CeCelia Ibson v. United Healthcare Services
877 F.3d 384
| 8th Cir. | 2017Background
- Ibson enrolled herself and her husband in an employer-sponsored UnitedHealthcare Services, Inc. (UHS) plan; the employer (her former law firm) paid premiums and distributed plan materials but disclaimed the “plan administrator” role.
- Beginning in 2008 UHS denied and sought recoupment of previously paid claims while Ibson’s husband was receiving cancer treatment; UHS later paid some amounts but admitted it owes $190,579.91 to providers related to Wagner’s care.
- Ibson initially sued under state law; this court previously held her claims were ERISA-preempted and she refiled ERISA claims in 2015 asserting unpaid benefits, statutory penalties for plan-administrator failures, attorneys’ fees, and a contract claim based on a 2008 UHS email.
- The district court dismissed the contract claim as preempted and granted summary judgment dismissing the ERISA claims; the court noted remediable unfair treatment but concluded many claims were improper as pleaded.
- On appeal the Eighth Circuit affirms dismissal of (a) Ibson’s claim to Wagner’s unpaid benefits, (b) the §1132(c)(1)(B) penalty claim because UHS was not the plan administrator, and (c) the contract claim as preempted — but reverses as to Ibson’s equitable claim for restitution of premiums and remands limited issues.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Can Ibson recover unpaid benefits under 29 U.S.C. §1132(a)(1)(B)? | Ibson seeks $190,579.91 for Wagner’s care as a plan participant/beneficiary. | UHS contends benefits owed to the deceased beneficiary must be pursued by the beneficiary’s estate. | Dismissed for Ibson; benefits due Wagner must be pursued by his estate. |
| May Ibson pursue the same benefits in equity under §1132(a)(3)? | Ibson argues equitable relief can substitute for legal claims to obtain unpaid benefits. | UHS says equitable relief cannot circumvent §1132(a)(1)(B)’s prescribed claimant and remedies. | Dismissed: equity cannot be used to bypass statute’s claimant limitations. |
| Can Ibson recover premiums paid to UHS via equitable restitution under §1132(a)(3)? | Ibson seeks restitution of premiums paid because UHS allegedly violated the plan. | UHS argues such relief is compensatory/legal or otherwise unavailable. | Reversed: restitutionary relief for identifiable premiums may be equitable and available; remanded to determine plan violation and traceability/dissipation. |
| Is UHS liable for civil penalties under §1132(c)(1)(B) as plan administrator? | Ibson contends UHS acted as de facto plan administrator and can be fined. | UHS and the court point to ERISA’s designation rules: the plan sponsor (the law firm) is administrator when none is named. | Dismissed: UHS was not the plan administrator; law firm is the administrator under ERISA. |
Key Cases Cited
- Ibson v. United Healthcare Servs., Inc., 776 F.3d 941 (8th Cir. 2014) (prior appellate decision holding state-law claims preempted by ERISA)
- Geissal ex rel. Geissal v. Moore Med. Corp., 338 F.3d 926 (8th Cir. 2003) (estate representative has standing to sue for benefits owed a deceased beneficiary)
- Harrow v. Prudential Ins. Co. of Am., 279 F.3d 244 (3d Cir. 2002) (participant standing to sue as administrator of decedent-beneficiary’s estate)
- CIGNA Corp. v. Amara, 563 U.S. 421 (2011) (§1132(a)(3) authorizes ‘‘appropriate equitable relief’’ to redress plan violations)
- Sereboff v. Mid Atl. Med. Servs., Inc., 547 U.S. 356 (2006) (restitution in equity available where recovery is from a specifically identifiable fund)
- Montanile v. Bd. of Trustees of Nat’l Elevator Indus. Health Benefit Plan, 136 S. Ct. 651 (2016) (restitution unavailable if defendant dissipated identifiable funds; tracing requirement)
- Aetna Health, Inc. v. Davila, 542 U.S. 200 (2004) (ERISA’s broad preemption of state-law claims that relate to ERISA plans)