Third Circuit Holds ERISA Preempts Out-of-Network Physician’s Defamation Claim Over Statements in Explanation of Benefits Forms

In Ahn v. Cigna Health and Life Insurance Company, No. 25-1723, — F.4th —-, 2026 WL 1813215 (3d Cir. June 24, 2026), in a matter of first impression, the Third Circuit held that ERISA Section 514(a) preempts a healthcare provider’s state-law defamation claim based on allegedly false statements in explanation of benefits (EOB) forms that an insurer sent to plan beneficiaries. Plaintiff, an out-of-network otolaryngologist, treated patients insured under Cigna health plans and submitted claims for those services. Plaintiff alleged that Cigna denied his claims roughly 50 times and issued forms stating that it denied the claims because it did not pay for services performed by unlicensed providers, which Plaintiff contended falsely represented that he was not licensed to practice medicine. Plaintiff sued in New Jersey Superior Court, asserting defamation, defamation per se, and tortious interference. Cigna removed the case and moved for summary judgment on ERISA preemption grounds. Plaintiff withdrew his defamation and tortious interference claims, leaving only the defamation per se claim. The district court found that all of the relevant plans were governed by ERISA and granted summary judgment to Cigna, holding that the claim was preempted. Plaintiff did not challenge the ERISA-governance finding on appeal.

The Third Circuit affirmed. Reviewing de novo, the court explained that Section 514(a) preempts state laws that “relate to” an employee benefit plan, and that the Supreme Court has identified two categories of preempted state laws: those that make “reference to” ERISA plans and those that have an impermissible “connection with” ERISA plans. The court placed Plaintiff’s claim in the second category. Drawing on Egelhoff v. Egelhoff and Gobeille v. Liberty Mutual Insurance Co., the court held that communicating claim adjudications to participants and beneficiaries is a central matter of plan administration. ERISA requires plans to provide written notice setting forth the specific reasons for a claim denial, and Cigna discharged that duty by issuing the EOB forms. The court reasoned that statements in those forms about the reasons for denial are inseparable from Cigna’s statutory duty to explain claim denials, so allowing state defamation law to regulate the content of EOBs would let state law regulate matters squarely within ERISA’s heartland. The court found the Fifth Circuit’s decision in Mayeaux v. Louisiana Health Service & Indemnity Co. persuasive, noting that allowing providers to bring defamation claims over coverage determinations would jeopardize the relationships among traditional ERISA entities. The court rejected Plaintiff’s argument that defaming a provider does nothing to establish fiduciary standards, explaining that the correct inquiry is whether communicating benefits determinations to beneficiaries is a central matter of plan administration, and it is.

The court held that preemption applied for a second, independent reason. Plaintiff’s claim interfered with nationally uniform plan administration because subjecting EOB forms to the defamation law of every state in which participants reside or seek services would force administrators to master the laws of 50 states, undermining ERISA’s goal of minimizing administrative burdens. The court rejected Plaintiff’s reliance on Plastic Surgery Center, P.A. v. Aetna Life Insurance Co. and Pascack Valley Hospital, Inc. v. Local 464A UFCW Welfare Reimbursement Plan, noting that Plastic Surgery applied the same standards and that Pascack Valley involved a different preemption provision. The court also observed that Plaintiff had received no assignment of benefits from any beneficiary and had not asserted a claim under ERISA Section 502(a). The court affirmed the district court’s grant of summary judgment to Cigna.