“No one loves the messenger who brings bad news.” Antigone (lines 276-77).
What happens when an ERISA claimant brings state law claims against independent medical consultants retained by the Plan to provide medical reviews eventually relied upon in claim denials?
Are these claims preempted by ERISA?
Good news: Sometimes yes.
Here’s the case of Cacoperdo v Hartford Life Ins. Co., 2011 WL 4632881 (S.D.N.Y October 5, 2011) [PDF] (state law claims against plan’s independent medical consultants preempted by ERISA; Court also denies Plaintiff discovery propounded to independent physicians as a “fishing expedition”).
FACTS: Cacoperdo sought ERISA disability benefits from his employer’s plan. He received benefits for a while but eventually Hartford retained two different companies to prepare independent medical review reports. Hartford relied on these reports to deny the disability claim.
Plaintiff then sued, asserting ERISA claims against Hartford and state law tortious interference claims against the physicians providing independent reviews.
Plaintiff’s theory: The independent medical consultants are not ERISA entities. “[The independent medical consultants] knew or should have known of a valid contract between Hartford and the Plaintiff, and that they induced Hartford to breach the contract by creating medical findings that would lead Hartford to fail to discharge its duties and obligations under the contract.”
ISSUE: Whether claims against medical consultants are preempted by ERISA?
TRIAL COURT HELD: The claims against the physicians are preempted. The Court also denies discovery from the physicians.
- Unlike other court decisions which allowed state law invasion of privacy claims (Dishman v. UNUM, 269 F.3d 974 (9th Cir. 2001)) or outrage claims (Barker v. Hartford, 2007 U.S. Dist Lexis 55532 (N.D. Tex. July 31, 2007)), Plaintiff’s claim here specifically “derive[s] from his benefits claim….[T]he state law claim here stems from the Plan that is breached—not an independent duty of care owed to the Plaintiff [by the independent medical reviewers].” Op. at 5.
- “There was no direct evidence that [the physicians] breached an independent duty of care owed to Cacoperdo.” Op. at 5.
- The Court denied discovery from the physicians. The Court said: “[N]o factual allegations have been pled with any amount of specificity against [the reviewing physicians] that would support an independent state law tort cause of action against them. The Court will not allow Cacoperdo to engage in a fishing expedition against non-fiduciary third party vendors in order to determine whether any factual allegations can be made.” Op. at 6 (Emph. added).