 |
 |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|
|
|
|
Garcia v. Kaiser Foundation Hospitals6/9/1999
al to pay benefits." Id. at 53.
Generally, ERISA limits a prevailing plaintiff's award to equitable relief -- a clarification of the right to past or future benefits. Id.; Kuestner v. Health & Welfare Fund, 972 F. Supp. 905, 909-11 (E.D. Pa. 1997); Roeder v. ChemRex, Inc., 863 F. Supp. 817 (E.D.Wis. 1994). Under 29 U.S.C. § 1132(a)(1)(B), a plaintiff may not seek compensatory, punitive, or extra-contractual damages where an administrator of an ERISA plan fails to provide the benefits due under that plan. See, e.g., Massachusetts Mut. Life Ins. Co. v. Russell, 473 U.S. 134, 145-48 (1985) (hereafter "Russell"); Harsch v. Eisenberg, 956 F.2d 651, 660 (7th Cir.), cert. denied, 506 U.S. 818 (1992); Medina v. Anthem Life Ins. Co., 983 F.2d 29, 31-32 (5th Cir.), cert. denied, 510 U.S. 816 (1993); Turner v. Fallon Community Health Plan, Inc., 127 F.3d 196, 198-200 (1st Cir. 1997), cert. denied, 118 S.Ct. 1512 (1998). With regard to this issue, the United States Supreme Court, in Russell, made the following observation:
"Significantly, the statutory provision explicitly authorizing a beneficiary to bring an action to enforce his rights under the plan -- [29 U.S.C. § 1132(a)(1)(B)] -- says nothing about the recovery of extra contractual damages, or about the possible consequences of delay in the plan administrators' processing of a disputed claim. Thus, there really is nothing at all in the statutory text to support the Conclusion that such a delay gives rise to a private right of action for compensatory or punitive relief." 473 U.S. at 144.
As a result, the Court concluded that extra-contractual damages were not available in ERISA actions under 29 U.S.C. § 1132(a), noting:
We are reluctant to tamper with an enforcement scheme crafted with such evident care as the one in ERISA. As we stated in Transamerica Mortgage Advisors, Inc. v. Lewis, 444 U.S. 11, 19, 100 S.Ct. 242, 246, 62 L.Ed.2d 146 (1979): " here a statute expressly provides a particular remedy or remedies, a court must be chary of reading others into it." See also Touche Ross & Co. v. Redington, 442 U.S. 560, 571-574, 99 S.Ct. 2479, 2486-2488, 61 L.Ed.2d 82 (1979). "The presumption that a remedy was deliberately omitted from a statute is strongest when Congress has enacted a comprehensive legislative scheme including an integrated system of procedures for enforcement." Northwest Airlines, Inc. v. Transport Workers, 451 U.S., at 97, 101 S.Ct., at 1583. Id. at 147.
In Kuestner, supra, the United States District Court for the Eastern District of Pennsylvania held that the proper remedy for an ERISA plan administrator's improper denial of treatment was "not compensation for the value of the treatment . . . denied, but rather equitable relief requiring the proper administration of such a plan." 972 F.Supp. at 910. The plaintiff in Kuestner, a participant in an ERISA plan, brought an action against the plan after it denied coverage for his wife's drug therapy. Id. at 907.
The plaintiff sought the following relief:
"(1) declaratory relief that the requested therapy was covered under the plan; (2) compensatory damages for benefits which should have been paid; (3) compensatory damages for pain, suffering, and emotional distress suffered as a result of the loss of drug therapy; (4) treble damages under the state consumer protection act; and (5) attorney's fees and costs." Id. at 908.
In dismissing plaintiff's claims requesting monetary damages, the court reasoned that the monetary compensation requested by plaintiffs constituted extra-contractual damages caused by improper or untimely processing of a benefit claim. Id. at 910. Because extra-contractual damages are
Page 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Hawaii Personal Injury Attorneys
Personal Injury Lawyers
|
| |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|
By using the system, you agree to TERMS OF SERVICE
|