In Access Mediquip L.L.C. v. UnitedHealthcare Insurance Company, No. 10-20868 (5th Cir. 2011), the plaintiff, Access Mediquip (“Access”), was appealing a summary judgment in favor of the defendant UnitedHealthcare Insurance Company (“United”). Access had brought suit against United, based on United’s refusal to pay some or all of Access’s claims for reimbursement for its services in procuring medical-devices, and finding the financing for those devices, for the health care providers of over 2,000 patients insured under ERISA plans administered by United. The issue for the Fifth Circuit Court of Appeals (the “Court”): are Access’s state-law claims of promissory estoppel, quantum meruit, unjust enrichment, negligent misrepresentation, and violations of certain provisions of the Texas Insurance Code preempted ERISA.In analyzing the case, the Court noted that, with certain nonapplicable exceptions, section 514(a) of ERISA states that ERISA “shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan . . . .”
The Court concluded that Access’s promissory estoppel, negligent misrepresentation, and Texas Insurance Code claims are not preempted by ERISA. Those claims are premised on allegations and evidence that Access provided its services in reliance on United’s representations that it would pay reasonable charges for Access’s services. The state law underlying those claims does not purport to regulate what benefits United provides to the participants and beneficiaries of its ERISA plans. Rather, whether those claims succeed depend on what representations United makes to third parties about the extent to which it will pay for their services. To prevail on these claims, Access need not show that United breached the duties and standard of conduct for an ERISA plan administrator, since Access’s alleged right to reimbursement does not depend on the terms of the ERISA plans. Moreover, a one-time recovery for Access on these claims will not affect the on-going administration or obligations of the ERISA plans that United administers, since the recovery in no way expands the rights of the patient to receive benefits under the terms of a health care plan.
However, Access’s quantum meruit and unjust enrichment claims are preempted by ERISA. Those claims depend on Access’s assertion that, without its services, the patients’ ERISA plans would have obliged United to reimburse a different provider for the same services. Access could recover under those claims only to the extent that the patients’ ERISA plans confer on their participants and beneficiaries a right to coverage for the services provided.