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A new federal appeals court decision could affect how easily patients or others can sue employer-sponsored health plans and their administrators over benefits decisions in state court.
A three-judge panel at the 1st U.S. Circuit Court of Appeals ruled Wednesday that a 2020 Supreme Court ruling on a benefits law case, Rutledge v. Pharmaceutical Care Management Association, does not increase plaintiffs' ability to sue over benefits decisions in state court.
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The federal Employee Retirement Income Security Act normally "preempts," or brushes away, state-law suits involving ERISA.
The Supreme Court held in the Rutledge opinion that a state law that indirectly affects an ERISA plan might survive if it doesn't have a connection with ERISA or ERISA plans.
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But a benefits suit probably has too much of a connection to ERISA if a court would have to look at an ERISA plan's documents to handle the case, and ERISA clearly preempts any "state-law cause of action that duplicates, supplements or supplants the ERISA civil enforcement remedy," U.S. Circuit Judge Sandra Lynch writes in an opinion for the 1st Circuit panel.
The Supreme Court's Rutledge ruling has no effect on civil suits over benefit decisions, because those suits clearly relate to ERISA, Lynch says.
The case is Cannon v. Blue Cross and Blue Shield of Massachusetts.
The plaintiff, Scott Cannon, is the father of Blaise Cannon, a man with asthma who died in 2020 at the age of 26.
Scott Cannon, who is suing individually and as the personal representative of Blaise Cannon's estate, says Blaise Cannon died soon after Massachusetts Blue declined to cover the asthma inhaler recommended by a physician.
Scott Cannon's claims include allegations of breach of contract and wrongful death.
Massachusetts Blue welcomed the new ruling.
"We are pleased with the decision of the U.S. Court of Appeals for the First Circuit and its thoughtful analysis of ERISA preemption," the company said.
Lou Schneider, an attorney for Scott Cannon, said his client intends to appeal further.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
