In Gables Insurance Recovery, Inc. v. Blue Cross and Blue Shield of Florida, Inc., No. 15-10459 (11th Cir. 2015) (Unpublished), the district court had held that, because ERISA completely preempts plaintiff Gables’s claims, the court had subject matter jurisdiction, and then had dismissed Gables’s claims without prejudice for failure to exhaust ERISA administrative remedies. Upon review, the Eleventh Circuit Court of Appeals (the “Court”) affirmed the district court’s judgment.
In this case, South Miami Chiropractic LLC had provided medical services to an insured under a Florida Blue health insurance plan. The terms of Florida Blue’s insurance contract with its insured govern its payment to medical providers for services they provide to its insureds. When South Miami Chiropractic sought payment from Florida Blue, the insurer failed to pay. South Miami Chiropractic then assigned its right to payment to Gables, which sought to collect from Florida Blue. Gables sued Florida Blue in state court, alleging six state law causes of action, generally based on a breach of contract.
On appeal, Gables argues that the district court erred in determining that there was complete preemption and thus federal question jurisdiction. Gables does not challenge the district court’s finding that it failed to exhaust administrative remedies. Thus, the Court considered only whether Gables’s causes of action were completely preempted. In considering this issue, the Court applied the following two-part test which the Supreme Court established in Aetna Health Inc. v. Davila: (1) whether the plaintiff could have brought its claim under § 502(a) of ERISA; and (2) whether no other legal duty supports the plaintiff’s claim. The answers to (1) and (2) are yes. As to (2), the claims involve solely an ERISA plan and an ERISA duty to pay benefits. As to (1), the claims relate to a denial of coverage under an ERISA plan and, having received an written assignment of the right to medical benefits (even though it is a sub-assignee of the plan participant and not the healthcare provider), Gables has statutory standing to pursue the benefits. As such, total preemption applies, and the Court therefore affirmed the district court’s decision.