Gables Insurance Recovery, Inc. v. Blue Cross and Blue Shield of Florida, Inc.
813 F.3d 1333
11th Cir.2015Background
- South Miami Chiropractic provided services to an insured under a Florida Blue health plan; Florida Blue allegedly failed to pay. South Miami assigned its right to payment to Gables Insurance Recovery, Inc. (Gables).
- Gables sued in Florida state court asserting six state-law claims (breach of contract as third-party beneficiary/assignee, oral contract, quantum meruit, open account, account stated), expressly disclaiming ERISA relief.
- Florida Blue removed to federal court, arguing ERISA §502(a) completely preempted the state-law claims; it then moved to dismiss for failure to exhaust ERISA administrative remedies.
- The district court denied remand, concluded ERISA completely preempted Gables’s claims, had federal-question jurisdiction, and dismissed without prejudice for failure to exhaust.
- On appeal Gables challenged only the complete-preemption ruling; the Eleventh Circuit reviewed de novo and affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ERISA §502(a) completely preempts Gables’s state-law claims so removal was proper | Gables: claims arise from independent state-law duties (oral agreements, quasi-contract) and thus are not preempted | Florida Blue: all claims depend on denial of benefits under an ERISA-regulated plan and therefore fall within §502(a) | Held: Complete preemption applies; claims depend on ERISA-plan duties and are removable |
| Whether Gables could have sued under §502(a) (i.e., whether claims fall within ERISA’s scope) | Gables: Sued under state law; seeks to avoid ERISA scope | Florida Blue: claims allege wrongful denial of coverage under ERISA plan so they fall within ERISA’s scope | Held: Claims are within ERISA’s scope (Davila/Metro. Life framework) |
| Whether Gables had statutory standing under ERISA to bring §502(a) claims | Gables: lacks standing because it is a sub‑assignee (not the original provider) | Florida Blue: assignment/sub-assignment gave derivative standing to pursue benefits | Held: Eleventh Circuit recognizes derivative standing for Gables as sub-assignee; standing exists |
| Whether any independent legal duty supports Gables’s claims (Davila second prong) | Gables: oral confirmations and other state duties suffice as independent bases | Florida Blue: alleged oral confirmations are tethered to plan coverage and not independent duties | Held: No independent legal duty pled; claims depend on ERISA-plan rights and satisfy Davila second prong |
Key Cases Cited
- Conn. State Dental Ass’n v. Anthem Health Plans, Inc., 591 F.3d 1337 (11th Cir. 2009) (discussing ERISA complete preemption and standing for assignees)
- Aetna Health Inc. v. Davila, 542 U.S. 200 (2004) (two‑part test for ERISA complete preemption)
- Metro. Life Ins. Co. v. Taylor, 481 U.S. 58 (1987) (complete preemption doctrine under ERISA)
- Cagle v. Bruner, 112 F.3d 1510 (11th Cir. 1997) (recognizing derivative standing for provider‑assignees under ERISA)
- Tango Transp. v. Healthcare Fin. Servs. LLC, 322 F.3d 888 (5th Cir. 2003) (permitting derivative standing for assignees/sub‑assignees)
- Simon v. Value Behavioral Health, Inc., 208 F.3d 1073 (9th Cir. 2000) (limiting derivative standing to health‑care providers to avoid commercialization of claims)