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Compliance October 9, 2009
State Court Next Stop for Union Plan Wrongful Payment Suit
October 9, 2009 (PLANSPONSOR.com) - A Taft-Hartley
plan is not permitted to recoup more than $13,000 in wrongly
paid health plan claims under the Employee Retirement Income
Security Act (ERISA), but may be able to take the dispute
into New York state court, a federal judge in New York has
ruled.
Reported by Fred Schneyer
The decision came in a suit by theN.Y. State Teamsters Council Health & Hosp. FundagainstDaniel Williams and his ex-wife Nicole Ferren, with allegations that Williams and Ferren submitted $13,287.43 in medical claims for Ferren after the two were divorced and that the plan mistakenly paid them. The suit said Williams never informed the plan of the divorce.
Plan lawyers’ suit against Williams and Ferren made claims of breach of contract, fraud, and unjust enrichment both under state law and under ERISA’s civil enforcement mechanism.
However, Senior U.S. District Judge Neal P. McCurn of the U.S. District Court for the Northern District of New York rejected the ERISA claims, saying that ordering the money to be repaid to the fund would constitute money damages, which are considered “legal relief” rather than “equitable relief” claims available under ERISA.
McCurn also declined to rule on the claims based on New York state law, but did leave open the possibility plan lawyers could refile the suit in state court.
An EBIA report pointed out that case law on the issue of where to bring claims like those in the case is still unsettled, but that most judges considering similar cases have permitted state claims to move forward after ruling they are not pre-empted by ERISA.
McCurn’s ruling is available
here
.