Position:Other Recent Decisions

University Spine Center v. Empire Blue Cross Blue Shield

The U.S. District Court for the District of New Jersey grants the motion by the defendant insurance company to dismiss the complaint by the plaintiff health care provider due to lack of standing and for being time-barred. The plaintiff is an out-of-network health care provider. The defendant is the insurance company that insures the medical benefits under a company-sponsored group health plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). The plan contains a two-year statute-of-limitations requirement for filing suit against the plan and contains an antiassignment provision prohibiting participants from assigning their rights to anyone. The plaintiff performed several spinal procedures on a patient covered by the plan and submitted claim forms for reimbursement to the defendant on the patient's behalf. The defendant only reimbursed the plaintiff for a portion of the claims requested and, consequently, the plaintiff filed suit against the defendant, alleging ERISA violations, including the failure to make all plan payments, breach of fiduciary duty and failure to produce requested documentation. The defendant argues that the plaintiff lacks standing and, regardless of a lack of standing, that the claims are time-barred by the two-year statute-of-limitations requirement of the plan. In addition to the motion to dismiss, the defendant moves for reimbursement of its attorney fees and costs because the plaintiff initiated the suit despite its lack of standing and because the...

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