Justia ERISA Opinion Summaries

Appellant Margerita Cervantes allegedly contracted hepatitis C as a result of treatment she received at the Endoscopy Center of Southern Nevada (ECSN). Appellant obtained treatment at ECSN as part of the health care benefits she received through her culinary union. The union operated a self-funded ERISA health care plan and retained Respondents, Health Plan of Nevada and other health and life insurance entities, as its agents to assist in establishing a network of the plan's chosen medical provider. Appellant filed a lawsuit alleging that Respondents were responsible for her injuries because they failed to ensure the quality of care provided by ECSN and referred her to a blatantly unsafe medical provider. The district court concluded that Cervantes' claims were preempted by ERISA section 514(a). The Supreme Court affirmed, holding that state law claims of negligence and negligence per se against a managed care organization contracted by an ERISA plan to facilitate the development of the ERISA plan's network of health care providers were precluded by ERISA section 514. View "Cervantes v. Health Plan of Nevada" on Justia Law

John Steffens, a beneficiary under an ERISA plan provided by BlueCross, required surgery after an automobile accident. BlueCross paid for a significant portion of Steffens' medical expenses as it was required to do under the Plan. Steffens then sued the other individual in the accident, naming BlueCross as a defendant. Steffens asked for a judgment against BlueCross foreclosing any claim it may have had for subrogation. BlueCross filed a counterclaim against Steffens, alleging it had paid $67,477 on behalf of Stevens and that under the Plan, Steffens was obligated to reimburse BlueCross. The circuit court ordered Steffens to reimburse BlueCross $64,751 plus attorney fees. The court of appeals reversed the circuit court's order and remanded, holding that BlueCross must prove that the surgery-necessitating injuries were related to the accident. The Supreme Court granted review and reversed the judgment of the court of appeals, holding that it was not arbitrary and capricious for the Plan administrator to interpret the Plan and conclude that BlueCross was entitled to reimbursement because the expenses that BlueCross paid arose from an accident for which a third party may have been liable.View "Steffens v. BlueCross BlueShield" on Justia Law