A recent decision states that only parties listed under ERISA section 502 can sue to recover benefits. An exception has been carved out only to healthcare providers to whom a beneficiary has assigned his claim in exchange for health care.
ERISA section 502 limits the right to sue to recover benefits, enforce rights, or clarify rights under a plan to participants or beneficiaries. Humanistic Mental Health Foundation provided medical services to either a participant or beneficiary in the GE Life Disability and Medical Plan. The Plan administrator denied partial payment of charges by Humanistic. Simon alleged that the participant or beneficiary assigned his or her claims to Humanistic who assigned the claims to the Simon. Simon claimed standing to sue because:
He raised a "colorable claim" under ERISA.
He was a creditor of Humanistic with a personal stake in the action.
Under the principal of subrogation, he could sue as an assignee of an assignee.
The court held that Simon was not a healthcare provider assignee and therefore could not sue.
Source: Simon v. General Electric Co., 2001 U.S. App. LEXIS 19512 (2nd Cir. 2001). Howard Pianko, Epstein Becker & Green