In Advanced Physicians, S.C. v. National Football League, No. 20-10998, __F.App’x__, 2021 WL 2773112 (5th Cir. July 1, 2021), the Fifth Circuit affirmed the district court’s (N.D. Tex) dismissal of Advanced Physician’s (“Advanced”) state-law tortious-interference claim against the National Football League (“NFL”) based on ERISA preemption. Advanced claimed that the NFL instructed the NFL Player Insurance Plan’s insurance company, Cigna Health and Life Insurance Company (“Cigna”), to deny health claims for NFL players treated by Advanced on the basis that Advanced’s claims were “work-related.” Advanced sued the NFL in state court alleging tortious interference with its patient relationships in violation of Illinois law. The NFL removed the case to federal court on the basis of ERISA preemption and the district court agreed that there was complete ERISA preemption of the tort claim.
The Fifth Circuit, following the two-part Davila test for ERISA preemption, found that Advanced could have brought its claim under ERISA § 502(a)(1)(B), which is the civil enforcement mechanism to seek a denial of ERISA benefits. The court explained that the essence of Advanced’s claim is that the NFL facilitated a coverage denial. To prevail on its state-law claim, Advanced has to show that its patients were covered by the ERISA plan, that they assigned their right to plan benefits to Advanced, and that the claims would not be excluded under the terms of the plan. Because plan interpretation is essential to Advanced’s tort claim, it is completely preempted.
*Please note that this blog is a summary of a reported legal decision and does not constitute legal advice. This blog has not been updated to note any subsequent change in status, including whether a decision is reconsidered or vacated. The case above was handled by other law firms, but if you have questions about how the developing law impacts your ERISA benefit claim, the attorneys at Roberts Disability Law, P.C. may be able to advise you so please contact us.
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