Court Ruled For CIGNA: Denied NFL Player’s Chiropractic Claims = ERISA

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ERISAclaim.com Offers Webinars To Examine The Latest Federal Court Decision On Dec 28, 2011 That A Chiropractor’s State Lawsuit Against Cigna Must Be Removed To Federal ERISA Court, For His Denied Claims From Treating NFL Players, Despite that “He Purposefully Chose Not To Bring Claims Under ERISA”.

The Court basically told us that ‘purposefully chose not to bring claims under ERISA’ legally means ‘purposefully chose not to get paid’ under ERISA”, simplified by Dr. Zhou.

ERISAclaim.com offers Webinars to examine the latest federal court decision on Dec 28, 2011 that a chiropractor’s state lawsuit against CIGNA must be removed to federal ERISA court, for his denied claims from treating NFL players, despite that “he purposefully chose not to bring claims under ERISA.” ERISAclaim.com Webinars will discuss why “the Court finds that plaintiff’s state law claims are completely preempted by ERISA”. This court decision is profoundly important for all healthcare providers nationwide, as thousands of providers have knowingly or unknowingly but “purposefully chose not to bring claims under ERISA” for all ERISA healthcare claims, resulting in millions of dollars in lost revenue for otherwise legitimate ERISA healthcare claims.

“The Court basically ruled that federal ERISA law completely governs ERISA healthcare claims and completely invalidates or pre-empts all state laws. If a provider wanted to get paid, he/she must do ERISA,” says Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

The Court case Info: Vetanze v. NFL Player Insurance Plan, Case #: 11-cv-2734-RBJ-KLM, Filed 12/28/11, in the United States District Court for the District of Colorado.

According to the Court document, the following is the case background:

“This case was originally filed in Arapahoe County District Court (Case Number 2011CV1897). Defendant removed the case to this Court based on federal question jurisdiction. Defendant argues that plaintiff’s state law claims are preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. § 1001, et seq. The case is before the Court on plaintiff’s motion to remand.”

According to the Court document, the following is the factual background:

“Plaintiff, Nelson Vetanze, is an individual who does business as Omni Chiropractic in Aurora, Colorado. The NFL Player Insurance Plan (the “Plan”) provides insurance benefits to National Football League (“NFL”) players. In September 2010, the Plan informed Vetanze that claims received for services rendered in July and August of 2010 for NFL players and their families would not be honored. The Plan, through its administrator CIGNA, explained that it would not honor claims received within a certain month or within a certain number of days after a game because such claims were subject to Workers’ Compensation. Vetanze submitted evidence that he believes demonstrated that the claims were not work-related. However, the Plan still refused to consider the claims or conduct an investigation. On September 21, 2011 Vetanze filed this suit seeking reimbursement for services rendered plus double damages and attorney’s fees pursuant to “C.R.S. § 10-3-1115-1116.” Complaint ¶6.

Plaintiff alleges that he “is not a plan beneficiary under ERISA or under the plain language of the policy, and that his claims “are not subject to removal.” Complaint ¶¶4, 7. Nevertheless, defendant filed a notice of removal, arguing that ERISA governs claims for benefits under the Plan because “the Plan provides group health insurance benefits to ‘eligible current Players, certain former Players, and Dependents’” (#1, ¶7). The Plan provides that it “shall be construed and enforced in accordance with ERISA and the laws of the State of Indiana,
to the extent such laws are not preempted by ERISA” (#1, ¶8) (citing Exhibit B, p. 41). Thus, defendant argues, federal question jurisdiction arises. because Vetanze’s state law claims are completely preempted by ERISA. Plaintiff moved to remand. The motion has been fully briefed.”

The plaintiff argued why “he purposefully chose not to bring claims under ERISA”:

“Plaintiff argues that he is not a “Plan participant or beneficiary” (#8, p.1). Rather, he is a “healthcare provider” bringing claims as a first party claimant as defined under Colorado state law. Id. at 1-2. Plaintiff contends that he purposefully chose not to bring claims under ERISA as a beneficiary or an assignee of beneficiaries. He argues that his claims are not based solely on legal duties created by ERISA. Rather, they arise from a state statute and the common law theory of estoppel. Thus, under the well-pleaded complaint rule, he has not alleged claims sufficient to invoke federal jurisdiction.”

Relying upon the U.S. Supreme Court decision in Aetna Health Inc., v Davila (No. 09–804), the Court concluded:

“Because defendant has demonstrated, by a preponderance of the evidence, that (1) the plaintiff could have brought his claim under § 502(a)(1)(B); and (2) no other independent legal duty supports the plaintiff’s claims, the Court finds that plaintiff’s state law claims are completely preempted by ERISA. Therefore, the Motion to Remand [docket #8] is Denied.”

“The Court basically told us that ‘purposefully chose not to bring claims under ERISA’ legally means ‘purposefully chose not to get paid’ under ERISA”, simplified by Dr. Zhou.

To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm

Located in a Chicago suburb in Illinois, for over 12 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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