Legal Memorandum: ERISA Claim for Health Benefits

Issue: When can a plaintiff submit an ERISA claim for health benefits under federal law?

Area of Law: Employee Law
Keywords: ERISA claim; Health benefits; Federal law
Jurisdiction: Federal
Cited Cases: 880 F.2d 972; 881 F.2d 237; 845 F.2d 1286; 625 F.2d 1285; 792 F.2d 432; 688 F. Supp. 564; 457 F. Supp. 1146; 867 F.2d 409; 479 U.S. 916; 761 F.2d 864
Cited Statutes: 29 U.S.C. § 1132(a)(1)(B); Section 502(a)(1)(B) of ERISA; 9 U.S.C. § 1132(e)(1); 29 U.S.C. §§ 1001(a), (c); 29 U.S.C. § 1002(8); 29 U.S.C. § 1132(e)(1); 29 U.S.C. § 1132(a)(1)(B) ; 29 U.S.C. § 1132(a)(1)(B) ; 29 U.S.C. § 1132(e)(1)
Date: 04/01/2001

Section 502(a)(1)(B) of ERISA provides that ". . . civil action may be brought . . . by a participant or beneficiary . . . to recover benefits due him under the terms of his plan, to enforce his rights under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan."  29 U.S.C. § 1132(a)(1)(B).

In order to bring an action to recover benefits under a plan, the plaintiff must be a "participant" or "beneficiary" of the plan.  Id.  Conversely, if the plaintiff is not a "participant" or "beneficiary" of the plan, his or her remedy is provided exclusively by state tort law, and the case must be remanded to the state court.  See Dodd v. John Hancock Mut. Life Ins. Co., 688 F. Supp. 564, 568 (E.D. Cal. 1988).  In order for state law claims to be completely preempted for removal purposes, the plaintiff must be entitled to bring an ERISA claim as a participant or beneficiary in the plan.  Id.

The requirement that the plaintiff be a plan participant or beneficiary is both a standing and subject matter jurisdictional requirement.  Stanton v. Gulf Oil Corp., 792 F.2d 432, 434 (4th Cir. 1986).  The federal question jurisdiction of the court is limited by congressional boundaries.  Giardono v. Jones, 867 F.2d 409, 413 (7th Cir. 1989).  The grant of subject matter jurisdiction in 29 U.S.C. § 1132(e)(1) (1985) is exclusive and is limited to the […]

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