found that Cromwell “considered materially identical state-law claims[.]” It held there “that ERISA expressly preempted the providers’ state-law claims because they ‘relate[d] to’ an ERISA-governed plan. The same conclusion follows here.” The court noted that it did “not determine whether ERISA expressly preempts other state-law claims brought by third-party healthcare providers against plan administrators in different factual scenarios.” Finally, it held that the district court did not abuse its discretion in implicitly rejecting plaintiffs’ request for leave to file a second amended complaint if their existing claims were preempted. That request, “in a single sentence at the” end of their brief opposing the motion to dismiss, did not constitute a motion for Rule 15(a) purposes.
Full PDF Opinion