A U.S. district judge for the Eastern District of Pennsylvania partially denied a motion to dismiss a proposed class-action lawsuit against Aetna and Princeton (N.J.) University for allegedly seeking illegal benefit reimbursements from beneficiaries who have won personal injury settlements in court.
Plaintiff Andre Corbitt was a beneficiary of the Aetna-managed Princeton University Health Care Plan and is seeking the class action for alleged violations of the Employee Retirement Income Security Act and New Jersey law, according to court documents filed March 30.
Mr. Corbitt was injured in a 2016 accident. Aetna covered his recovery care, and then he successfully sued an individual involved in the accident for personal injury. Mr. Corbitt alleges that Aetna requested reimbursement for the coverage from the settlement funds that resulted from the personal injury lawsuit. Mr. Corbitt reimbursed the payer and then filed the original lawsuit against Aetna in January 2021.
Mr. Corbitt's lawsuit stems from his claim that Aetna asked for reimbursement by citing a subrogation provision in his plan. He alleges that the subrogation provision is unenforceable because it only appears in the summary plan description and doesn't actually allow Aetna to seek reimbursement from members after personal injury settlements. Mr. Corbitt's proposed class action would represent other members that Aetna has asked for reimbursement from after settling personal injury cases.
Mr. Corbitt argued that the summary plan description should be officially designated as a formal plan document to be enforceable. The judge dismissed his claim that Aetna's use of one document as both a plan and a summary plan description is unlawful.
Aetna argued that Mr. Corbitt did not exhaust all options to follow the process for disputing the "adverse benefit determination." Mr. Corbitt also claims that he should be exempt from that process because an appeal would be futile.
The Pennsylvania judge ruled that it was "premature" for Aetna to dismiss the benefits claim and four other fiduciary duty claims under the Employee Retirement Income Security Act and rejected the payer's request to dismiss those counts.