THE ASSOCIATION OF NEW JERSEY CHIROPRACTORS, INC. v. DATA ISIGHT, INC., 2:19-cv-21973

Plaintiffs are out-of-network chiropractors who allege Aetna and Cigna hired Data ISight / MultiPlan to reprice reimbursements, resulting in underpayments and delayed appeal reviews in violation of ERISA.
Case filed 2019; after two prior motions-to-dismiss rulings that identified pleading defects, Plaintiffs filed a Second Amended Complaint (SAC) adding two provider plaintiffs.
Plaintiffs allege they obtained written assignment of benefits (AOBs) from insured patients and sue derivatively under ERISA § 502 for benefits and equitable relief (counts under § 502(a)(1)(B) and § 502(a)(3)).
Defendants moved to dismiss for lack of standing, for failure to plausibly allege Vendor Defendants were ERISA fiduciaries, and for failure to identify plan terms showing entitlement to benefits.
Court held Plaintiffs now sufficiently alleged AOBs and thus have standing; nevertheless dismissed Vendor Defendants as non-fiduciaries (ministerial role) and dismissed all claims against Aetna for failure to plead plan language; dismissed certain plaintiffs’ claims vs. Cigna for same reason. Dismissals without prejudice; 30 days to amend.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Standing to sue under ERISA via AOB	Plaintiffs allege they obtain written AOBs from Aetna/Cigna patients and thus may sue derivatively	Defendants argue pleadings lack specific AOBs or show anti-assignment plan terms	Court: SAC alleges written AOBs—standing satisfied; Cigna’s reliance on a different 2019 plan document not considered at this stage
Whether Vendor Defendants are ERISA fiduciaries	Vendors acted with discretion to reprice/deny claims and thus are fiduciaries	Vendors performed ministerial repricing per plan instructions and lacked discretionary authority	Court: allegations remain conclusory; Vendors are not alleged to have discretionary control—dismissed as non-fiduciaries
Sufficiency of pleadings for §502(a)(1)(B) benefits claims (Aetna)	Plaintiffs claim underpayment and denial of benefits	Aetna: Plaintiffs fail to identify specific plan(s) or plan language showing benefits were due	Court: Plaintiffs did not identify plan terms; §502(a)(1)(B) and related §502(a)(3) claims dismissed as to Aetna
Sufficiency of pleadings for §502(a)(1)(B)/(a)(3) claims against Cigna plaintiffs	Plaintiffs cite specific plan language only for Scordilis’ patient(s)	Cigna: other plaintiffs lack plan-specific allegations; S.G. patient plan may contain anti-assignment clause	Court: Claims by Loewrigkeit, Stivers, and Navesink against Cigna dismissed for failure to identify plan language; Scordilis’ claims survive as to Cigna at this stage

Ashcroft v. Iqbal, 556 U.S. 662 (2009) (facial plausibility standard for pleadings)
Bell Atl. Corp. v. Twombly, 550 U.S. 544 (2007) (plausibility pleading standard)
Fowler v. UPMC Shadyside, 578 F.3d 203 (3d Cir. 2009) (district courts must accept well-pleaded facts as true)
Connelly v. Lane Const. Corp., 809 F.3d 780 (3d Cir. 2016) (plaintiff must plead facts showing discovery may uncover proof)
Burtch v. Milberg Factors, Inc., 662 F.3d 212 (3d Cir. 2011) (distinguishing factual allegations from legal conclusions)
Pascack Valley Hosp. v. Local 464A UFCW Welfare Reimbursement Plan, 388 F.3d 393 (3d Cir. 2004) (healthcare providers generally are not plan beneficiaries absent AOB)
Am. Orthopedic & Sports Med. v. Indep. Blue Cross Blue Shield, 890 F.3d 445 (3d Cir. 2018) (enforceability of AOBs and provider standing)
N. Jersey Brain & Spine Ctr. v. Aetna, Inc., 801 F.3d 369 (3d Cir. 2015) (assignment-based standing under ERISA)
Edmonson v. Lincoln Nat’l Life Ins. Co., 725 F.3d 406 (3d Cir. 2013) (ERISA fiduciary defined by functional control and authority)
Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41 (1987) (§502(a)(1)(B) permits enforcement of benefits due under plan)