Rush Prudential HMO, Inc. v. Moran, 536 U.S. 355, 40 (2002)

Page:   Index   Previous  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  Next

394

RUSH PRUDENTIAL HMO, INC. v. MORAN

Thomas, J., dissenting

ERISA's enforcement scheme remains paramount. "Congress intended § 502(a) to be the exclusive remedy for rights guaranteed under ERISA." Ingersoll-Rand Co., supra, at 144. In accordance with ordinary principles of conflict preemption, therefore, even a state law "regulating insurance" will be pre-empted if it provides a separate vehicle to assert a claim for benefits outside of, or in addition to, ERISA's remedial scheme. See, e. g., Pilot Life, supra, at 54 (citing Russell, supra, at 146); Harris Trust, supra, at 99 (citing Silkwood, supra, at 248).

III

The question for the Court, therefore, is whether § 4-10 provides such a vehicle. Without question, Moran had a "panoply of remedial devices," Russell, supra, at 146, available under § 502 of ERISA when petitioner denied her claim for benefits.5 Section 502(a)(1)(B) of ERISA provided the most obvious remedy: a civil suit to recover benefits due under the terms of the plan. 29 U. S. C. § 1132(a)(1)(B). But rather than bring such a suit, Moran sought to have her right to benefits determined outside of ERISA's remedial scheme through the arbitral-like mechanism available under § 4-10.

Section 4-10 cannot be characterized as anything other than an alternative state-law remedy or vehicle for seeking benefits. In the first place, § 4-10 comes into play only if the HMO and the claimant dispute the claimant's entitlement to benefits; the purpose of the review is to determine whether a claimant is entitled to benefits. Contrary to the majority's characterization of § 4-10 as nothing more than a state law

5 Commonly included in the panoply constituting part of this enforcement scheme are: suits under § 502(a)(1)(B) (authorizing an action to recover benefits, obtain a declaratory judgment that one is entitled to benefits, and to enjoin an improper refusal to pay benefits); suits under §§ 502(a)(2) and 409 (authorizing suit to seek removal of the fiduciary); and a claim for attorney's fees under § 502(g). See Russell, 473 U. S., at 146- 147; Pilot Life Ins. Co. v. Dedeaux, 481 U. S. 41, 53 (1987).

Page:   Index   Previous  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  Next

Last modified: October 4, 2007