On February 13, 2020, Lowey won dismissal for its clients – Aetna and The Rawlings Company – when the Third Circuit Court of Appeals affirmed dismissal of the plaintiff’s ERISA class action. See Minerley v. Aetna, Inc., 2020 WL 734448 (3d Cir. Feb. 13, 2020).

When Minerley was injured in a car accident his employer’s ERISA health benefits plan provided to him by Aetna – the Aetna PA HMO Policy – paid for his emergency care. Aetna then sought reimbursement. Minerley failed to exhaust his administrative remedies before suing to contest Aetna’s right to reimbursement. 

On appeal Minerley argued: (1) he did not have to exhaust administrative remedies because the Aetna PA HMO Policy was not an ERISA plan document governing his benefits; (2) he never received a copy of the Aetna PA HMO Policy; and (3) Defendants breach their fiduciary duty by requiring reimbursement. The Third Circuit was “not persuaded by either argument.” Op. at 6.

The Third Circuit found that insurance policies may serve as ERISA plan documents.

The Third Circuit also found Defendants were not “Plan Administrators” and were not subject to ERISA’s plan disclosure requirements.

Finally, the Third Circuit found Defendants did not breach their duty by requiring reimbursement, holding: “that position is difficult to reconcile with the Supreme Court’s observation that 29 U.S.C. § 1132(a)(3) countenances only such relief as will enforce the terms of the plan or the statute, reflecting ERISA’s principal function: to protect contractually defined benefits.” Op. at 10-11.

Lowey’s successful defense of Aetna’s right to reimbursement is a win for all similarly situated health insurers.

Lowey has successfully won dismissal of several similar class actions for its health insurance clients: Wurtz v. Rawlings Co., LLC, 2016 WL 7174674 (E.D.N.Y. Nov. 17, 2016); Meek-Horton v. Trover, et al., 910 F.Supp. 2d 690 (S.D.N.Y. 2013); Potts v. Rawlings Co. LLC, 897 F.Supp. 2d 185 (S.D.N.Y. 2012); Mattson v. Aetna Life Ins. Co., 124 F.Supp. 3d 381 (D.N.J. 2015).

You can learn more about Lowey’s commercial litigation and healthcare practice groups here:  https://www.lowey.com/commercial/ and https://www.lowey.com/health-care/