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The court ruled that the Employee Retirement Income Security Act (ERISA) does not preempt certain state statutory and common law claims for negligent misrepresentation and other unfair deceptive practices. In an action filed in 2009 in the Southern District of Texas, AMQ alleged that defendant United Healthcare Insurance Co., in spite of making such assurances, had refused to pay AMQ over $20,000,000 for devices it had purchased on behalf of United's insured. AMQ alleged violations of ERISA and state common and statutory law. The 5th Circuit held that the district court had misread its precedent on the issue and had improperly found that AMQ's state law claims depended on or were derived from the rights of the patients to recover benefits under their ERISA plans, thus requiring preemption. Instead, the Circuit Court held, "[c]onsultation of the plans' terms is…not necessary to evaluate whether United's agents' statements [promising AMQ it could bill United] were misleading" and that "[AMQ]'s alleged right to reimbursement does not depend on the terms of the ERISA plans." In the $22 million lawsuit, Access Mediquip L.L.C. (AMQ), which provides medical devices and device management services to hospitals, ambulatory surgery centers and insurers, sued United Healthcare for failing to reimburse AMQ for equipment United had promised it would cover. "The decision is significant not only for Access Mediquip, but also for many other providers who frequently are confronted with denials by insurers after obtaining assurances that payment will be provided," says D. Brian Hufford of Pomerantz Haudek Grossman & Gross LLP, who argued the appeal. AMQ purchases the devices from manufacturers after verifying coverage and receiving assurance from the insurer that it can bill the insurer directly for the device.
The court ruled that the Employee Retirement Income Security Act (ERISA) does not preempt certain state statutory and common law claims for negligent misrepresentation and other unfair deceptive practices.
In an action filed in 2009 in the Southern District of Texas, AMQ alleged that defendant United Healthcare Insurance Co., in spite of making such assurances, had refused to pay AMQ over $20,000,000 for devices it had purchased on behalf of United's insured. AMQ alleged violations of ERISA and state common and statutory law. The 5th Circuit held that the district court had misread its precedent on the issue and had improperly found that AMQ's state law claims depended on or were derived from the rights of the patients to recover benefits under their ERISA plans, thus requiring preemption. Instead, the Circuit Court held, "[c]onsultation of the plans' terms is…not necessary to evaluate whether United's agents' statements [promising AMQ it could bill United] were misleading" and that "[AMQ]'s alleged right to reimbursement does not depend on the terms of the ERISA plans."
In the $22 million lawsuit, Access Mediquip L.L.C. (AMQ), which provides medical devices and device management services to hospitals, ambulatory surgery centers and insurers, sued United Healthcare for failing to reimburse AMQ for equipment United had promised it would cover.
"The decision is significant not only for Access Mediquip, but also for many other providers who frequently are confronted with denials by insurers after obtaining assurances that payment will be provided," says D. Brian Hufford of Pomerantz Haudek Grossman & Gross LLP, who argued the appeal. AMQ purchases the devices from manufacturers after verifying coverage and receiving assurance from the insurer that it can bill the insurer directly for the device.
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