United States Court of Appeals

for the Fifth Circuit

No. 20-10998

Advanced Physicians, S.C., 

Plaintiff—Appellant,

versus

National Football League, 

Defendant—Appellee.

Appeal from the United States District Court

for the Northern District of Texas

USDC No. 3:19-CV-2432

Before Davis, Duncan, and Oldham, Circuit Judges.

Per Curiam:*

Advanced Physicians (“Advanced”) appeals the district court’s 

dismissal of its state-law tortious-interference claim against the National 

Football League (“NFL”). According to its complaint, Advanced began 

providing medical treatment to former NFL players in 2007. In exchange for 

that treatment, the players assigned to Advanced their health insurance 

* Pursuant to 5th Circuit Rule 47.5, the court has determined that this 

opinion should not be published and is not precedent except under the limited 

circumstances set forth in 5th Circuit Rule 47.5.4.

United States Court of Appeals

Fifth Circuit

FILED

July 1, 2021

Lyle W. Cayce

Clerk

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No. 20-10998

2

benefits under the NFL Player Insurance Plan (“Plan”) so that Advanced 

could “receive payment from the Plan.” The Plan, in turn, covered certain 

expenses that were “Medically Necessary.” But it specifically excluded

expenses “incurred in connection with an Occupational Disease or an 

Occupational Injury,” along with expenses “incurred . . . in connection with 

an Injury or Sickness which is covered under any workers’ compensation or 

similar law.” Cigna Health and Life Insurance Company (“Cigna”) was “the 

sole entity with the legal right to administer the medical benefits covered by 

the Plan.”

Advanced treated dozens of NFL players between 2007 and 2014 and 

“received payment from Cigna with minimal difficulties.” The payments 

eventually stopped. According to Advanced, this occurred because “the 

NFL directed Cigna to deny all of Advanced’s claims as work-related.” 

Advanced sued the NFL in Illinois state court, alleging that the NFL had 

tortiously interfered with its patient relationships in violation of Illinois law.

The NFL removed the case to the Northern District of Illinois on the 

theory that the Employee Retirement Income Security Act of 1974 

(“ERISA”) completely preempted Advanced’s claim. See Aetna Health Inc.

v. Davila, 542 U.S. 200, 210 (2004) (recognizing complete preemption under 

ERISA); Metro. Life Ins. Co. v. Taylor, 481 U.S. 58, 67 (1987) (holding that 

completely preempted state-law claims arise under federal law and are

removable to federal court (citing 28 U.S.C. §§ 1331, 1441(b))). The district 

court agreed and upheld the NFL’s removal. Then it transferred the case to 

the Northern District of Texas, where Advanced was litigating similar claims 

against Cigna. That court also found complete preemption under ERISA. So 

when Advanced refused to amend its complaint to state a valid ERISA claim, 

the district court dismissed it. Advanced timely appealed.

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The Supreme Court has established a two-part test for determining 

when ERISA completely preempts a state-law claim. First, we must ask 

whether the plaintiff “could have brought his claim under ERISA 

§ 502(a)(1)(B).” Davila, 542 U.S. at 210. We answer that question by 

identifying what the plaintiff is truly “complain[ing] . . . about.” Id. at 211. If 

the “only action complained of” is the “denial[] of coverage promised under 

the terms of [an] ERISA-regulated employee benefit plan[],” Davila’s first 

requirement is satisfied. Ibid.; see also 29 U.S.C. § 1132(a)(1)(B). Second, we 

must ask whether the plaintiff’s suit implicates a “legal duty . . . independent 

of ERISA or the plan terms.” Davila, 542 U.S. at 210. We answer that 

question by reviewing the plaintiff’s allegations alongside the state law on 

which they are based. See id. at 211–13. If “interpretation of the terms of [a] 

benefit plan[] forms an essential part” of the plaintiff’s claim, Davila’s 

second requirement is satisfied. Id. at 213.

Here, the only action Advanced complained of was the NFL’s 

“direct[ing] Cigna to deny all of Advanced’s claims as work-related.” In 

other words, the “essence” of Advanced’s complaint is that the NFL 

wrongfully facilitated a coverage denial. Hubbard v. Blue Cross & Blue Shield 

Ass’n, 42 F.3d 942, 946 (5th Cir. 1995). ERISA § 502(a)(1)(B) allows 

beneficiaries like Advanced to vindicate that claim. See 29 U.S.C. 

§ 1132(a)(1)(B).

Furthermore, interpreting an ERISA benefit plan forms an essential 

part of Advanced’s tort claim. To prevail on its claim of tortious interference, 

Advanced must show that it had a “reasonable expectation of [maintaining] 

a valid business relationship” with its NFL patients. Dowd & Dowd, Ltd. v. 

Gleason, 693 N.E.2d 358, 370 (Ill. 1998) (quotation omitted). Advanced’s 

complaint makes clear that its business relationship with NFL players hinged 

on those players being covered under the Plan: the relationship began when 

the players assigned their benefits to Advanced so that Advanced could 

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“receive payment from the Plan”; and the relationship faltered when Cigna 

and the NFL determined that the players were seeking treatment for “workrelated” injuries not covered under the Plan. Whether the NFL players 

actually sought “work-related” treatment plainly requires interpreting the 

work-related exclusions in the Plan. So Plan interpretation is essential to 

Advanced’s claim. Therefore, Advanced’s tort claim is completely 

preempted.

AFFIRMED.

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