Health Administration Responsibility Project

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Jurisdiction under ERISA

• defined by ERISA 502(e)(1)
• State-Federal concurrent jurisdiction over 502(a)(1)(B) claims i.e.: claims, under the terms of the plan, to: recover plan benefits due,
  enforce rights, or
  clarify rights to future benefits.
• Federal courts have Exclusive jurisdiction over all other claims "arising under" ERISA.
• A pure malpractice claim should not be removable since: Malpractice is not a federal issue, and
  Medical Quality Control is not Completely Preempted by ERISA
• ERISA does not govern if: Your insurance is unconnected with your employment, or
  The covered person is self-employed (29 CFR 2510.3-3(b)), or
  is a partner in a professional partnership (29 CFR 2510.3-3(c)), or
  the insurance IS connected with your employment, but your employer is an agency of any level of government, or
  is a religious organization (29 USC 1002(l)), or
  set up the plan solely to comply with insurance laws, or
  set up the plan outside the US primarily for nonresident aliens
  (ERISA 4(b)(29 USC 1003(b)), or
  is minimally involved, i.e.: The employer makes no contributions toward the premiums,
  Participation is completely voluntary for the employees,
  employer doesn't "endorse" the program,
  the employer does no more than allow the insurer to publicize it to the employees,
  collect premiums through the payroll deduction, and
  remit them to the insurer; and the employer gets no compensation except for its administrative services. (29 CFR 2510.3-1(j))
• ERISA does not govern if you have an individual settlement with your employer, e.g.: You are injured on the job, and have a tort claim against your employer, and
  Your employer promises in writing to pay your medical expenses, and
  You promise in writing not to sue your employer, and
  Your employer breaches that agreement. Then you can sue in State court for breach of that contract, and the case is not preempted by ERISA.
  See: Stiles v. Memorial Hermann, TX, 2006, and
  Graham v. Balcor, 9th Circuit, 1998