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Text of Seventh Circuit Opinion: Chiropractors Were Not Entitled to ERISA Claims Procedures for Contractual Payments by Insurers (PDF)
U.S. Court of Appeals for the Seventh Circuit
Oct. 2, 2015 "Plaintiffs concede that they are not participants under the definition in [ERISA] Section 1002(7) ... [b]ut plaintiffs describe themselves as beneficiaries.... The problem with this contention all but catapults off the page: a 'beneficiary' is a person designated 'by a participant' or 'by the terms of an employee benefit plan,' and plaintiffs are neither.... No employee's benefits are at issue and none had to pay an extra penny as a result of the insurer's treatment of some procedures as capitation based rather than fee-for-service based ... Plaintiffs are not 'beneficiaries' as ERISA uses that term, so they are not entitled to the procedures established by Section 1133 and the implementing regulations.... The damages and injunctions therefore must be vacated, and the award of attorneys' fees to plaintiffs falls with them." [Pennsylvania Chiropractic Association v. Independence Hospital Indemnity Plan, Inc., Nos. 14-2322, 14-3174 and 15-1274 (7th Cir. Oct. 1, 2015)] MORE >> |
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