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This is an ERISA pre-emption case. In dismissing the plaintiff’s state common law claims, the court made the following observations.

“[T]he Third Circuit has noted that claims for bad faith and breach of contract … ordinarily fall within the scope of ERISA preemption, if such claims relate to an ERISA-governed benefits plan.”

“[C]laims alleging breach of contract, bad faith, or negligence in connection with the denial of benefits under an ERISA-covered plan are preempted under ERISA, because those claims ‘are premised on the existence of the plan[.]’”

“By disputing its right to reimbursement for a medical procedure performed on a patient insured by an ERISA plan, Plaintiff’s common law causes of action are quintessential ERISA claims.”

“Plaintiff’s claims ‘seek reimbursement of billed medical charges and relate to challenges to the administration of benefits rather than the quality of the medical treatment performed.’”

“A dispute over reimbursement for a procedure performed on a patient insured by an ERISA plan is ‘squarely within ERISA’s ambit.’”

“Plaintiff alleges no facts that support the existence of a contract sufficiently independent from the patient’s Plan, as was present in Pascack Valley Hospital, Inc. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393, 400 (3d Cir. 2004).”

Date of Decision: September 26, 2018

Plastic Surgery Center v. Aetna Life Ins. Co., U. S. District Court District of New Jersey Civil Action No. 17-13467 (FLW) (LHG), 2018 U.S. Dist. LEXIS 166514 (D. N.J. Sept. 26, 2018)