Legal Memorandum: Malpractice Claims and ERISA Plans

Issue: Within the 11th circuit, do courts permit malpractice claims against providers of vocational rehabilitation services under an ERISA plan?

           No case was found addressing the issue of malpractice of a vocational rehabilitation services provider pursuant to an ERISA plan.  Numerous cases were found discussing medical malpractice and other forms of professional negligence.  In fact, courts hold with near uniformity that ERISA does not preempt a true medical malpractice claim simply because one or more of the defendants is an ERISA plan or an ERISA fiduciary, or because the plaintiff is an ERISA plan participant.  However, courts have held that claims artfully labeled as medical malpractice actions may be preempted if in fact the alleged wrongdoing takes place in the context of administration of plan benefits—e.g., withholding treatment because the plan advises that the participant/patient is not covered for that treatment—even if the benefit determination may be construed as medical advice.  Corcoran v. United Healthcare, Inc., 965 F.2d 1321, 1331 (5th Cir.) ("[W]e conclude that United makes medical decisions—indeed, United gives medical advice—but it does so in the context of making a determination about the availability of benefits under the plan.  Accordingly, we hold that the Louisiana tort action asserted by the Corcorans for the wrongful death of their child allegedly resulting from United’s erroneous medical decision is pre-empted by ERISA."), cert. denied, 113 S. Ct. 812 (1992); Kuhl v. Lincoln Nat’l Health Plan, Inc., 999 F.2d 298, 303 (8th Cir. 1993) ("Artful pleading by characterizing Lincoln National’s actions in refusing to pay for the surgery as ‘cancellation’ or by characterizing the same administrative decisions […]