North Jersey Brain & Spine Center v. Aetna, Inc.
801 F.3d 369
| 3rd Cir. | 2015Background
- North Jersey Brain & Spine Center (NJBSC) provided neurosurgical care to three patients covered by ERISA-governed Aetna plans; each patient signed an assignment: "I hereby assign to [NJBSC] all payments for medical services rendered."
- Aetna allegedly underpaid or refused to pay certain claims; NJBSC sued Aetna under ERISA § 502(a)(1)(B) in state court for unpaid benefits; Aetna removed to federal court.
- The District Court dismissed NJBSC’s complaint for lack of standing, holding that an assignment of the right to payment did not confer derivative standing to sue under ERISA absent explicit assignment of the legal claim.
- NJBSC appealed; the Third Circuit reviewed de novo and considered whether an assignment of payment alone confers standing under federal common law developed for ERISA.
- The Third Circuit concluded that an assignment of the right to payment necessarily includes the right to sue for nonpayment and that allowing providers to sue furthers ERISA’s purposes and access to care.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether an assignee healthcare provider gains derivative standing to sue under ERISA § 502(a) when a patient assigns only the right to payment (without explicit assignment of the legal claim). | Assignment of the right to payment is sufficient; assignment logically includes enforcement rights to collect payment. | Assignment must explicitly include the legal claim/right to sue; mere payment assignment is insufficient to confer § 502(a) standing. | The Third Circuit held that an assignment of the right to payment confers derivative standing to sue under § 502(a). |
Key Cases Cited
- CardioNet, Inc. v. Cigna Health Corp., 751 F.3d 165 (3d Cir. 2014) (discusses derivative standing and assignments in ERISA context)
- Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393 (3d Cir. 2004) (ERISA § 502(a) authorizes participants or beneficiaries to recover plan benefits)
- Conn. State Dental Ass’n v. Anthem Health Plans, Inc., 591 F.3d 1337 (11th Cir. 2009) (assignment furthers ERISA’s purposes only if provider can enforce right to payment)
- Tango Transp. v. Healthcare Fin. Servs. LLC, 322 F.3d 888 (5th Cir. 2003) (assignment of payment held sufficient to sue)
- I.V. Servs. of Am. v. Inn Dev. & Mgmt., 182 F.3d 51 (1st Cir. 1999) (assignment of right to payment satisfies colorable claim for derivative standing)
- Misic v. Building Serv. Emps. Health & Welfare Trust, 789 F.2d 1374 (9th Cir. 1986) (assignment of reimbursement rights gave provider ERISA standing)
- Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989) (courts develop federal common law of rights and obligations under ERISA)