A federal judge from the District of Colorado has ruled for The NFL Player Insurance Plan (the Plan) in a case in which it was sued by a medical provider after it refused to honor the medical provider’s claims, finding that the claims should have been subject to Workers’ Compensation laws.
Specifically, the court found that the provider’s claims were “preempted by the Employee Retirement Income Security Act of 1974.”
The plaintiff was Nelson Vetanze, an individual who does business at Omni Chiropractic in Aurora, Colorado. The defendant, the Plan, provides insurance benefits to NFL players.
In September 2010, the Plan informed Vetanze that claims received for services rendered in July and August of 2010 for NFL players and their families would not be honored. The Plan, through its administrator CIGNA, explained that it would not honor claims received within a certain month or within a certain number of days after a game because such claims were subject to Workers’ Compensation.
Vetanze subsequently sued in state court to collect payment, claiming that he “is not a plan beneficiary under ERISA or under the plain language of the policy, and that his claims are not subject to removal.”
The defendant countered that removal was proper “because Vetanze (1) has derivative standing to assert an ERISA claim, because he obtained written assignments of claims for benefits from the Plan’s participants; (2) is, in actuality, asserting a claim for the recovery of benefits under the Plan; and (3) is asserting a claim that does not implicate a legal duty independent of ERISA.”
The court relied heavily on Aetna Health Inc., v. Davila, where the United States Supreme Court created a test for determining complete preemption:
“Where the individual is entitled to coverage only because of the terms of an ERISA-regulated employee benefit plan, and where no legal duty (state or federal) independent of ERISA or the plan terms is violated, then the suit falls within the scope of ERISA § 502(a)(1)(B). In other words, if an individual, at some point in time, could have brought his claim under ERISA § 502(a)(1)(B), and where there is no other independent legal duty that is implicated by a defendant’s actions, then the individual cause of action is completely pre-empted by ERISA § 502(a)(1)(B).
542 U.S. at 210.
“Thus, this Court must determine (1) whether the plaintiff could have brought its claim under § 502(a)(1)(B), 29 U.S.C. § 1132 (a)(1)(B), and (2) whether no other legal duty supports the plaintiff’s claims. Hansen v. Harper Excavating, Inc., 641 F.3d 1216, 1221 (10th Cir. 2011); Memorial Health Sys v. Aetna Health, 730 F.Supp.2d 1289, 1294 (D. Colo. 2010).
Addressing the first prong, the court concluded that the defendant “has met the requirements of the first prong: Vetanze has derivative standing by virtue of the assignment of his patients’ benefits, and he is seeking benefits under the terms of the Plan.”
Turning to the second prong, the court reviewed the plaintiff’s argument and its reliance on Franciscan Skemp Healthcare, Inc. v. Central States Joint Bd. of Health and Welfare, 538 F.3d 594, 596 (7th Cir. 2008) for its “proposition that a plaintiff can separate his possible ERISA claims from other claims that arise on an independent basis.
“However, the plaintiff’s claims in Franciscan Skemp were based on a conversation that occurred between the healthcare provider and an employee of the employee benefit plan. Here, it is the very denial of benefits and payment that creates the basis for plaintiff’s claims. Such a separation is not possible in this case.
“In sum, plaintiff’s claims seek ‘only to rectify a wrongful denial of benefits promised under [an] ERISA-regulated plan, and do not attempt to remedy any violation of a legal duty independent of ERISA.’ Davila, 542 U.S. at 214. An ‘artful pleading on the part of a plaintiff to disguise federal claims by cleverly dressing them in the clothing of state-law theories will not succeed in keeping the case in state court.’ Franciscan Skemp, 538 F.3d at 596.”
Nelson Vetanze, doing business as Omni Chiropractic v. NFL Player Insurance Plan; D. Colo.; Civil Action No. 11-cv-2734-RBJ-KLM, 2011 U.S. Dist. LEXIS 148887; 12/28/11
Attorneys of Record: (for plaintiff) Keith Evan Frankl, The Frankl Law Firm, P.C., Denver, CO. (for defendant) Jack M. Englert, Jr., Holland & Hart, LLP-Greenwood Village, Greenwood Village, CO.
