Opinion ID: 4549171
Heading Depth: 5
Heading Rank: 3

Heading: Aetna’s counterarguments

Text: Aetna offers essentially two counterarguments. Neither is persuasive. First, it contends that any reference to an ERISA plan in the calculation of damages—no matter the degree of examination required—triggers express preemption. But that argument is belied by Iola, where we held that misrepresentation claims based on statements made prior to the adoption of an ERISA 27 plan were not preempted even though establishment of those claims, and in turn the court’s assessment of damages, “require[d] . . . a cursory examination of the plan provisions,” including “whether the representations . . . were at odds with the plan itself, or with the plaintiffs’ understanding of the benefits afforded by the plans.” 700 F.3d at 85. Likewise, the Center’s core contention—that oral promises of payment induced it to act to its detriment—and the proof that would be required involve, at most, only a “cursory examination” of plan provisions “turn[ing] largely on legal duties generated outside the ERISA context.” Id. (internal quotation marks and citation omitted). 20 Second, Aetna argues that the Center’s claims are premised on ERISA plans because the plans required preapproval of 20 The sole authority on which Aetna relies, Nobers, is also readily distinguishable. Nobers held common law claims preempted because the calculation of damages required “construction of [an] ERISA plan[].” 968 F.2d at 406. But the Nobers plaintiffs were a class of employees who alleged that “they [sh]ould have received substantially greater pension and related benefits,” id. at 404, assessing damages therefore would have required benefit calculations that “sit[] within the heartland of ERISA,” Iola, 700 F.3d at 84; see Kollman, 487 F.3d at 149–50. The Center, on the other hand, does not allege that Aetna’s liability flows from its promise to provide J.L. and D.W. benefits under their ERISA plans; it alleges “a separate promise that references various [ERISA] benefit plans, none of which directly applies to [the Center] by its terms, as a means of establishing the value of that promise,” Stevenson v. Bank of N.Y. Co., 609 F.3d 56, 60–61 (2d Cir. 2010). 28 J.L.’s and D.W.’s surgeries. Aetna places great weight on this point, presumably because before concluding that an out-ofnetwork provider’s state law claims were not completely preempted by section 502(a), 21 the Second Circuit in McCulloch observed that the provider “was not required by the plan to pre-approve coverage for the surgeries that he performed.” 857 F.3d at 150–51. Of course, we are not bound by this out-of-circuit precedent, but Aetna misapprehends it in any event. In context, the McCulloch court was contrasting a prior case where it had found that the preapproval required of innetwork providers under the plan was “inextricably intertwined with the interpretation of Plan coverage and benefits,” Montefiore Med. Ctr. v. Teamsters Local 272, 642 F.3d 321, 330, 332 (2d Cir. 2011); see McCulloch, 857 F.3d at 150–51. Moreover, the court went on to explain that when it came to out-of-network providers, the ERISA plan imposed a duty only on the plan participant or beneficiary to seek precertification; as they are neither parties to the plan nor parties to an innetwork provider agreement, there was no corresponding duty on out-of-network providers. McCulloch, 857 F.3d at 150–51, 151 n.7. Rather, the provider there, like the Center, “called Aetna for [its] own benefit to decide whether [it] would accept or reject a potential patient who sought [its] out-of-network 21 Complete preemption is a separate, jurisdictional doctrine that in this context arises out of section 502(a). Davila, 542 U.S. at 210. Under this doctrine, if a litigant could have brought a cause of action under section 502(a) and if “no other independent legal duty . . . is implicated by [the] defendant’s actions,” the claim is federal in nature. Id. 29 services,” id. at 151, and the plan “simply provide[d] the context for” the out-of-network provider’s claim, id. at 149. In short, McCulloch, if anything, weighs against express preemption here, as does other case law: The mere fact that a claim arises against the factual backdrop of an ERISA plan does not mean it makes “reference to” that plan. See Travelers, 514 U.S. at 661 (“[P]re-emption does not occur . . . if the state law has only a tenuous, remote, or peripheral connection with covered plans . . . .” (second alteration in original) (citation omitted)); Iola, 700 F.3d at 85 (holding section 514(a) does not preempt misrepresentation claims arising out of statements made about an ERISA plan prior to the plan’s adoption); Dishman v. UNUM Life Ins. Co. of Am., 269 F.3d 974, 983–84 (9th Cir. 2001) (concluding that state law claims were not expressly preempted even though there was “clearly some relationship” to an ERISA plan); see also Morris B. Silver M.D., Inc. v. Int’l Longshore & Warehouse Union, 206 Cal. Rptr. 3d 461, 472 (Ct. App. 2016) (“[T]he fact [that] an ERISA plan is an initial step in the causation chain, without more, is too remote of a relationship with the covered plan to support a finding of preemption.”). Because the Center’s claims, as pleaded, neither seek benefits due under the plans, nor require more than a cursory examination of the plans, they do not make impermissible “reference to” the plans. 30