Who IS the proper defendant in a claim seeking ERISA benefits?
Generally the ERISA Plan is the proper defendant, BUT you need to know about this new case determining that the INSURER is a proper defendant. Larson v United Healthcare Insurance Co., et. al, __ F.3d __, (7th Cir. July 26, 2013) (adopting Ninth Circuit analysis that insurer may be proper defendant).
FACTS: Five named plaintiffs asserted a class action against five health insurers, claiming the insurers were improperly requiring co-payments for chiropractic care. The insurers moved to dismiss contending, among other things, that the insurers were not proper defendants in a benefits claim asserted under ERISA Section 1132(a)(1)(B).
TRIAL COURT HELD: Granted dismissal: “[A]n ERISA claim for benefits due under an employee-benefit plan ordinarily should be brought against the plan.”
7th CIRCUIT HELD–REVERSED
Under Section 1132(a)(1)(B) (also known as Section 502(a)(1)(B)) a civil action may be brought to recover benefits due under a plan.
The general rule is that the proper defendant in a suit for benefits is normally the plan. Op. at 8.
“But it does not follow from the general rule that an ERISA claim for benefits may NEVER be brought against an insurer.” Op. at 9. (Emphasis in original).
“Section 1132(a)(1)(B) does not specify who may be sued. Nor does it limit ‘the universe of possible defendants[.]‘” Op. at 13.
“When an employee-benefits plan is implemented by insurance and the insurance company decides contractual eligibility and benefits questions and pays the claims, an action against the insurer for benefits ‘is precisely the civil action authorized by Section 1132(a)(1)(B).’” Op. at 14.