AllianceMed LLC v. Aetna Life Ins. Co.

6 Citing cases

  1. OSF Healthcare Sys. v. SEIU Healthcare II Pers. Assistants Health Plan

    671 F. Supp. 3d 888 (N.D. Ill. 2023)   Cited 3 times

    In fact, in the regulations governing ERISA, 29 C.F.R. § 2560.503-1(b)(4) expressly allows authorized representatives like OSF to file internal claims and appeals but, importantly, does not confer standing to authorized representatives to pursue civil actions against a plan. Advanced Physical Med. of Yorkville, Ltd. v. SEIU Healthcare II Home CARE, No. 22 C 2976, 2023 WL 2161664 at *3, 2023 U.S. Dist. LEXIS 29670 *8 (N.D. Ill. Feb. 22, 2023); AllianceMed LLC v. Aetna Life Ins. Co., No. CV-16-02435-PHX-JAT, 2017 WL 394524 *3, 2017 U.S. Dist. LEXIS 12387 (D. Ariz. Jan. 30, 2017). Further demonstrating its intent, in 29 U.S.C. § 1132(a)(1)(B), Congress explicitly limited civil actions to participants or beneficiaries.

  2. Advanced Physical Med. of Yorkville v. Allied Benefit Sys.

    22-cv-02972 (N.D. Ill. Mar. 24, 2023)

    Infoneuro Grp. v. Aetna Life Ins. Co., 2019 WL 3006549, at *9 (C.D. Cal. May 3, 2019) (quoting AllianceMed LLC v. Aetna Life Ins. Co., 2017 WL 394524, at *3 (D. Ariz. Jan. 30, 2017)) (cleaned up); see Atlantic Neurosurgical Specialists P.A. v. United Healthcare Grp., Inc., 2021 WL 3124313, at *9 (D.N.J. July 22, 2021) (section 25060.503-1(b)(4) “applies only to internal appeals and not lawsuits in federal courts” because the regulation “does not discuss the filing of a civil lawsuit”)

  3. Advanced Physical Med. of Yorkville v. Cigna Health & Life Ins. Co.

    22-cv-02991 (N.D. Ill. Mar. 24, 2023)   Cited 1 times

    Infoneuro Grp. v. Aetna Life Ins. Co., 2019 WL 3006549, at *9 (C.D. Cal. May 3, 2019) (quoting AllianceMed LLC v. Aetna Life Ins. Co., 2017 WL 394524, at *3 (D. Ariz. Jan. 30, 2017)) (cleaned up); see Atlantic Neurosurgical Specialists P.A. v. United Healthcare Grp., Inc., 2021 WL 3124313, at *9 (D.N.J. July 22, 2021) (section 25060.503-1(b)(4) “applies only to internal appeals and not lawsuits in federal courts” because the regulation “does not discuss the filing of a civil lawsuit”).

  4. Alkon v. Cigna Health & Life Ins. Co.

    2:20-cv-02365 (D.N.J. Aug. 3, 2021)   Cited 3 times

    entative does not negate an unambiguous anti-assignment provision or otherwise independently provide a cause of action pursuant to § 502(a)(1)(B)"); Mbody Minimally Invasive Summery P.C. v. Empire Healthchoice Hmo, Inc., No. 13-cv-6551 (DLC), 2016 WL 2939164, at * 6 (S.D.N.Y. May 19, 2016) (holding "plaintiffs `authorized representative theory on standing also fails because of the unambiguous anti-assignment provisions of the Governing Plans"); Aerocare Med Transom Sys Inc v. Int'1 Bhd. of Elec. Workers Local 1249 Ins. Fund, No. 5:18-cv-0090 (GTS/ATB), 2018 WL 6622192, at * 8 (N.D.N.Y. Dec. 18, 2018); Memorial Hermann Health Sys. v. Pennwell Corp. Med. and Vision Plan, No. H-17-2364, 201? WL 6561165, at * 1 Q (S.D. Tex. Dec. 22, 2017) (holding that the regulation applies "solely" to administrative appeals and does not create standing to file suit against a plan or its administrators); AllianceMed LLC v. Aetna Life Ins. Co., No. CV-16-02435-PHX-JAT, 2017 WL 394524 at * 3 (D. Ariz. Jan. 30, 2017) (same); Infoeuro Grp. v. Aetna Life Ins. Co., No. 2:19-cv-05083- AB (JCx), 2019 WL 3006549, at * 9 (C.D. Cal. May 3, 2019) (same). To understand why this Court and others have reached the consensus that the Claims Procedure Regulation only applies to internal claims and appeals, not to federal lawsuits, the Court turns to the language of the regulation.

  5. Windmill Wellness Ranch, L.L.C. v. Meritain Health, Inc.

    No. SA-20-CV-01388-XR (W.D. Tex. Jun. 25, 2021)   Cited 1 times

    However, authorized representative status does not confer standing to sue in federal court. AllianceMed LLC v. Aetna Life Ins. Co., No. 16-02435, 2017 WL 394524, at *3 (D. Ariz. Jan. 30, 2017) (“Although the C.F.R. allows a representative to act on the claimant's behalf when dealing with the insurance company, it does not bestow upon that representative standing to file suit against the company in federal court.”); Mem'l Hermann Health Sys. v. Pennwell Corp. Med. And Vision Plan, No. 17-2364, 2017 WL 6561165, at *10 (S.D. Tex. Dec. 22, 2017) (collecting cases that reject 29 C.F.R. § 2560.501-1(b)(4) as a basis for bringing claims in federal courts). CONCLUSION

  6. Mem'l Hermann Health Sys. v. Pennwell Corp. Med. & Vision Plan

    CIVIL ACTION NO. H-17-2364 (S.D. Tex. Dec. 22, 2017)   Cited 10 times
    Recognizing that the Fifth Circuit treats standing under ERISA as a jurisdictional matter and applying Rule 12(b)

    In considering similar arguments courts have held that 29 C.F.R. § 2650.503-1(b)(4) applies to submission of administrative claims and appeals on behalf of beneficiaries, but does not apply to claims asserted in civil actions filed in federal courts. See e.g., Menkowitz v. Blue Cross Blue Shield of Illinois, Civil Action No. 14-2946, 2014 WL 5392063, * 3 (D.N.J. October 23, 2014); AllianceMed LLC v. Aetna Life Insurance Co., No. CV-16-02435-PHX-JAT, 2017 WL 394524, at *3 & n. 3 (D. Ariz. Jan. 30, 2017). Moreover, plaintiff's complaint has not cited 29 C.F.R. § 2650.503-1(b)(4) as a basis for the claim to Plan benefits asserted in this action.